Clinical alerting: Moving beyond nurse call

When most people think about clinical alerting, they think nurse call systems. This is not without reason: Nurse call integration solutions were the original clinical alerting solutions on the healthcare scene and have been around since the early 2000s. Additionally, the integration is simple to understand. The patient presses their nurse call button and that alert is delivered directly to the nurse's mobile device.

This integration and the related workflows are still effective and used widely across U.S. hospitals and health systems. They speed nurse response times, aid quiet hospital initiatives, help with patient satisfaction (HCAHPS scores), and therefore boost reimbursements. But many more complex clinical alerting solutions have emerged over the last decade. Clinical alerting integrations with patient care devices, lab and radiology result systems, and electronic medical records (EMRs) are much more intricate than nurse call. They're automated instead of human-initiated and connect many more endpoints. The growth of these solutions along with the need for fast and accurate notifications for important, actionable events has driven mobile clinical workflows to another level in recent years.

Patient Care Devices: Nurse call integrations naturally expanded to other clinical workflows with patient care devices as hospitals' integration needs began to change and hospitals set their focus on improving patient outcomes and satisfaction. One of the primary benefits of clinical alerting for patient care devices is its ability to significantly diminish alert fatigue that's common due to frequently sounding devices like patient monitors and ventilators—a Johns Hopkins study found an average of 350 alarm conditions per day, per bed, and 85–99 percent of those alerts were non-actionable. Implementing a clinical alerting solution in this area helps hospitals and health systems meet The Joint Commission's National Patient Safety Goal (NPSG) 06.01.01: "Improve the safety of clinical alarm systems."

Clinical alerting for patient care devices also helps improve efficiency as it can centralize or sync staff assignments, and consolidate event management workflows across device systems. Like nurse call, although perhaps to an even greater degree, clinical alerting integrations with patient care devices improve patient care and satisfaction.

Lab and Radiology Results: Here's another area where clinical alerting integration can help hospitals comply with The Joint Commission. NPSG #2 is "Improve the effectiveness of communication among caregivers," and a secondary component of that is NPSG.02.03.01: "Report critical results of tests and diagnostic procedures on a timely basis." A clinical alerting solution that can integrate directly with a Radiology Information System (RIS) or a Laboratory Information System (LIS) not only alerts the ordering physician of a critical test result, but it can also help close the communications loop when the physician notes acceptance of the results in the patient's EMR. Critical test result systems help eliminate the game of phone tag between radiologists/lab personnel and the ordering physician, and have proved to help improve discharge times.

EMR: We saved the most interesting integration for last. There's enormous potential for optimizing your investment in costly EMR systems with a clinical alerting solution and an HL7 engine. As an example, a clinical alerting solution can integrate with the admit, discharge, transfer (ADT) system to automate notification of changes in patient status, but there are many other powerful applications. Let's take a look at two use cases.

An academic medical center in the south-central U.S. already had clinical alerting for nurse call and patient monitoring devices, as well as for building management systems. They were looking for a way to send notifications not considered to be protected health information (PHI)—such as patient reminders—easily via SMS (text) messages. To accomplish this, they employed a clinical alerting solution to take the HL7 feed from the patient's EMR and extract the mobile phone number (if available). Then the system generates an automatic reminder or notification to the patient that links to their secure patient portal. This integration fills in a gap in communications for EMR/health information systems (HIS) and also improves patient satisfaction and reduces the likelihood of readmission.

Another academic medical center, this one on the East Coast, implemented workflow messaging that delivered orders to respiratory therapists from the EMR, and then logged responses that the physician can see. This change to the workflow offers a big improvement to care team coordination and patient care by reducing copy/paste errors and phone tag for both the delivery of orders as well as follow-up about how the patient responded to a treatment. This can improve HCAHPS scores, increase staff efficiency, and also improve traceability with patient records by closing a common EMR gap.

These two academic medical centers had different EMR systems. In fact, the type of EMR doesn't matter as long as it uses HL7.

Clinical alerting has evolved well beyond nurse call, and the applications outlined above indicate the benefits the entire industry can reap from that evolution. Clinical alerting applications such as solutions from Spok help solve core challenges in the industry: patient experience and satisfaction, staff and workflow efficiencies, patient safety and quality outcomes, and care team collaboration. The good news is this can have an exponentially positive effect: Interoperability grows with each input and output that's added, and there's more flexibility than there's ever been before. We're just getting started.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.​

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