“Where’s my nurse?”: How to empower nurses to spend more time with patients

As a new parent, there’s nothing scarier than being in your daughter’s hospital room when an alarm goes off and you can’t find her nurse.

But that’s exactly what happened to me.

My daughter — only a few days old — was fighting for her life in a neonatal intensive care unit, and I was in the hall, trying to find her nurse.

Of course, it wasn’t the nurse’s fault, and she was always apologetic. The reality is, she had other responsibilities, other commitments that kept her away.

At the time, I was working in a hospital, so I understood her situation. I got it. But many families don’t realize that nurses are often overwhelmed and can’t always be there for their patients.

Unfortunately, these heart-wrenching situations leave patients and their families with a lasting impression of their care team and the hospital.

What keeps nurses from the bedside

Every single day, nurses are saddled with administrative tasks — looking for equipment and supplies, tracking down medications, checking for critical lab results, collaborating with the care team and documentation, just to name a few — and inefficient workflows that take them away from their patients.

In fact, a recent study found that nurses may spend less than two hours of a 12-hour shift in direct patient care. A portion of this unproductive time is spent using old, inefficient tools for communicating and coordinating with multiple points of care, both inside and outside the four walls of the hospital.

Even today, at some of the country’s top hospitals, nurses wait hours for a simple call back from a sent page.

Worse yet, nurses are continuously flipping through multiple versions of paper on-call schedules, simply trying to figure out which specialist or attending physician is on service. Often, mistakes are made in the interpretation of these paper documents, igniting a series of follow-up efforts to relay important information to the right provider.

Meanwhile, my newborn daughter’s alarm is going off, and I’m anxiously walking the halls, looking for her nurse.

What it means to empower nurses

All across the country, hospital systems are recognizing that they have to increase the amount of time that nurses can spend on the most important task: caring for patients and comforting families.

Hospitals are researching clinical communication and collaboration vendors and investing in near-real time tools for nurses so that they can get the help they need more quickly and communicate with the people they need more easily.

Empowering nurses with a mobile, secure care team communication tool means that they receive a response back from providers an average of 30 minutes faster. It also means that nurses can respond to changing patient conditions and alarms 30 minutes faster, which has a huge impact on patient and family satisfaction.

Nurses also experience an 81% decrease in the number of repeat calls to providers, as the technology has properly identified the correct on-call provider and eliminated errors.

Today, solving this problem is possible. We can remove communication barriers. We can fix broken workflows. And we can take the administrative burden off nurses and let them get back to enhancing the care quality and the patient experience.

Four simple steps for reducing third-party service costs

In the age of near-constant mergers and acquisitions, health systems are taking on tremendous costs in the form of third-party — or purchased — services.

When a hospital or health system acquires a private practice, it inherits all of that practice’s contracted purchased services, including IT and telecom, clinical services, security, maintenance and more.

When hospitals, and especially health systems merge, the purchased services problem gets compounded as the newly merged system takes on all existing service contracts from all practices affiliated with the previous organizations.

Third-party services can represent as much as 20% of your organization’s annual spend.

While purchased services are crucial to operations, they’re not always top-of-mind when evaluating costs and budgets. After all, if a system is working well, it’s typically overlooked. But when you consider that third-party services can represent between 15-20% of an organization’s annual spend, it becomes obvious that these are opportunities in disguise.

Purchased services are often an untapped source of savings across the supply chain, and they present unparalleled opportunities for standardization of processes and technology.

Here’s a simple four-step process to successfully lower your organization’s purchased services costs while improving care delivery.

Gather the data

For many healthcare organizations, simply gaining visibility on third-party contracts and costs can be challenging. More often than not, these contracts are managed by various people throughout the organization.

Start gathering the data by making a list of all third-party vendors used throughout your organization and their associated stakeholders. It’s important to speak with every stakeholder on your list and review each vendor’s contract.

There are a few key things to look for in your service contracts:

What’s my rate?
What are the scaling terms?
Is there an auto-renewal in place? If so, when?
What are the termination clauses?

The next hurdle is collecting all financial data for your vendors. Check with your accounts payable department and take a look at your purchased orders. But unfortunately, purchased orders won’t tell the whole story. Many third-party vendors have variable costs that make it difficult to get an accurate account for how much they’re really costing you. Your general ledger will help you uncover variable costs.

Use your general ledger to help you uncover your vendors’ variable costs.

You may find that the individual cost of many of your third-party vendors is relatively small, but when you aggregate your spend, the numbers start telling a larger story. Place vendors into categories to get a more accurate picture of how much your organization is truly spending.

Gain executive buy-in

Armed with your data, it’s time to earn your executives’ buy-in.

Engaging them early in the conversation is a great way to build the case for moving forward with this project and understanding the shifts in your organization’s culture that might result from a new strategy.

Speaking with your executives can help you understand the “sacred cows” in your organization, those vendors that are above reproach for some members of the health system.

With this in mind, you can navigate the surmountable road blocks and build the business case to make changes.

Analyze performance

Analyzing the performance of your organization’s purchased services has three main parts:

Comparing spend
Assessing utilization
Evaluating the quality and efficacy

Some vendors charge hidden or variable fees, so looking at one month’s service charges could be misleading. Look at each vendor’s historical spend, trends and variability. Then, consider your regional benchmarks: What prices are other vendors in your area offering for a similar service?

Another important aspect to consider is utilization. Here are some basic questions that can help you begin to assess your organization’s utilization:

Who is actually using each vendor?
How are they using it?
Could the service be used more efficiently?

Finally, do some digging to find out your staff’s level of satisfaction with your third-party vendors.

What kinds of outcomes are you paying for?
Are stakeholders happy with the performance?
What kinds of performance metrics can the vendor provide?
Does the vendor make your staff’s job easier?

Evaluate standardization options

Completing the first three steps will give you a firm grasp of what types of services you’re paying for, how they’re being used throughout your organization and your staff’s openness to try new solutions.

When considering replacing a multitude of similar vendors with a single standardized solution, make sure that your new vendor does the following:

Addresses all stakeholder needs and goals
Has a positive impact on your organization’s overall spend
Plays a role in your organization’s strategic objectives

At the end of your evaluation, you should be prepared to make specific vendor recommendations based on your analysis and your organization’s strategic imperatives.

Third-party vendors are essential to hospital or health system operations and shouldn’t be overlooked when evaluating spend. When your organization undergoes a merger or acquisition, it’s even more important to gain the visibility you need to help the new organization operate more efficiently.

Learn about how Piedmont standardized its after hours answering service across more than 170 physician practices, reducing its costs by 21%.

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Mark Ferraro is Consulting Director of Purchased Services at Vizient, Inc. Mark brings more than 14 years of experience in the healthcare industry. Prior to joining Vizient, Mark was the Executive Vice President for a national Hospital Physical Inventory company. He has also held positions as a Senior Consultant in Purchased Services for MedAssets and a Purchased Services Consultant for Owens and Minor. Mark received his bachelor’s degree in History and Political Science from Longwood University in Farmville, Virginia and his Master of Science degree in Business Administration from Strayer University in Richmond, Virginia. Mark is also a member of The Association for Healthcare Resource & Materials Management (AHRMM), Virginia Association for Healthcare Resource & Materials Management (VAHRMM) and The Healthcare Financial Management Association (HFMA.)

Vizient, Inc., the largest member-driven health care performance improvement company in the nation, provides innovative data-driven solutions, expertise and collaborative opportunities that lead to improved patient outcomes and lower costs. Vizient’s diverse membership base includes academic medical centers, pediatric facilities, community hospitals, integrated health delivery networks and non-acute health care providers and represents approximately $100 billion in annual purchasing volume.

Why secure messaging isn’t enough

In today’s health systems, secure messaging is a must-have, but it’s only one piece of a much larger clinical communication strategy.

For hospitals around the country, secure text messaging has represented a major step forward for simple care team communication. Compared to overhead paging systems and outdated medical pagers, HIPAA-compliant texting apps are much more convenient for clinician communication.

For health systems, though, secure messaging apps have always been a half measure. They make clinical communication easier and greatly reduce the risk of accidentally exposing PHI, but they aren’t robust enough to coordinate care teams and manage hospital resources.

Secure messaging is a must-have tool, but it’s only one piece of a much larger clinical communication strategy that must also interoperate with the hospital’s ecosystem, including the EHR, alerts, notifications and nurse call systems.

How secure messaging apps are like pagers

The appeal of secure texting apps is simple enough: they’re convenient, they keep all clinical conversations on a single secure platform and they have intuitive user interfaces that feel familiar for end users.

Unfortunately, secure texting platforms also carry on one of the major problems of yesteryear’s direct-to-provider pagers: lack of situational awareness. Like physician pagers, secure texting applications can’t prioritize notifications and route messages to the right person at exactly the right time.

For practicing physicians, this lack of situational awareness has real consequences. Routine text notifications become a distraction at the patient’s bedside and an annoyance at home when the physician is off-call.

Secure texting applications provide nurses with another way to get messages to physicians, but they don’t help to simplify a nurse’s complicated and fractured workflows. The nurse is still responsible for figuring out who’s on-call and how to contact that person.

In a workplace full of alerts, alarms and notifications, unprioritized secure messages simply add to the noise.

Making secure messaging meaningful

High-quality patient care depends on two things: the accuracy and timeliness of communication. In other words, every member of the patient’s care team must be able to communicate quickly and efficiently.

Secure messaging apps foster highly fragmented communications that move across complicated workflows.

Alone, secure messaging can’t account for situational variables that make it difficult to know who’s available and ready to take action to advance patient care.

Clinicians must first figure out which group is on-call, which provider within that group is managing patient issues “right now” and then relay the issue using the secure messaging app. And if that provider happens to have been called into emergency surgery, they must figure out whom to message next.

Making secure messages meaningful takes an intelligent notification routing system that organizes, prioritizes and directs messages to the right care team member at the right time. Combining secure texting with intelligent automation is the only way to reduce the noise and make notifications more useful – and reduce care delays.

Secure texting is a step in the right direction, but improving the patient’s experience and the clinician’s satisfaction requires building an intelligent communication framework that connects clinicians to clinicians, as well as clinicians to the organization’s technological ecosystem.

Evaluating your processes and redesigning your communication strategy around a full-service clinical communication and collaboration app will give secure messages meaning and eliminate the friction that slows down your care team and gets in the way of your organization’s strategic goals.

How to identify and address physician burnout

Across virtually every sector, professional burnout is quickly becoming an urgent issue for employers. Burnout is particularly common in fields like social work, teaching and medicine.
Physicians report higher burnout rates than almost any other profession, and studies show it’s getting worse.

According to a report in Mayo Clinic Proceedings, 54.4 percent of physicians indicated that they experienced at least one symptom of burnout in 2014. That’s up nearly 9 percent since 2011.

The study also shows that physician burnout isn’t directly related to any particular region of the country — it’s an industry-wide problem and requires an industry-wide solution.

Symptoms

Burnout can cause depression, alcohol abuse and even suicide, and with physicians’ suicide rates among the highest of any profession in the country, it’s essential that everyone inside your organization be on the lookout for signs that a colleague is experiencing burnout.

Causes

There are many causes of professional burnout, such as having a poor work-life balance, but physicians tend to have a few distinctive contributing factors — including administrative tasks like recording notes in the EMR and trying to coordinate care outside of their organization — which make them uniquely susceptible to burnout.

Spending too much time in the EHR

Electronic health records (EHR) have completely changed physician workflows, but physicians often report — and studies show — that they spend too much time in the EHR and not enough time with patients.

In fact, a 2016 time motion study shows that for every hour a physician spends with a patient, he/she spends nearly two hours in the EHR. The study also reports that physicians spend only 27% of their time in direct patient interaction.

Coordinating care across providers

Physicians understand that patient care extends far beyond the four walls of their organization, and they often take responsibility for helping coordinate care across the patient’s care continuum.

Unfortunately, the EHR can’t always connect physicians to members of the patient’s care team outside the organization or on-call physicians, so coordinating care adds another layer of frustration as physicians engage in an extended game of phone tag. In relying on EHRs for clinical communication, healthcare organizations have built communication islands that limit care collaboration and waste physicians’ time.

Prevention

Preventing burnout takes a combined effort between the physician and the organization, but the first step to preventing physician burnout is simply acknowledging the problem.

Burnout is a taboo topic across industries, and to truly address it, we have to make cultural changes that make it easier for physicians to admit they’re experiencing symptoms of burnout and seek help when they’re feeling overwhelmed.

Giving the proper care to patients requires that physicians take care of themselves as well. When physicians are starting to feel mentally and physically tired, it’s necessary to take some time off to reconnect with friends and family and reevaluate their diet and exercise regimen.

For healthcare organizations, finding ways to free up physicians from administrative tasks can help stabilize their work-life balance. Scribes, for example, can help physicians focus on their face-to-face interactions with patients and spend less time documenting in the EHR.

Additionally, a clinical communication and collaboration platform can make it easier and quicker for physicians to coordinate care inside and outside the organization, giving physicians more time to focus on the patient.

When a physician is burned out, it has ripple effects throughout the hospital or practice. Left unchecked, physician burnout can have an extremely detrimental effect on the organization’s ability to deliver quality care to patients. Understanding what causes burnout and how we can address it is essential to the health of our physicians, patients and healthcare organizations.

Getting it right: 10-point checklist for mobile devices and testing in nursing

This article originally appeared in Becker’s Hospital Review on July 9, 2018.

Use of mobile devices by nurses is increasingly prevalent in hospitals and health systems. According to a 2018 survey, 72 percent of respondents reported using a program that provides nurses with devices.

Smartphones enhance speed of care by providing nurses and other clinical staff with the convenience of always-available communication tools and clinical applications. Connected nurses more easily communicate and collaborate on patient-centered care with care team members. The benefits of nurse mobility are numerous.

However, mobile devices for nurses must be rigorously tested and validated. Evaluating mobile devices is a process that should not be rushed. The consequences of purchasing the wrong device and not testing usage in real-life scenarios for thousands of nurses can be disastrous—both financially and in terms of communication breakdowns.

I am constantly surprised by how many health systems have deployed nurse mobility devices only to have them end up unused in a drawer. Getting it right can launch an integrated delivery network to the forefront of digitized care team collaboration.

This article lays out best practices and a 10-point checklist to consider when planning and implementing a mobile device strategy for nursing teams.

Consider the usability of the device. First and foremost, make sure the devices you put into your users’ hands are well received. Form factor, battery life and performance all play into user acceptance of the devices. Shortcomings in any of these categories will have a negative impact on adoption.
Verify the compatibility between the device and your user applications. While the most obvious application to consider is the mobile app for your EHR, it isn’t the only application you should test. Be sure to create an application inventory on a role-by-role basis—a helpful guide to your app testing.
Consider the durability of the device. Review the durability in three key areas. First, how rugged the device is from a drop perspective. Ideally you should consider devices that pass repeated four-foot drops. Second, how well the device can tolerate liquids. Users don’t control when and where they inadvertently drop devices, and at some point one will end up in a sink or toilet. Finally, how well the device handles the common sanitization agents used by your facility. Good infection control practices include regular disinfection of the devices—make sure they won’t disintegrate as a result.
Test the reliability of the device on your wireless network. Not all devices seamlessly transition between wireless access points when the user walks through a hospital. As hospitals have added more access points to improve coverage, devices interact with more access points, which increases the frequency of network issues on the device. This instability is one of the most common contributors to device failures.
Validate the voice quality of the device. In most cases, the device is used primarily as a phone. Test the voice quality of the device when paired up with your wireless network and PBX. If it can’t be a good phone, then the rest doesn’t matter.
Ensure your device will support a secure operating system. Pay attention to the operating system shipped with the device, as well as future plans during the course of the device’s lifecycle in your organization. Specifically, make sure the device will always have the ability to run an operating system that continues to receive security patches from the vendor. Guard against an end-of-life operating system.
Purchase during the first half of the device lifecycle. In short, make sure the devices you deploy have enough horsepower to last at least three years. Purchasing devices early in the lifecycle will help maximize usable life. If you purchase too late in the lifecycle, users will complain about performance long before you plan to retire the devices.
Plan for organizational change required for device deployment. Change is hard and it’s human nature to resist change. Make sure you consider your training program, how you will overcommunicate with end users, and who can become your “change champions” to help evangelize for the change.
Consider the manageability of the devices. Use a mobile device management (MDM) solution to deploy and manage your devices. If you don’t currently have an MDM, bundle that decision in with the device selection. Do not try to deploy devices enterprise wide without an MDM.Pilot the device in real-world situations. Your device evaluation needs to go beyond hands-on sessions in conference or training rooms. These environments can help narrow your devices down to a short list, but they do not represent the environment in which your users will use the devices. After all, most clinical users move all over the unit, if not the entire hospital. Plan to have users in various roles use the devices in their everyday workflows. This is the best way to identify the strengths and weaknesses of the device in your environment.

Getting your mobile device strategy right is crucial. Informed leaders will make sure nursing professionals are part of a thoughtful, rigorous and structured process. Before making a purchase, ensure the device you choose meets the needs of your nursing team.

To download the article as a PDF, click here.

Is your answering service disaster-proof?

It’s tempting to think natural and manmade disasters can’t happen here.

Until they happen here.

By the time a wildfire, flood, earthquake, snowstorm or explosion happens, it’s too late to make a plan. Disasters put your community under tremendous stress, especially its healthcare infrastructure.

Fortunately, healthcare doesn’t stop for disasters.

While hospital emergency departments become the frontlines during a disaster, physician practices play an important role, too.

Timely communication between providers and patients plays an essential role in preventing exacerbation of illness during these times of emotional stress and resource challenges.

Physicians and practice managers have to identify communications risks and create policies to minimize those risks.

Open lines of communication

When an emergency happens, your first line of defense is your answering service.

Even if your office doors are closed, your answering service can still take your patient’s messages, route emergency calls and help you stay in contact with your most vulnerable patients.

Unfortunately, not every answering service is capable of helping you virtually operate your office during a disaster.

Pitfalls of human-centric answering services

Human-centric medical answering services and call centers aren’t immune to disasters, especially if they’re provided locally.

If you’re having trouble opening your practice, it’s a safe bet that operators from your local answering service are having trouble, too.

The answering service’s call center could be damaged during the wildfire, snowstorm or flood. And if the roads are out, the operators might not be able to get to their office to field your calls.Alternatively, your human-centric answering service might be located in another city and state entirely. It could experience an unforeseen disaster that makes it impossible for them to operate.

Suddenly, your answering service isn’t taking your overflow and overnight calls. Your in-office receptionist is overwhelmed and can’t keep up with your call volume.

Considerations for a 21st-century answering service

When you’re identifying your communications risks and evaluating your current answering service’s performance, consider the following:

Power outages

Power outages are common. That’s why many companies use backup generators to offset temporary outages. Unfortunately, in the case of a natural disaster, the power could be out for days or even weeks.

Does your human-centric answering service have a protocol for an extended power outage? Are there back-up protocols in place to prevent failure?

If the answer to either of those questions is “no,” your patients won’t have any way of reaching the right on-call provider during a disaster.

Call and message routing

Even if your answering service doesn’t lose power during a disaster, what happens if your on-call provider can’t answer his or her phone?

Make sure your answering service has a plan for routing emergency messages when the on-call provider doesn’t answer. There should always be a protocol in place for automatic message escalation.

Infrastructure

Damage to communication infrastructure is common during disasters. Power outages, for example, can affect landline phone service, especially if you depend on broadband connections, like Voice over Internet Protocol.

If a wildfire, hurricane or some other kind of disaster compromises your landline phone and internet connection, how would your answering service contact your physicians?

Staying connected

No matter who you are or where you live, the chances are, a disaster will happen eventually. Make sure your practice is ready for the inevitable.

We’ve created a disaster and emergency communications checklist to help you identify risk so that you can start building a contingency plan to help you continue to provide support to your patients in critical moments.

Download our disaster and emergency communications checklist here.

HIMSS18 and the future of clinical communications

What I learned about the future of clinical communications at HIMSS18

I spoke to a number of healthcare leaders at HIMSS18 about their collaboration strategies and the tools they use to make care coordination easier, and it was obvious that clinicians are still struggling with the friction inherent in today’s communication infrastructure. This friction comes from our industry’s complex workflows and outdated, disconnected communications technology.

Solving this conundrum requires that we reimagine the role and function of clinical communications in care delivery. This means rethinking how we might leverage advances in technology and mobility to make it easier for clinicians to quickly connect with one another — and to deliver actionable information to them so they can better manage care.

The communication technologies that got us where we are today will not get us where we need to be tomorrow, and tomorrow is all about timely patient-centered collaboration that allows clinicans to speed time to care and treatment.

Why is healthcare communication so complex?

Healthcare communication is complex because clinicians employ workflows in which situational variables must be considered to determine whom to contact and how to do so. Figuring this out places a tremendous burden on the clinician who initiates communication to another care team member — a burden that takes the clinician away from value-added patient care activities, is error prone and contributes to delays in care.

We have asked clinicians to solve an extremely complex puzzle amidst an already very busy day. It’s easy to understand how mistakes are made.

How did communication technology become so fragmented?

Over the past three decades, technological innovations in virtually every sector have helped us solve problems and become more efficient, and the same is true in healthcare.

Telephone-based answering services were created to simplify the relay of messages to physicians. Pagers were created to streamline direct-to-provider notifications. Nursing devices were developed to communicate patient needs and facilitate conversations across care team members. Secure texting applications, alerts and alarms systems, real-time location tracking and the like were all created for a specific purpose.

The problem we now face is an inherently disconnected portfolio of communication tools. We are starting to feel the pain of these siloed systems, and we must take steps to bring them together.

How do we prepare for the future of communications in healthcare?

As I observe the movement of healthcare to outpatient settings and the home, it becomes clear that communication processes must overcome geographic and organizational boundaries.

Value-based care and population health management require care team collaboration across providers and care settings that extend beyond the four walls of the hospital or clinic, and so too must our communication solutions.

I spoke with several leaders at HIMSS18 who have come to realize their electronic medical record (EMR) system is incapable of supporting the urgent, time-sensitive communication that occurs outside the EMR. An effective solution needs to transcend the EMR and facilitate collaboration across clinicians in disparate organizations.

Organizations that rely on their EMR as their clinical communications and collaboration (CC&C) platform are building a communications “island” that limits collaboration. The ability to facilitate timely communication across an entire patient-care ecosystem requires a completely different approach.

We must eliminate the friction in clinical communication

The next leap in clinical communication will help our frontline clinicians speed time to care through efficient, patient-centered, cross-continuum collaboration.

I really believe that the healthcare market is ready for a purpose-built CC&C platform that helps clinicians coordinate care inside and outside the four walls of a facility by bringing together a wide range of siloed communication tools. Tomorrow’s care requires a CC&C platform that facilitates intercommunication between these compartmentalized systems and eliminates the friction in patient care.

It is our duty to empower the clinical community with CC&C solutions that support their quest to improve the efficacy of treatment and quality of life for the patients they serve.

The important role nurses play in care transition and reducing readmissions

In its simplest form, “care transition” is defined as a hospital discharge or movement from one care setting to another. The risk that readmissions pose to patient safety requires that transitional care processes are under constant evaluation.

Nurses are the linchpin in the coordination of patient care, and thus are best equipped to coordinate a successful transition. The bedside nurse, for example, may understand a great deal more about the patient’s needs as they travel through the care continuum than other care team members. And when those needs are communicated effectively, the nurse is given the opportunity to extend to the patient high-value care beyond organizational boundaries.

Nurses create transitional care plans by compiling all the pertinent patient information and creating instructions to be followed. Then they share the plan in detail with all members of the new care team so that the handoff is seamless for both the patient and the new unit or facility.

The most important factor in transition of care is communication during the handoff process.

What to communicate and when

The goal of the handoff is to safely transfer the patient from one care setting to another (or to discharge the patient from the hospital completely) by exchanging the necessary information with, and by effectively transferring the responsibility of care to, either a new care team or the patient’s family.

It’s a lot to put on any nurse’s plate, but by standardizing and implementing an effective and comprehensive transition communication process, nurses can elevate patient safety, avoid adverse events that lead to costly readmissions and decrease patient anxiety during the transfer process.

It’s important to remember that the transfer process doesn’t apply only to moving a patient from an acute setting to the home or a post-acute environment. There are many different handoff scenarios within the same organization, unit and floor that need your close attention.

For example, nurses should be prepared to provide handoff communication:

At shift change
During a break
When patients are transferred within the hospital (e.g., from the ER to ICU, from radiology to the OR, etc.)

It’s extremely important for the purposes of continuity of care that the communication between the nurse and either the new team of clinicians or the family prepares them in such a way that they’re able to anticipate the patient’s needs and make timely decisions.

At a high level, to adequately prepare the new care team, the following should be included in the handoff communication:

Patient care instructions
Treatment description
Medication history
Services received
Any recent or anticipated changes

More specifically, and especially in the case of transfers to a new care team or facility, an effective care transition communication plan will include:

Patient’s name and age
Reason for admission
Pertinent co-morbidities
Code status
Current isolation or precautions
Elopement risk
Lab results—including any pending and/or abnormal findings
Relevant diagnostic studies
Fall risk assessment
Any assessment findings that are appropriate to the patient’s current health

Many times, nurses on the receiving team care for patients for whom they lack pertinent health data. For example, EKG results are often left out of the transition communication between hospitals and subacute rehabilitation facilities. In this case, if a patient has an episode of chest pain, the receiving team could conduct an EKG on their own, but without prior results to compare with, they can’t successfully rule out something dangerous, such as angina. So, they may err on the side of patient safety and send the patient back to the hospital, resulting in a readmission. However, if an EKG result is included in the transition communication, the receiving team can conduct an EKG on their own, compare the results with the EKG performed at the hospital, and determine whether there is an emergent need for a readmission or the issue is something they can safely handle in their own setting.

Pay extra close attention to medication communications

While including all pertinent test results in the handoff communication is extremely important, there’s another area that needs special attention, because it causes more admissions than any other factor: medication.

It’s estimated that 30% of hospitalized patients have at least one discrepancy on discharge medication reconciliation. Communicating medication details is an area that poses the greatest risk for error as well as the greatest opportunity to effect a positive outcome. In fact, over 66% of emergency readmissions for patients over 65 years old are due to adverse medication events.

Breaches in handoff, such as failure to include specific details of the patient’s medication history and future dosage needs, have dire consequences.

However, defective handoffs are also known to cause problems beyond adverse events. Issues such as delays in care, inappropriate treatment, and increased length of stay arise when transition communication is not strategically planned and delivered.

There are many root causes of a defective handoff, but since nurses play the most important role in the transition communication process, you must strategically develop and communicate the transitional care plan—not only by considering what information you believe should be communicated, but by extending a dialogue to the receiving team and understanding what information they feel is necessary to provide the best follow-up care possible.

Optimize rapid response team efforts with automated, real-time communication

Agnes Cappabianca worked as a stroke nurse manager at NYU Lutheran Medical Center, a Brooklyn-based teaching hospital. She was in the middle of a shift when the unthinkable happened—she suffered a stroke and found herself admitted to the hospital as a patient in her own ward.

The hospital’s rapid response team (RRT)—one that Agnes had helped train and prepare for these critical situations—sprang into action. Within 30 minutes, the team had final results of her CT scan and blood tests and began to administer tPA treatment.

Her role in advocating advances in stroke care within the hospital seems to have saved her life.

The primary goal of rapid response

The American Heart Association and the American Stoke Association® have warned since 2010 that “the benefits of tPA in patients with acute ischemic stroke are time-dependent.” The associations’ guidelines recommend a door-to-needle time of 60 minutes or less for the treatment to be effective.

In most hospital settings, the process for communicating the needs of a newly admitted stroke patient to care team members is manually intensive. These workflows usually have many steps, numerous decision points and multiple handoffs—creating many opportunities for communication breakdowns and delays in a situation in which every second counts.

One of the primary goals all RRTs strive for should be to reduce the number of steps in the communication process—including the number of decision points, communication handoffs and number of people involved in transmitting the information.

Some hospitals have achieved this goal by implementing a unified communication and collaboration solution that automates many of the steps in the RRT process, such as sending notifications to all team members—including team leadership—at the same time. With just one call, schedules are analyzed and the appropriate care team members are identified and contacted simultaneously—based on their preferred contact method.

This eliminates numerous steps and players from the communication processes and makes significant strides toward improving patient outcomes by speeding time to treatment.

Building an effective rapid response protocol

Pre-planning is required for a communication platform to optimize the capabilities of RRTs. Evidence based guidelines and individual hospital protocols determine the number and composition of responding teams. Some hospitals assign different care team members to different teams depending on urgency levels.

For example, Henry Ford Macomb Hospital in Clinton Township, Michigan, has two RRTs. One is dedicated to Level II traumas and does not include an anesthesiologist in the alert system because Level II trauma patients rarely require advanced airway management. However, the Level I trauma RRT—the team assigned to the most critical cases—does include an anesthesiologist.

Deciding whom to alert depending on the urgency of the situation is a key factor in RRT success.

Another important factor is identifying timelines for each care team member’s arrival at the patient’s bedside. For St. Rita’s Medical Center, a 419-bed hospital in Lima, Ohio, the pre-set arrival time for the rapid response nurse is three minutes; it’s five minutes for their 4A nurse. St. Rita’s also set guidelines for both the physician arrival and ordering of the CT scan at 10 minutes.

An effective communication platform feature that aids RRT outcomes is an automated callback and escalation process. This eliminates critical minutes being wasted on resending notifications and manually escalating the issue to another provider when team members do not arrive on time.

The proof is in the results

St. John Hospital and Medical Center (SJHMC) in Detroit aimed to comply with the guidelines set by The Joint Commission and the American Heart Association/American Stroke Association, all of which call for having CT scans interpreted within 45 minutes of the patient’s arrival and having treatment administered within 60 minutes.

SJHMC implemented PerfectServe and used the flexibility of the platform to develop its stroke team protocol. The protocol called for alerts to a multidisciplinary team of nurses, physicians and staff from neurology, the ED and neurosurgery, as well. Each team member’s preferred method of contact was configured in PerfectServe Synchrony so that when a stroke alert is sent from the ED, each member (or their on-call counterpart) is contacted via their preferred method.

The ability to contact team members directly on their personal mobile devices, as opposed to using overhead paging systems, eliminates the potential for missed pages.

After the system and process were implemented, SJHMC saw significant improvements in time to treatment for its stroke patients. The on-call neurologists’ response times dropped 90%, from 22 minutes to just 2 minutes.

Their door-to-CT scan completion time decreased 41%, from 78 minutes to 46 minutes.

Additionally, SJHMC was able to administer life-saving tPA to three times more stroke patients than they were before.

Making lasting, life-saving process improvements

Most hospitals in the Unites States have some version of an RRT in place for major medical events. Some hospitals have even included local EMS organizations in their rapid alert processes in order to improve speed-to-treatment times.

There’s no question that streamlined and automated communication aids RRTs in their work to lower mortality rates for stroke patients and other traumatic injuries.

Rapid response alerts have proven benefits for clinicians, too. Having a rapid response alert program in place eliminates stress and frustration for the ED staff, which usually has the primary responsibility of initiating treatment to stroke and trauma patients.

In addition to simultaneous instant alerts to appropriate response team members, PerfectServe’s rapid response alert system also sends activation notices to hospital leadership. These notices include the time the alert was activated and the time each care team member arrived (as input by the nurses involved). This additional insight into rapid response operations gives healthcare leaders the opportunity to identify problem areas and make lasting process improvements that ultimately save more lives.

The top 5 things you can do with PerfectServe

A day in the life of nurses and physicians is fast-paced and full of decisions. Clinicians receive an overwhelming amount of communications each day.

What if there was a way to streamline and consolidate those clinical communications? And make sure you’re contacting the person you need to reach, rather than searching and struggling to find them?

Watch the above video to learn about the top 5 things you can do with PerfectServe.