Pointers

This is a somewhat tangential post, but springs from the last post about pagers. In computer science, pointers are a data type whose value refers directly to another value stored elsewhere in the computer memory using its address. The "ghost pager" system reminds me intensely of pointers. All hospitals have had to figure out a way of identifying who to page for what. For example, all patients must be linked to a physician and their pager number. On call days, the accepting team on call must have a pager for the emergency department to contact. The least efficient way is to print out a long list each day of who is on call and who is caring for which patient. In that case, there's lots of room for errors and communication problems. How do you deal with cross-coverage where a primary team has left the hospital but signed over their patients to the on-call team? How does a nurse know who to page?

Another system, which many hospitals use, is to have generic physical pagers. There is an admitting pager and every day at 8am, the post-call team hands over the physical pager to the on-call team. That way, there's one number that is always used for admissions (or codes or consults or whatever) and it can be handed around to the person who needs it. This is also inefficient as it requires a physical handoff, but at least it standardizes a code of communication.

But Stanford's elegant solution is to use "ghost pagers" like pointers. Certain generic roles have pager numbers assigned to them without a physical pager. For example, there is a number for the chief residents, admitting on call team, medicine team 3 intern A, etc. So a nurse, consultant, emergency department, or anyone always has the same number to contact for a certain role. But instead of assigning those numbers to a physical pager, Stanford makes them a "pointer" where that number "points" to a different pager. Through the operator, I can make the admitting pager forward to me. This way, no physical handoff of a pager needs to be made, and we don't do the belt-full-of-pagers look. Only a handful of hypothetical "ghost" pagers point to ours.

I always have the medicine team 3 intern A pager forwarded to me; that way, any patient assigned to my team is assigned to my pager. When I leave the hospital, I forward my pager (as a pointer) to the on-call intern's pager; that way, a nurse trying to get a hold of my role (medicine team 3 intern A) automatically gets the covering intern. I think it's pretty cool.

Image from Wikipedia shown under GNU Free Documentation License.