Advanced Clinical Collaboration Drives System-Wide Outcomes at Leading Orthopedic Hospital

Introduction

Based in New York City with locations in Long Island, New Jersey, and Connecticut, Hospital for Special Surgery (HSS) is the premier academic medical center in the United States focused on musculoskeletal health. HSS performs more than 15,000 admissions and 30,000 surgical procedures annually and has been one of the top-ranked hospitals in orthopedics and rheumatology for 30 consecutive years, ranking number one in orthopedics for the past 12 years.

Communication Challenges

With 3,500 users spread across 175 clinic locations going in and out of surgery and using a mix of owned and shared devices, fast and effective communication was a struggle for HSS. Clinicians found it difficult to locate the correct provider and deliver messages quickly, which wasted time and created potentially harmful delays in patient care. Communication relied heavily on unsecure pagers and voicemail messages, and care team members would often wait for extended periods to relay a simple message.

Providers were frustrated by cumbersome workflows, which contributed to general concerns of burnout. But perhaps more worrisome was the escalation of patient risk, particularly in situations like the review of critical lab results.

For example, after verifying a critical lab result, a message was sent through PerfectServe asking the ordering provider to call the lab, at which time they were asked to review the results in the EHR. HSS policy dictates that providers must get live verbal confirmation that critical results are available, meaning a lab tech could not simply leave a voicemail and move on. The process could take anywhere from a few minutes to a few hours, depending on the provider’s schedule when the message was received (e.g., during surgery).

If the ordering provider was not on shift, the lab would consult the on-call schedule and go through the same process, hoping there weren’t any last-minute schedule changes. When the ordering or on-call provider was eventually reached, the lab had no concrete way of knowing whether or not the results were viewed or if any action was taken.

To improve the large volume of nurse-to-provider and care team communications, HSS needed an enterprise communication platform to securely connect clinicians and improve speed to care across all inpatient and outpatient settings.

Delivery on Key Hospital Metrics

Having all clinical staff and support teams on PerfectServe has dramatically changed the efficiency and effectiveness of clinical communication within HSS. With a median time to read of just one to two minutes across all PerfectServe messages, cross-departmental workflows have facilitated timelier patient care and throughput. A variety of answering services and pagers were left behind, and all communication moved to a unified, easy-to-access platform, saving clinicians’ time and precious hospital resources.

Benefits realized are listed below and grouped into three primary categories: patient care and satisfaction, provider and staff satisfaction, and clinical operations. These benefits are not exhaustive, but they do demonstrate many of the wide-ranging effects of a thoughtfully implemented communication and collaboration platform.

Improved Patient Care and Satisfaction

Quicker Clinical Response to Critical Lab Results
PerfectServe’s Clinical Collaboration solution has automated a manual process to improve acknowledgment times by 42%, with the quickest turnaround time of 7 seconds (from the final result in the LIS to provider acknowledgment).

Accelerated Clinician Response to Specialty Consult Requests
On-call requests, like a specialty consult, saw response times reduced by three to five minutes per outreach. If the intended provider is unavailable, messages are automatically escalated to a designated colleague who will respond and take any action needed.

Increase in HCAHPS Scores
HSS’s HCAHPS scores saw notable increases in these categories following the PerfectServe implementation:

• Hospital rating: +2.3 points
• Hospital recommend: +0.9 points
• Staff address emotional needs: +1.2 points
• Response to concerns: +1.2 points

Reduction in Communication Errors
PerfectServe is now the sole platform and single source of truth for communication across the entire organization, leaving behind seven different answering services and a heavy reliance on operators for connecting calls. The new automated workflows have eliminated the chance for human error when connecting interested parties, which speeds time to treatment and decreases daily care team toil.

Reduce the Spread of Infectious Disease
In response to COVID-19, HSS leveraged PerfectServe to create a workflow that automatically directs patients’ positive COVID tests to impacted groups like Infection Control. This allows for rapid communication between responsible parties. When a patient tests positive, appropriate precautions are taken to ensure the safety of staff and other patients. Since going live with this workflow in March of 2020, the COVID-19 inpatient and outpatient teams have been alerted hundreds of times.

Improved Patient Communication and Staff Response Times
HSS physician assistants (PAs) now read 96% of initiated conversations from PACU and inpatient floors in under 15 minutes. The PAs are part of 8,000-10,000 conversations per month and respond to messages in less than 3.5 minutes on average.

Faster Rapid Response Teams
With PerfectServe, HSS saw rapid response times improve by 73%, dropping from 2 minutes, 30 seconds to just 40 seconds. The increased speed is largely credited for limiting the number of times the Sepsis Response Team is alerted.

Improved Physician and Nurse Satisfaction

Improved Accuracy Rate for Contacting the Correct Clinician
PerfectServe now facilitates all clinical communication for HSS, seamlessly and dynamically referencing 1,819 users, 5,915 schedules, 7,060 notification rules, 3,069 contact rules, and 6,863 routing rules to instantly and accurately deliver 100% of messages. From the end user’s perspective, the sheer number of rules and schedules is not important, as initiating and sending communication is as easy as following a simple, guided workflow.

Contacting the Right Physician Faster
To contact a physician, clinicians previously had to log into the HSS intranet, search for the correct pager number, send the page, and then wait for a callback. But with PerfectServe, a user only needs to know the name, or perhaps the role, of the person they want to contact (e.g., Sports Attending On Call). This yields inevitable communication efficiencies.

Nurses prefer sending texts since that’s typically less intrusive than making a phone call. But that can bring certain challenges around variability of use and patient privacy, especially since HSS has 290 shared devices for inpatient nurses, 149 shared devices for patient care directors, and 473 inpatient nurses using personal devices.

With PerfectServe, nurses were able to eliminate this variability by sending secure messages through desktop and smartphone applications (the latter of which is available on both shared and personal devices). This improved their mobility and removed the reliance on legacy landline phones. Furthermore, because the application is embedded within their Epic EHR, nurses can initiate communication from their workstations on wheels (WOWs) while still garnering all of the workflow benefits offered by PerfectServe.

Since images and other attachments are not stored directly on devices, they can be sent securely and accessed from any device—including personal smartphones or tablets—equipped with PerfectServe’s cloud-based technology.

Free from the dependence on pagers and the vague, inefficient workflows they require, HSS now has an instant form of communication that makes it easy to triage messages based on urgency and automatically close the feedback loop when a message is received—no pagers required.

Improved Nurse-to-Provider Communication
Nurses and PAs share roughly 10,000 unique, secure communications within PerfectServe every month with an average acknowledgment time of just 3.3 minutes.

Elimination of Disparate Physician On-Call Schedules
With nearly 6,000 different schedules to manage every week, PerfectServe is now the single source of truth for the HSS on-call schedules, enabling clinicians to quickly update their availability and preferences while showing all changes in real time. This serves as the foundation for Dynamic Intelligent Routing, which references schedules to dynamically route messages to the appropriate clinician.

Improved Clinical Operations

Reduced Overhead Costs
By replacing traditional answering services with PerfectServe, HSS saw an annual savings of roughly $3,000 per physician, totaling approximately $600,000 per year. HSS also avoids approximately $80 per unit in pager replacement fees annually because they no longer need the hardware or paging system support. With 1,700 pagers previously in use, that’s a onetime savings of $136,000 and an annual savings of $80,000 without pager maintenance, for a total of $216,000 in the first year plus another $80,000 annually. Without these costs, HSS saved $816,000 in the first year plus an additional $680,000 every year thereafter.

Accelerated Patient Throughput
Internal studies have shown improved patient outcomes and decreased length of stay (LOS) when nurses use PerfectServe to alert the rehab department of patients who are ready for therapy. In fact, when measured from the six months prior to go-live through the six months after implementation, the overall length of stay decreased by 5.2% (77 hours down to 73 hours). HSS also reduced the time required for moving patients from the PACU to an inpatient floor. Now, 90% of all moves are completed in less than 15 minutes.

Improved Post-Discharge Communication
PerfectServe gives patients easy access to providers after surgery. When a patient calls an HSS clinic, their call can be immediately connected to a clinical nurse practitioner with the press of a button. This kind of access plays a key role in mitigating potential problems and ensuring care plan adherence.

Faster Time to Treatment
By reducing the time required to reach a provider, receive a timely response, deliver critical test results, or accelerate action from a rapid response team, PerfectServe’s role in communication and care coordination drives reduced time to treatment in many areas.

More Efficient Surgery Operations
Since implementation in April of 2017, the Nurse Practitioner group has received thousands of messages with a median response time of six minutes. And in the initial six months following PerfectServe go-live, HSS reduced the average PACU discharge time by 26% (from 90 minutes to 67).

Improved Efficiency of Clinical Support Staff and Non-Clinical Coordination

• Chaplain services: HSS gives all patients a spiritual care brochure that specifically encourages them to request that a nurse reach out to a chaplain through PerfectServe whenever necessary.
• Dietary services: Since nutritionists began using PerfectServe in April 2018, they have received nearly 1,000 messages with a median time to read of one minute.
• Environmental services: By connecting the Environmental Services team to PerfectServe, HSS is able to better facilitate room cleaning and turnover, which opens beds faster and allows for more efficient patient placement.
• Security services: The security team began using PerfectServe in May of 2019. Since then, they have received over 40,000 messages with a median time to read of one minute. Most of the messages are from staff reporting patients’ lost belongings. If something goes missing, a nurse can easily send the patient’s information, including location, to the security team. Then, if security finds the item, they can quickly return it to the patient. This offers a nice boost for patient satisfaction.
  Since the main HSS facility is located in the crowded borough of Manhattan, it can also be difficult to facilitate transportation for patients being discharged. HSS now uses PerfectServe to communicate to the security team when patients are ready to leave, which allows them to work with loved ones and caregivers to arrange for timely and stress-free pickup.
• Transport: Since going live in May 2020, the transport team has received close to a thousand messages with a median time to read of two minutes, improving turnover times and lengths of stay.
• Other: HSS added auxiliary support teams to their PerfectServe platform, including IT on-call, language services, department administrators, case managers, engineers, and health information management (HIM) specialists, ensuring a closely connected workforce regardless of departmental affiliation.

Seamless Communication Across Settings

PerfectServe was implemented to become the single on-call answering service for HSS, requiring all clinics to use the platform. In doing so, PerfectServe can easily track physician on-call schedule updates and shifts and creates a seamless channel for communication between acute and ambulatory settings. Clinicians get the information they need right away, improving patient care, provider satisfaction, and operational savings.

What Can Unified Communication Do for Your Organization?

As the data shows, HSS has used its broad deployment of PerfectServe to achieve impressive results in a number of key areas that impact clinicians and patients alike. Their success highlights the true potential of modern clinical communication and collaboration technology, which brings care team members together on a common platform and equips them with the information, structure, and established workflows they need to provide the best care for patients at all times.

What can unified communication do for your staff? Reach out to our team to learn how we can help your organization achieve impactful results like HSS has seen with PerfectServe.