Moving Beyond Pagers: Modernizing Emergency Code Communication

Across many healthcare facilities today, code teams are still being activated through legacy pager systems. These systems, while ubiquitous, create preventable delays, coordination failures, and missed responses.

The shift to modern, interoperable code activation tools is no longer optional. Healthcare organizations relying on outdated pager infrastructure are putting patients at unnecessary risk while creating operational inefficiencies that burden clinical teams.

Below, we’ll discuss why pagers are no longer suitable for emergency communication workflows, what modern code activations should look like, and how to replace pagers in healthcare organizations that want to modernize and improve code team activations. 

‍

Why Pagers Are Failing Modern Hospitals

Today’s complex clinical environments demand real-time coordination, contextual information, and accountability – critical capabilities that pagers alone simply cannot provide.

‍

One-Way Communication Leads to Delays and Risk

The fundamental limitation of pagers is one-way transmission. When a code is activated, the pager beeps, but there’s no way for the sender to know if the recipient received the alert, understood it, or is responding. A physician might be in a dead zone. A nurse’s pager battery might be dead, or the device could be lost. In each scenario, the sender has no way of knowing the page failed.

The resulting phone tag wastes critical minutes. After sending the page, operators must call to confirm receipt and recipients have little situational context. Consider a Code STEMI where the interventional cardiologist is paged but doesn’t feel the vibration or hear the alert during a procedure. Ten minutes may pass before someone realizes the cardiologist never acknowledged. Another five minutes elapse tracking down backup. Those fifteen minutes increase the risk of permanent heart damage or death.

‍

No Audit Trail or Accountability

Pager systems provide virtually no data for quality reviews. While the switchboard may record when team members were notified or who acknowledged alerts, there’s limited data around how long each step took. After adverse events, it’s more difficult for hospitals to determine whether communication failures contributed to poor outcomes. Performance improvement becomes guesswork without objective data showing where delays occurred.

The absence of audit trails is problematic for hospitals trying to maintain regulatory compliance. The HIPAA Security Rule, for instance, requires audit controls in any information system that contains PHI. This technical safeguard ensures that all activity and information sharing within the organization is recorded for accountability. Maintaining compliance through pagers alone is difficult given that it’s often discouraged – and sometimes impossible – to send PHI through pagers in the first place. 

‍

Frequent Technical Failures

Pager infrastructure is aging and unreliable. While many pagers rely on powerful radio waves in and around the hospital, spaces such as basement locations, elevator shafts, and heavy concrete construction can have poor coverage. System-wide outages, while rare, leave hospitals without their primary emergency notification system entirely.

Devices can also fail, whether batteries die or pagers are dropped or damaged. One hospital’s study revealed their daily pager communication failure rate was 5.5% – a rate which decreased to 2.2% after the organization implemented secure messaging.

‍

Manual Workflows Slow Everything Down

Pager-based code activation relies on manual processes that introduce delays. In some instances, switchboard operators must look up who’s on call, manually search for contact information, and send pages sequentially. Rather than alerting all team members simultaneously, systems often notify one at a time. By the time the last team member is notified, several minutes have passed. Even for systems that offer one-touch activation that notifies multiple pagers simultaneously, there can still be delays if the switchboard has to manually identify the correct people to contact. 

Additionally, escalation pathways require more manual work. If the primary on-call provider doesn’t respond, the switchboard must manually identify backup personnel and send another page. Every minute spent on these manual processes directly impacts patient outcomes.

‍

The Hidden Costs of Relying on Pagers

The problems with pagers extend beyond technical limitations. These outdated systems create cascading costs that impact clinical outcomes, staff wellbeing, and organizational compliance.

‍

Increased Clinical Risk and Slower Time-to-Treatment

Delays in pager-based communication directly impact patient outcomes, which is especially critical in emergency situations where every second counts. One hospital study found that a delay of over 15 minutes in rapid response call activations led to increased hospital mortality and longer hospitalization. 

In addition, STEMI programs aim to have a door-to-balloon time under 90 minutes. When code activation relies on pagers, critical minutes are consumed simply trying to reach the interventional team. In one hospital study, door-to-balloon time was reduced from 101-148 minutes to 56-108 minutes after implementing a protocol that required emergency physicians to directly contact the interventional cardiologist. 

‍

Burnout and Cognitive Load for Clinical Teams

Pagers create unnecessary friction that can contribute to clinician burnout and frustration. Because pages provide minimal situational context, clinicians must stop work, find a phone, call back for details, and determine whether immediate attention is required. This cycle repeats throughout shifts, fragmenting attention and preventing focused patient care.

‍

IT and Compliance Challenges

Pager systems represent aging infrastructure requiring ongoing maintenance while providing limited value. Equipment needs replacement, base stations require service, and finding parts becomes increasingly difficult. Some hospitals spend around $180,000 annually just to keep pager infrastructure operational.

Security concerns are also a concern. Pagers transmit unencrypted messages that can be intercepted, which not only puts patient information at risk but – combined with the lack of audit logs – can also violate compliance regulations. A 2016 study by Trend Micro revealed that all that was needed to decode 54 million pager messages was software-defined radio (SDR) and a $20 USB device.

Additionally, integration with modern hospital IT infrastructure is difficult, meaning code activation can’t leverage contextual information from EHRs or scheduling systems.

‍

What Modern Code Communication Should Look Like

The limitations of legacy pagers highlight what effective emergency communication systems must provide. Modern code activation tools should meet several essential criteria that directly address the gaps in traditional approaches.

‍

Integration with On-Call Schedules & Directories

The right people must be notified instantly, without manual lookup or switchboard dependency. This requires tight integration between code activation tools and the organization's scheduling and directory systems. 

When a code is activated, the system should automatically identify who is currently on-call for each required specialty, what their preferred notification method is, and how to reach them. If the cardiology team is needed, the system knows that Dr. Smith is on-call for interventional cardiology this evening, Dr. Jones is the backup, and both can be reached via their mobile devices with STAT alerts enabled.

This integration eliminates the delays and errors inherent in manual directory lookups. No one needs to search for who’s on-call or try to figure out what their pager number is. The system should maintain this information dynamically, updating in real-time as schedules change. When clinicians swap shifts or coverage responsibilities change, code activation automatically adapts without requiring manual intervention.

Beyond simply knowing who to notify, modern systems should leverage directory information to provide multiple notification paths. If the primary contact method fails, the system can automatically try alternative methods or escalate to backup personnel.

‍

Instant Activation

Every second matters during emergencies. Modern code activation must alert all necessary team members at the same moment, not sequentially.

When a Code Blue is called, the physician, respiratory therapist, and any other required team members should receive alerts simultaneously. There should be no lag between the first person notified and the last, which reduces overall response time compared to sequential paging.

The technical architecture to support this is straightforward with modern communication platforms. Rather than sending individual messages one at a time, the system broadcasts to all recipients simultaneously. The infrastructure can handle hundreds of concurrent notifications without degradation in delivery speed.

Instant activation also means minimal delay between the moment someone decides to call a code and when team members receive the alert. There should be no time wasted navigating phone menus, waiting for switchboard operators to answer, or repeating information multiple times. Simple, one-touch code activation interfaces allow anyone to mobilize emergency teams in seconds.

‍

Real-Time Delivery, Read Receipts & Escalations

Unlike pagers that transmit into the void with little feedback, modern systems confirm that messages were delivered and read. This accountability transforms emergency communication from best-effort notification to reliable, traceable coordination.

Read receipts provide immediate visibility into who has seen the alert. Within seconds of activation, coordinators can see exactly which team members have acknowledged the code and who may need follow-up. This eliminates the uncertainty of pager-based systems where no one knows if critical messages were received.

When team members don’t acknowledge alerts within a defined timeframe, automated escalation takes over. For example, if the primary on-call interventional cardiologist doesn’t respond within two minutes, the system automatically notifies the backup. If the backup also doesn’t respond, the system can escalate further up the call hierarchy. 

Modern mobile messaging platforms also leverage multiple communication channels – push notifications, SMS fallback, phone calls – to ensure alerts get through even when one path fails. If a clinician’s data connection is temporarily unavailable, the system automatically tries SMS. If that fails, it can place a phone call. This redundancy ensures critical messages arrive.

‍

Contextual Alerts with Clinical Information

Generic pages that simply say “Code Trauma, ETA 10 minutes” force responders to guess what they’re walking into. Modern code communication systems should include rich contextual information that helps teams prepare and respond appropriately.

Location details should be specific and actionable. Rather than a vague message, alerts should specify the exact unit, room number, and bed location. Patient information also provides more context and helps teams prepare. For example, when receiving a trauma team activation, knowing the patient’s age, injury pattern, and relevant medical history allows the trauma team to prepare the appropriate equipment and anticipate complications. This context eliminates the delays that can occur when teams arrive unprepared and must spend valuable minutes gathering information.

Integration with clinical systems makes contextual information actionable, reducing the time it takes to make critical decisions. In one study of emergency department care, receiving instant smartphone push notifications of test results reduced time between laboratory or imaging results and disposition decision by 18 minutes. 

‍

Auditability for Quality & Patient Safety Teams

Modern code activation systems should capture comprehensive audit trails that support quality assurance and patient safety initiatives.

Time-stamped logs must track every stage of the response, including: 

• When was the code first called? 
• When did each team member receive a notification? 
• How long until acknowledgement? 

This granular timing data reveals exactly where delays occur and which steps of the response process need improvement. Individual and team accountability becomes measurable, while trend analysis over time shows whether changes actually improve performance. 

Additionally, compliance documentation becomes straightforward. When regulators or accreditors ask how the organization ensures effective emergency response, modern systems provide concrete evidence. Detailed logs demonstrate that codes are activated promptly, the right people are notified, team members respond quickly, and performance is monitored continuously.

‍

How Hospitals Are Successfully Replacing Pagers Today

Healthcare pager replacement directly impacts patient outcomes and clinical workflows. Here’s how real hospitals transformed their clinical communication and coordination by modernizing their entire emergency response processes. 

‍

Health Sciences North: Legacy Pager Replacement 

Health Sciences North (HSN), a regional hospital for Northeastern Ontario, previously relied on an antiquated paging system and was dependent on an external switchboard service. The combination resulted in connecting delays and frequent phone tag. Additionally, the hospital was using an in-house on-call scheduling system that required each department to send their schedule to the switchboard every week. This was complicated to manage and occasionally resulted in the wrong people getting paged.

HSN partnered with Hypercare to replace its legacy paging system and switchboard dependency with a unified clinical communication platform. The Hypercare team provided hands-on training to 2,000 users and within the first month of implementation, 70% of eligible users were active, over 45,000 messages were sent, and 46 different on-call schedules were imported and managed through the platform. 

‍

Example: Royal Victoria Regional Health Centre (RVH)

For Royal Victoria Regional Health Centre (RVH), the hospital sought a solution to improve its communications and code team activations across multiple critical scenarios, including Code STEMI, Code Blue, and Code Stroke. RVH relied on a traditional switchboard system to manually page interventional cardiology teams – a process prone to delays.

‍RVH partnered with Hypercare to implement a real-time, automated emergency response system. This included automated, one-tap Code STEMI alerts with integrated real-time scheduling, escalation mechanisms, and secure ECG transmission. As a result, emergency code activation delays were reduced, shortening time to treatment.

“Activating a STEMI is now seamless,” says Dr. Mark Kotowycz, Interventional Cardiologist & Medical Director, Cardiac Intervention Unit, RVH. “We no longer wait for pages to be returned – the entire team is alerted instantly. The faster we mobilize, the sooner we can open the artery, directly improving patient outcomes.”

‍

How to Begin Your Pager Replacement Journey

The transition from legacy pagers to modern code communication can feel like a significant undertaking, but it can be navigated by following the steps below. 

‍

1. Assess Current Workflow Gaps

Before implementing any new system, take time to understand exactly how the existing code activation process works today and where the problems are. This assessment provides the baseline against which you’ll measure improvement.

• Map the entire code activation process: Start by mapping the current flow and determining the ideal future state. Begin from the moment someone decides to call a code and trace every step: Who do they notify? How is that notification sent? Who receives it? Where are the handoffs? This process mapping reveals complexity and dependencies that may not be immediately obvious. It also helps to compare the existing workflow to the desired one. 
• Collect actual performance data: Real data grounds the conversation and helps quantify the scope of the problem. Figure out specifics such as, how long does it currently take from code activation to first responder arrival? What percentage of pages receive acknowledgment? How often do escalations occur? 
• Talk to team members who use current workflows: Emergency department nurses, switchboard operators, code team members, and quality coordinators all have valuable insights about what needs to improve. Their frontline perspective often identifies issues that data alone misses.
• Review past adverse events: Identify communication failures. Were there situations where delayed notification contributed to poor outcomes? Times when the right person wasn’t reached? Patterns of communication breakdown during high-stress situations? These case reviews make the urgency for change tangible and specific.

‍

2. Involve Code Committees, ED, Switchboard, and IT Early

Successful pager replacement requires buy-in from every group that touches emergency communication. Stakeholders should be involved in the planning process from the beginning to help define requirements and success criteria.

Consider that emergency department staff are often the primary code activators. Their input on activation interfaces and workflows is critical. If the new system makes it harder for ED nurses to call codes, the technology will be more difficult to adopt.

Switchboard teams may initially worry that modernization threatens their roles. Address these concerns directly by showing how new systems will make their work easier and more meaningful. Communicate that reducing manual page-sending frees switchboard staff to focus on more complex coordination and patient experience improvements.

On the IT side, organizations need to assess integration requirements, security implications, and support needs. Engage the IT team early to ensure the chosen solution fits within existing infrastructure and support capabilities. Their technical expertise helps avoid costly mistakes and ensures smooth implementation.

‍

3. Pilot One Code Type First (STEMI, Code Blue, Rapid Response)

Rather than trying to replace all pager-based communication at once, start with a focused pilot that demonstrates value and builds confidence. For example, when HSN replaced hundreds of pagers with Hypercare’s clinical communication tool, the hospital ran a successful pilot with the emergency department before initiating a rapid rollout across the rest of the teams. 

Choose a code type that has clear baseline metrics, happens with reasonable frequency, and involves a manageable number of team members. Code STEMI or Code Blue are often good choices because response time is easily measurable and the clinical impact is clear.

Define specific, measurable goals for the pilot and gather feedback continuously throughout. Performance metrics and input helps you refine workflows before expanding to additional code types or units. It also gives stakeholders voice in the process, building ownership and buy-in.

‍

4. Focus on Interoperability, Not Just Messaging

To increase chances of success, code communication systems must integrate seamlessly with other hospital systems and create connected, interoperable workflows.

• On-call scheduling: This integration ensures code activations always reach the right people. Rather than maintaining separate schedules in multiple systems, a single source of truth drives both routine communication and emergency response. When schedules change, code activation automatically adapts.
• Directory synchronization: This keeps contact information current without manual updates. As staff join, leave, or change roles, the code activation system reflects these changes automatically. This integration eliminates the common problem of notifications going to outdated phone numbers or former employees.
• EHR integration: This brings patient context into emergency communication. Code alerts can include relevant clinical information about the patient. Response documentation flows back to the EHR, creating a complete picture of the emergency response timeline.

These integrations transform code activation from a standalone notification system into part of a cohesive clinical communication infrastructure. The result is faster, more reliable, and more intelligent emergency response.

‍

Why Hypercare Is the Modern Replacement for Hospital Pagers

Moving beyond pagers requires a platform built for clinical emergency communication realities. Hypercare is a unified clinical communication platform that combines messaging, scheduling, and code activations to keep healthcare teams connected and compliant.

‍

Reliable, Instant, Multi-Channel Code Activations

Hypercare mobilizes code and rapid response teams in seconds with automated, reliable notifications that reduce time to care. STAT messages override silent mode and display prominently, ensuring critical notifications are never missed. 

Built-in escalation policies provide backup when primary responders don’t acknowledge by retrying alternative contact methods, and subsequently informing the rest of the team for manual follow-up if needed. In addition, multi-channel delivery with SMS and phone call fallbacks guarantees message receipt even when primary methods are unavailable.

‍

Integrated Scheduling & Contact Directory

Hypercare makes it easy to connect with the right on-call provider while managing and sharing schedules in real time. The platform maintains a unified, searchable directory with up-to-date contact details including phone numbers, fax, and emails. 

When codes are activated, the system automatically identifies and notifies appropriate on-call team members. Schedule changes also sync in real-time. When clinicians swap shifts, code activation immediately reflects updates without lag time or misdirected pages.

‍

Mobile-First, Secure Messaging Built for Clinical Environments

Hypercare enables instant communication with clinical and healthcare teams through secure, healthcare compliant messaging. All data is encrypted in transit and at rest, with role-based access controls and comprehensive audit trails that track every communication. 

The mobile-first design works seamlessly on iOS, Android, and desktop, whether providers are in clinic, on rounds, or responding to emergencies. Audit trails capture complete response timelines for quality improvement and regulatory compliance.

‍

Key Takeaways for Hospital Leaders

Emergency workflows cannot rely on one-way, outdated tools. Legacy systems introduce preventable delays, compromise patient safety, and provide limited performance data for improvement. 

Modern code communication platforms address these problems while enabling faster, more reliable emergency response. Communication platforms with built-in code activation workflows reduce delays, improve patient outcomes, and offer full visibility. Hypercare is a proven, modern solution ready to replace pagers at scale. Explore Hypercare’s healthcare pager replacement and code activation solution or book a demo to learn more.