When hospitals transfer patients between facilities, departments and EMS environments, fragmented or imperfect communication can drag down efficiency and endanger patient outcomes. However, hospitals can leverage regional communication platforms to streamline collaboration and reduce the risk of errors during care transition.
Pulsara Founder and CEO James Woodson, MD, and Georgia Trauma Commission Trauma System Planner Billy Kunkle explored the value regional communication network systems provide during an April 2 webinar hosted by Becker's Hospital Review and sponsored by Pulsara.
During the webinar, Mr. Kunkle offered real-life scenarios to illustrate the need for regional communication networks. Imagine this: A cardiologist admits a 79-year-old man with a history of atrial fibrillation to change the battery on his implantable cardioverter-defibrillator. The man has been off his anticoagulant medicine for three days, and awakens the next morning feeling confused and weak. His confusion worsens and a nurse alerts the rapid response team through an internal messaging system. A nurse arrives and after evaluation believes the confusion is due to dehydration and sends a message to the admitting physician.
While waiting for the physician to respond, the patient becomes more confused. The family and staff worry it may actually be a stroke and the nurse calls a stroke alert. The stroke team notifies the admitting cardiologist to order a CT-scan of the man's head. After a long time waiting for the order, the patient finally makes his way to the radiology suite but has now become combative. The team is unable to reach the admitting physician and eventually has to abort the scan. The patient goes to the intensive care unit where an intensivist takes over. After evaluation, she sedates the patient before completing imaging 6.5 hours after initial symptoms presented.
When strokes present in the emergency department, Mr. Kunkle said the ED aims to complete the scan within the first 15 to 20 minutes. In this inpatient case, fragmented communication resulted in a 6.5-hour process just to get imaging and the patient ended up with a large vessel occlusion stroke and permanent deficits. Studies suggest this delayed care is common in inpatient settings for conditions like ST-elevation myocardial infarction or stroke, according to Mr. Kunkle.
But facilities can take steps to address inpatient emergency responses by standardizing time sensitive team communication and care collaboration regardless of patient location with a tool like Pulsara. Most time sensitive emergencies like STEMI, stroke, and trauma present to the emergency department where they have a standard streamlined protocol that is well rehearsed. However, events that occur on the floor often don’t follow the same protocol and they definitely don’t have the same volume of cases. Pulsara can reduce variance and variability in your system by standardizing the response regardless of presentation and patient location.
In this real-life scenario, physicians could have used Pulsara's mobile tool to instantly build the interdepartmental care team with a simple tap, uniting all relevant parties and allowing them to rapidly coordinate care based on their standardized protocols. All clinicians can communicate through text-based, video and audio conversations, share data and multimedia, and continue to build the care team as the case evolves with the tap of a button.
Clinicians struggle with alarm fatigue — when everything is critical, nothing is critical. Because Pulsara is for more emergent cases, Dr. Woodson said providers are more likely to respond to Pulsara than they would to traditional communication channels. In addition, all data like response times and critical events are stored and can be utilized to help you analyze and improve your system while simplifying reporting.
Pulsara is an exceptional communication and care collaboration tool for prehospital transports and inter-facility transfers. In another real-life example, Mr. Kunkle relayed a case where EMS brought a teenager to the ED for a dislocated knee from a wrestling tournament. The medic radioed into the receiving hospital where a nurse heard the report and thought the medic described a kneecap or patella dislocation that had been reduced in the field. The patient was placed in a non-urgent room and a different nurse quickly took the bedside report. After a negative X-ray, the treating physician discharged the patient with a splint.
The next day, the patient returned in severe pain and was eventually diagnosed with a vascular injury and had to undergo a below the knee amputation. This unfortunate circumstance was another scenario where Pulsara could have helped.
In most systems today, medics call a report to someone who will never take care of the patient and then give a bedside report in an often chaotic environment. Their documentation in their ePCR is typically not complete at patient handoff and it is common for downstream providers to never receive critical information from EMS in real time. What information they have is often handed down verbally multiple times.
Instead, Pulsara creates a dedicated patient communication channel that allows this critical communication and multimedia to go downstream to all care team members. If clarification is needed, it is easy to get in touch with the treating medic even after they depart.
Pulsara's platform improves the provider and patient experience while also enhancing population health and reducing healthcare costs. Hospitals can use Pulsara for prehospital and interfacility communication as well as time sensitive emergencies like STEMI, stroke, sepsis, trauma and cardiac arrest — essentially any team communication that crosses healthcare organizations or involves uniting scattered resources.
"We're in an incredibly fragmented healthcare market. We all want to achieve big things but we have to figure out how to break down these silos and work together," Dr. Woodson said. "Pulsara can help you achieve your Quadruple Aim goals by focusing on uniting care teams even if members work for different healthcare organizations."
To view a recording of this webinar, click here.