Most hospital communications are event driven and time sensitive. As a result, hospitals are filled with event detection and response systems. What makes one hospital more efficient than another, though, is the ability to manage event detection and response information in real time and use that information to improve clinical and administrative operations.
At Becker's 5th Annual Health IT + Revenue Cycle Conference in Chicago, Vocera sponsored an executive roundtable to explore how a clinical communication and collaboration platform can aggregate and integrate data, transform it into actionable information and communicate it to nurses, physicians and other clinical staff.
Ben Kanter, MD, chief medical information officer at Vocera, and Tom Stafford, VP and CIO of Halifax Health, discussed the importance of communication technology to patient outcomes and best practices for implementing a CC&C platform.
Without timely communication, rapid response systems fail
On April 15, 2019, Notre Dame Cathedral in Paris suffered a devastating fire. Although first responders in Paris had prepared by developing an early warning system, this system broke down due to lags in communication. The fire department wasn’t called until 30 minutes after the smoke alarm went off. Although the cathedral staff and the Paris fire department understood the system and were prepared, much of the building was lost.
This event holds lessons that can help hospitals build smarter real-time health systems. In a traditional rapid response system, there are afferent and efferent components. Afferent is the sensing limb and efferent is the action limb. The organization understands there's an issue and then responds. Communication forms the link between sensing and acting. This was where Notre Dame's rapid response system broke down.
"The clinical communication and collaboration platform acts as the central nervous system of a smart hospital. Without it, hospitals become nearly paralyzed because they can't communicate and act quickly enough," explained Dr. Kanter.
Transforming patient care with a CC&C platform: Halifax Health's journey
Halifax Health is East Central Florida's largest healthcare provider. It has a tertiary and community hospital with 678 beds and more than 500 physicians on staff. Halifax Health has used Vocera since 2009 to improve clinical communication and collaboration.
Effective communication doesn't depend solely on information in the EHR. Mr. Stafford commented, "Hospitals all have EHRs, but those systems don't fill every need. We end up buying other systems to fill the gaps. Hospitals must connect those systems and unify information in one platform. Although the government has focused on system interoperability, I spend more time on intraoperability — connecting systems together."
After integrating data from multiple systems, Halifax Health sends it directly to Vocera communication solutions. When information needs to reach a physician or nurse quickly, the last place hospitals want to store that information is on a computer. On a med-surg floor, clinical staff may log onto a computer every 35 to 40 minutes. When information sits on a computer, it's not quickly accessible.
Vocera has transformed how Halifax Health provides care throughout the organization. The emergency department is one of the first places Halifax Health implemented Vocera. The 99,000-square-foot ED had constant overhead pages and the environment was extremely chaotic. Once Vocera was deployed, overhead paging was eliminated. "When Hurricane Matthew hit four years ago, 900 patients showed up in our ED. Despite the crowds, the atmosphere was quiet thanks to the staff's Vocera badges," said Mr. Stafford.
Halifax Health's CC&C platform has played a critical role in streamlining the patient discharge process. Physicians can often discharge patients without informing anyone. Previously, until nurses saw the discharge orders in the computer, they couldn’t react. With Vocera, when a physician discharges a patient, the nursing staff is notified through their badge within 20 seconds. As soon as the certified nursing assistant hears the discharge order, he or she starts working with the patient. After Halifax Health implemented this process, one unit saw an 8 percent reduction in length of stay in one of their med/surg units.
Halifax Health also uses Vocera and Wolters Kluwer to launch sepsis alerts. Wolters Kluwer takes 250 data points from the EHR and trending lab values. Using natural language processing, it predicts sepsis in patients with high accuracy. Mr. Stafford noted, "Sepsis is all about timing. You want the care team to be aware of sepsis as soon as it happens. As soon as the system fires off an alert via Vocera, the team can see whether the patient has mild, moderate or severe sepsis."
The key to successful CC&C system deployments: Change management
When implementing information systems in hospitals, change management is one of the biggest challenges. Healthcare tends to be averse to change. Mr. Stafford observed, "When I transitioned into healthcare from the medical device manufactory industry, I thought it would be easy because all I'd be doing is installing software. I quickly realized that software requires adoption and adoption is based on laws of culture and behavior. It's much harder to get one physician to use a new app than to design a complex robot."
As Halifax Health built its real-time health system, it focused on two aspects of change management: 1) be persistent and never give up; and 2) break change into small increments. "In most cases, we only get one shot to make a change. If the system doesn't work the first time, employees will ignore you and prevent you from trying again. We have to make small changes so end users don't perceive that they have a big effect on their work," said Mr. Stafford.
Change management can take time, but when done well, the results are worth it.
Another reality is that user adoption in healthcare is an ongoing process. Given high rates of employee turnover, new people are always learning how to use information systems. As a result, user-friendly solutions that are easy to pick up are critical. Even if an organization has a "big bang" implementation with a lot of employee training, educating new hires must happen continually over time.
Breaking down communication barriers and reducing clinician burnout with CC&C systems
Clinical communication and collaboration technology is designed to streamline communication among hospital staff. For instance, when physicians have to contact a patient's nurse, they may not know the nurse's number or even her name. Phone tag begins as they call the nursing station and the nurse tries to call back. With the Vocera app, all the doctor needs to know is the patient's room number. With that information, physicians can instantly connect with nurses via text or phone.
Vocera's powerful rules engine analyzes information to determine whom messages should go to, when they should be sent and how they should be escalated if they aren't acknowledged. For instance, if a nurse indicates that she's going to code blue, Vocera doesn't interrupt her with a note that a patient needs Tylenol or water. When Halifax Health does discharges using Vocera, the information isn't broadcast to the entire organization. It only goes to the nurses handling the patient.
Mr. Stafford said, "In healthcare, communication challenges arise every day. If I can improve communication using technology, I can assist in improving patient care and reducing physician and nurse burnout."
Voice-based communication between clinical staff and patients can also build trust and contribute to better patient outcomes. One hospital using Vocera conducted timing studies to see how quickly nurses got to patients' rooms after an alert. Although the nurses arrived in the same amount of time as before, the number of patient falls decreased. When patients heard the voice of the nurses they knew, they trusted that the nurse would arrive in a short period of time to help them.
Vocera's unified communication platform enables hospitals to create customized alerts. For instance, a bed alarm system doesn't differentiate based on the weight of the patient or the patient's fall risk. Dr. Kanter explained, "The Vocera platform integrated with the patient bed recognizes that a bed alarm is coming from a particular room. Based on information from the EHR, it knows that the patient is a high fall risk and can launch a customized alarm based on data from multiple systems."
Conclusion
The most recent literature suggests that as little as a 15-minute delay in the activation of a rapid response system results in worsened patient outcomes, more ICU transfers and longer lengths of stay. It all comes down to time. Hospitals must shorten the time to act, remove points of failure from the system and make it easier for physicians and nurses to do their jobs.
Mr. Stafford commented, "As a CIO, I believe the best place for a nurse or physician is by their patient. Our clinical communication and collaboration system has enabled us to get data to caregivers in unique ways, so they don't have to leave the bedside to go to a computer."