For decades, the Joint Commission’s National Patient Safety goals for hospitals have emphasized the importance of improving the effectiveness of communication among caregivers. In the past, the Joint Commission cited communication breakdown as the single greatest contributing factor to sentinel events and delays in care in U.S. hospitals.
Yet despite all the incredible advances in technology, communications between caregivers is too often slow, disruptive and burdensome to both clinicians and patients. The source of these problems is readily apparent: Most hospitals have too many communication devices, which make it difficult for clinicians and staff to easily share timely, meaningful information.
At UW Medicine’s Valley Medical Center (VMC), a 321-bed acute care community hospital and clinic network in the suburbs of Seattle, we recognized the need to consolidate caregiver communications and alarm/alert notifications on a single, HIPAA-compliant device. In early 2015, we began a phased rollout of the Voalte smartphone system in Renal Respiratory, our largest and busiest unit. Our goals for this initiative were aligned with VMC’s four “Patients Are First” strategic pillars – provide the highest quality care, improve patient experiences, lower costs and become an employer of choice by improving clinician and staff experiences.
Closing the communication gaps
Before implementing this system, our caregivers and staff often could not quickly connect with each other, which caused uncertainty, delays in care and workflow inefficiencies. Constant communication “hand-offs” (for example, through unit secretaries) were commonplace and increased the likelihood of miscommunications and errors.
These problems not only affected patient care but also added stress and extra work for physicians and nurses. To achieve our goal of becoming an employer of choice, we needed to help ease their workload and provide them with faster, more actionable information.
To close these communication gaps, we integrated the Voalte system with our Epic Rover mobile app, Connexall middleware, nurse call system, patient monitoring and the hospital switchboard. We made available shared Apple® iPhones to physicians, nurses, hospitalists, technicians, therapists, staff personnel and others on our interdisciplinary team. The Voalte Messenger enabled desk-based staff such as unit secretaries, the ED charge nurse and discharge planners to exchange secure text messages with our smartphone users.
Our new smartphones also feature a status bar that provides information on nurses’ availability, room assignments and back-up coverage. About 60% of our smartphone communications are texts, which allow clinicians to communicate directly instead of waiting for callbacks or getting information second-hand. Physicians and nurses also immediately know when a message is important and requires immediate attention and find the right person to contact when a nurse is busy or on break.
Better outcomes
To assess the impact of the smartphone system on quality of care, we tracked the unit’s performance on the following metrics:
• Hospital-acquired pressure ulcers and skin integrity events
• Fall and slip events
• Medication errors
We continue to see steady and significant reductions in all three areas. A key area of focus was improving communications and workflow in alarm management, which has ranked in the top three on the ECRI Top 10 Health Technology Hazards list each of the last three years. For example, to expedite responses to fall and slip events, we route alarms only to smartphone users on the side of the unit closest to patient. The system also includes an escalation pathway so that when a primary nurse is unavailable, alarms and notifications immediately go to the back-up nurse and then the charge nurse when necessary. The transparency embedded in the use of the smartphone system helps foster a culture of ownership, accountability and shared responsibility -- a powerful motivating force throughout our hospital.
The smartphones also enable our clinicians to spend more time focused on patient care with fewer interruptions. Texting can quickly resolve questions and issues without having to waste time tracking down and talking to different people. And the phones’ status bar lets others know when a nurse may be “busy” administering medications to patients, which helps reduce errors.
Because some functions of Epic Rover are integrated into the smartphones, nurses can upload photos into patient charts. This has been especially useful in managing skin integrity events, since nurses can now send many pictures to the wound care team and talk about the plan of care in real time.
By improving workflow efficiency, information sharing and staff engagement, we have significantly reduced the number of fall and slip events, skin integrity events and medication errors throughout the hospital. In our first three months after implementing this system, VMC saved roughly $54,000 in cost avoidance on the Renal Respiratory Unit.
Improved patient experiences
Better, more efficient communications between caregivers have also had a direct impact on patients by helping to make their stays less stressful. They have fewer interruptions and their nurses respond faster and can more quickly answer their questions.
Even subtle things such as reducing the noise caused by pagers and beeping alarms can make a big difference in patient perceptions and the healing process. One family member told me, “It’s nice to have a quiet hospital that feels like a hotel for a change. Maybe my Dad can actually get some rest.”
I believe there is a direct correlation between our use of smartphones and the fact that Renal Respiratory became our first unit to receive a 99% rating on a patient satisfaction survey. Our clinicians also give the smartphones high marks. According to Vinita Singh, the Nurse Manager of the Renal Respiratory Unit, “this is the technology every nurse wants and every patient deserves.”
Lessons learned
VMC now uses smartphones on all our med-surg units. We are continually finding new ways to use them more effectively, and some key takeaways from our experiences that could be helpful to other hospitals include:
• It’s critically important to understand how new communications technology will be used in daily practice and train clinicians accordingly
• During the planning stages, make sure all operational stakeholders and informatics personnel are at the table to get a thorough, wide-angle view of workflow
• Use technology to hold people accountable without being punitive and continually assess whether they have the right tools, workflows and training to be successful
• Understand your culture when you set up your directories to make certain you’re using terms that everyone can immediately recognize
• You can never get enough feedback from physicians, nurses and hospitalists
We continue to expand our smartphone communication capabilities. In Phase 3 of our hospital-wide rollout, we plan to connect with our clinic network and first responders to smooth the transition of care throughout the healthcare continuum. We also will integrate additional alarm and alert functionality through Connexall middleware and are considering more apps for our ED as well as clinical educational apps.
We view the system as a Swiss army knife with unlimited potential. We’ve only begun to scratch the surface of what it can do to benefit our clinicians and patients.
James Jones, BSN, MBA, MSN, NEA-BC
VP of Patient Care Services and Nursing Operations
James is an active industry and organizational spokesperson with UW Medicine’s Valley Medical Center, which is the largest non-profit public district hospital in the state of Washington. Since joining the organization in 2014, he has been one of the driving forces behind its strategic and operational Mobile Communication Strategy. Valley Medical Center has received multiple HealthCare’s Most Wired and HIMSS Analytics Stage 7 awards and has been named one of U.S. News and World Report’s Best Hospitals.
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