Paging and Communication Guidelines
Pilot – VCUHS Internal Medicine Inpatient Units – N9, CCH3
To help facilitate communication between nurses and physicians the following guidelines were created
collaboratively by representatives from nursing and the housestaff:

ALWAYS communicate with courtesy and respect when paging or returning pages – we are a team!

Virtual pagers - Physicians covering medicine patients are identified by a virtual pager. The virtual pager
number is entered in the admitting orders as “notify provider”. This pager identifies the physician covering
the patient 24 hours a day. If a virtual pager order is not placed at admission, page the team’s resident to
request the order. Use only virtual pagers when paging medicine housestaff.

When communicating by text page, use the following format:
o Priority label – FYI, Please Verify, Please Call, Please Come (see definitions that follow)
o Name of person to respond to
o Call back number – only use unit phone number if the unit does not have cell phones
o Patient’s last name & team
o Brief information statement
For example: “Please verify: Heather 52495 Smith Tm 4 Panic value K 2.1”

Housestaff members are expected to touch base with the primary nurse for each patient each morning to
discuss the plan for the patient that day. They appreciate nursing staff asking for clarification on orders or
routine lab requests.

Nurses are expected to participate in morning rounds with the team when feasible. The team will notify the
Unit Secretary (US) when they are on the unit for rounds. The US will notify nursing staff so they will know
when rounds are occurring.

Medicine teams have an open door policy in their team rooms. Nurses are encouraged and welcome to
discuss patient issues.

Night Float physicians are expected to come by the unit each evening to see if there are any issues they
need to address.

The Chain of Command and guidelines for escalation for Internal Medicine:
1. Page Intern using virtual pager on Kardex or assignment board.
2. If no response* in 10 minutes, page once more the same pager number.
3. If no response in 10 minutes, then page resident for the team (or night float resident at night).
4. If no response in 10 minutes, page the attending for the team (24/7).
5. If no response in 10 minutes, page Chief Resident on call, pager #1709.
* A response is defined as a phone call (from the physician or representative), an order, or physician arriving
Definition of Text Page Priority Labels:
FYI 
Information is being shared but does not require a response unless MD changing plan.
Please Verify 
Information is being shared and the person paging needs verification physician received
(i.e., panic values).
Please Call 
The person paging needs to speak with the physician as soon as they are available
about the issue being communicated.
Please Come  Patient with acute change and physician is needed at the bedside ASAP to help manage