Embedding PerfectServe in the EHR Improves Communication Efficiency

The University of Tennessee Medical Center (UTMC) is East Tennessee’s only academic medical center and Level I trauma center. With nearly 700 beds and seven Centers of Excellence, UTMC is Magnet® recognized and known for a strong commitment to high-quality care.

Challenges

Communication breakdowns have been identified by the Joint Commission as a top contributor in sentinel events,1 with other consequences including clinician frustration, reduced productivity, and care delays. Additionally, poor communication is detrimental to an organization’s bottom line, costing approximately $12 billion across healthcare systems each year. 

In 2015, the leadership team at UTMC recognized communication challenges, evaluated solutions to combat those problems, and decided to implement PerfectServe’s Clinical Collaboration solution across their hospital and ambulatory sites. Adoption was strong, with nearly 35,000 initiated communications every month. 

In 2020, UTMC sought to build upon PerfectServe's strong performance by integrating it with the electronic health record (EHR) to further streamline communication workflows. The primary goals were to increase clinician satisfaction and speed up patient care—objectives underscored by the COVID-19 pandemic.

“In the midst of the global pandemic, UT Medical Center has been running at more than 100% capacity for months. We simply don’t have time to waste.”

Clay Callison, MD, Chief Medical Information Officer, UTMC

Solution

To measure the impact of embedding PerfectServe within the EHR, UTMC created a quality improvement initiative with two study groups chosen specifically for the high volume of communication they send and receive throughout the organization.

Two Study Groups:

• Large nursing unit – nearly 40 nurses
• UT Hospitalist Group – more than 60 providers

Implementation

The study period began six weeks prior to go-live with the collection of baseline utilization, time measurement, and satisfaction surveys.

Data Collection:

• Provider and nurse satisfaction with UTMC’s communication processes—including paging, calls, and PerfectServe secure texting—were quantitatively evaluated based on six of the ten domains of satisfaction.
  • Quality
  • Ease of access
  • Timeliness
  • Efficiency
  • Innovation
  • Commitment to the customer (patient)
• Time it took to initiate a PerfectServe message was evaluated pre-deployment (outside the EHR) versus post-deployment (inside the EHR) using timed observational studies of more than two dozen nurses communicating throughout their shifts.
• Utilization metrics were evaluated via the PerfectServe analytics dashboard, including:
  • Total number of PerfectServe communications initiated each month
  • How many originated from the web interface vs. the new embedded EHR access point
  • Overall communication volume trends

Superusers represented each clinical area and received comprehensive training, as did the expert user group led by UTMC’s Nursing Coordinator. Go-live was supported by an on-site team that rounded throughout the day in all patient care and ancillary areas.

Results

The care team response was overwhelmingly positive across the organization and user groups.

Nurse Satisfaction
When evaluating overall satisfaction with communication processes, the nurses expressed a 28% increase in satisfaction, which is statistically significant with p<.001. Both the pre- and post-implementation surveys received a nurse response rate of more than 70%.

Provider Satisfaction
The provider group began the study with a very streamlined process, using the PerfectServe mobile app on their smartphones, but EHR embedded messaging still succeeded in increasing their satisfaction by 12% (p=.08). Provider survey engagement went from 45% pre-implementation to 73% post-implementation.

Time to Initiate Messages
Exceeding the targeted 10% decrease in time taken to initiate asynchronous communication, UTMC saw a 76.3% decrease. Each message sent using PerfectServe embedded within the EHR was 74 seconds faster on average, allowing UTMC to reclaim around 410 hours per month.

Financial Savings
With UTMC’s nurses and ancillary team members initiating nearly 20,000 messages each month, the 74 seconds per message given back to essential care tasks was profound, totaling approximately $117,675 in annual time savings.

Adoption
Although COVID-19 measures hindered initial communication volume, adoption was 73.3% and climbing at the conclusion of the six-month study. Even better, PerfectServe communication was up more than 21% year over year with patient census remaining consistent.

Clinicians who had previously never used PerfectServe were engaged by the simplicity of embedded messaging within the EHR.

Conclusion

Communication has a tremendous, well-documented impact on hospitals, care teams, and patients. Clinical communication platforms have emerged in the past decade as a comprehensive solution for efficient and standardized healthcare communication. Embedding PerfectServe’s Clinical Collaboration solution within the EHR saves time, drives additional solution utilization, and increases clinician satisfaction.

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