Hospitalized patients who are too ill to get out of bed depend on nurses for help.  The usual way to summon assistance is by pressing a call button found beside the bed.  But, with cutbacks and lots of sick patients to tend to, more and more nurses say answering the bell is one job too many.

There are lots of anecdotal stories of patients pushing the call button but no nurse shows up.  The most egregious example I've heard of is the elderly woman who was hospitalized with a broken leg.  She needed a nurse and pushed the button.  When she didn't get one, she called her son using long distance because he was in another city.  The son in turn called the nursing station on the floor where his mother was admitted and finally got hold of a nurse who attended to his mother.  The scientific literature suggests that it's taking longer for nurses to respond to calls.

Why that might be so is open to question.  You want to believe that short staffing and a heavy workload often make it impossible to respond as quickly as they would like.  But a study published earlier this year in a nursing journal gives some room for disagreement.  It found that response time was not affected by the total nursing hours or RN hours. The nurse call-light response time was longer when more patients were using the call-button on a given shift.  That happens when the average length of stay is shorter - in other words, when there's higher patient turnover.  That increases the work of nurses and reduces their opportunities to answer the call bell.

Some have argued the simple solution to the problem is to insist that nurses respond to a call bell within a certain time frame or face consequences.  The problem with that approach is that it doesn't work.   The blogosphere is replete with tales of frustrated nurses.  One nurse blogged about working in a rehabilitation facility where they had to answer call bells within three minutes.  The nurse said it's impossible to answer calls within three minutes while getting fourteen people to bed and giving them night time medications.  Another nurse said you don't answer a call button right away if you're checking meds, chemo, or blood products so you don't risk making an error.  Likewise, nurses may put off answering a call bell if they're at another patient's bedside or if they're on the phone with a doctor, a pharmacist or a nursing supervisor.  If they've paged a doctor in the middle of the night, they stay by the phone until the doctor calls back so they don't have to disturb them again.  Bottom line: a time limit doesn't always work.

When it comes to unanswered call bells, let's not let patients off the hook entirely.  Some patients act more helpless than others when they're hospitalized.  Some call for help when they don't need it.  At the same time, let's not forget patients at the other end of the spectrum.  Cognitive impairment, visual and hearing loss and decreased mobility make it difficult for some patients to use a hospital call bell when they need help.  Researchers at Dalhousie University interviewed thirty-seven patients over the age of seventy and found eleven were unable to use the bell; seven because it was out of reach and four because they were unaware of how to use it.  Two of four patients diagnosed with dementia were unaware of the call bell.  The researchers concluded that the problem could pose a risk to patients in hospital.

It would seem that the entire call bell system is due for a makeover.  There are three fixes being tried out at various hospitals.  The first solution has patient calls going directly to the nurse looking after the patient via a wireless smart phone instead of a central nursing station.  The problem with that approach is that it forces a nurse who is mixing chemo to answer a phone and that may not be an appropriate interruption.  As an ER physician who carries a smart phone while on duty, I can vouch for that. 

A second approach is to have the call go not to the nurse but to a central operator who takes calls and can summon support workers via text message to bring pillows or help with the television remote and summon nurses to deal with patient in pain and problems with IV meds. One hospital found it was able to screen out the10% of the calls that were made by mistake - saving nurses a lot of time.  Patient satisfaction shot up dramatically too.  A third approach may be the most promising.  Instead of waiting for calls, nurses do hourly rounds that help prevent patient calls by detecting problems beforehand.

I think it's a bit of a stretch to to ask nurses who can't find the time to answer calls now to find the time to do hourly check ups.  Still, you might be able to make the case that a few minutes spent checking up on patients every hour might save many minutes dealing with festering problems later on.