Real-time situational awareness: A prescription for smart hospitals

Hospitals have invested large sums of money digitizing their operations over the past decades.

Unfortunately, those investments have not necessarily resulted in improved outcomes or more efficient operations. For a hospital to take maximum advantage of this analog-to-digital transition, it must be able to transform data into actionable information in real time and act with intelligence to improve clinical care and operational efficiency.

Various consulting groups have weighed in on this topic. As an example, Gartner refers to this concept as the “Real-Time Health System” (RTHS). An RTHS, according to Gartner, is a healthcare organization that uses information and communication to accelerate change in business processes, eliminate waste and latency, and better balance resources and demand. To move from being “digitally dumb” to “digitally smart,” an organization needs a way to communicate effectively throughout the entire enterprise. Therefore, a critical component of an RTHS is a Clinical Communications and Collaboration (CC&C) platform. A CC&C platform integrates data from multiple systems, processes it, and provides actionable information to care team members in a way that allows them to connect, communicate and collaborate on their devices of choice. The ability to process data without delay creates real-time situational awareness which in turn enables clinicians to intervene quickly when and where it makes sense. In the absence of an effective CC&C solution, an organization is effectively paralyzed, unable to act effectively on the information it has created.

As an example, consider a common hospital scenario: a patient triggering a bed-exit alarm. A CC&C platform connected to an EHR that contains admission-discharge-transfer (ADT) data “knows” which patient is in which bed. Through integrations with nursing assignment and the EHR, a picture of the patient’s care team emerges. Additional integrations can deliver information concerning the patient’s specific falls risk score and bed-exit alarm status. Thus, when a bed-exit alarm does occur, the software can take that single limited point of data (“a patient is exiting a bed”) and transform it into much more personal and actionable information: “patient Bob Smith in room 212 who is a low fall-risk is exiting his bed.”

This information is then routed to exactly the right member of the care team based upon criteria such as availability, location, and licensure. To complete the example: if the patient exiting the bed has a low fall risk score, a CC&C system can transform that bed-exit alarm into a low-priority message that is routed directly to the patient’s nurse, making her aware of the situation but without unduly interrupting her ongoing work. If, however the patient has been assessed to be a high fall-risk, the same bed-exit alarm is instead transformed into a high-priority, highly interruptive message that can be routed to an entire team of nurses – offering maximum protection for the at-risk patient.

Reducing alarm fatigue
A sophisticated CC&C platform can leverage its ability to intelligently transform data (in the above case via integration with a patient’s unique fall risk) and deliver information with a contextual understanding of the care team (who is or isn’t immediately available) to reduce alarm fatigue, which takes a toll on clinician well-being and may interfere with the delivery of safe patient care. The broader the knowledge contained within the CC&C platform, the better it can filter out non-actionable notifications arising from the many systems now able to message their status. By personalizing alarms to the patient in real time, a CC&C platform can accomplish much of this filtering and in so doing, increase the positive predictive value of the information communicated to the clinical team. By personalizing alarms to the recipient, a CC&C platform can intelligently direct messages, avoiding interruptions to staff when they are not available or are involved in high priority patient-care tasks. For example, if a nurse is responding to a code blue alarm, it would be best to exclude her from messages and alarms until the code has been completed. Triage and escalation rules must be able to accommodate provider-centric factors as well as operational context to make this type of determination.

Improving emergency response
The ability to communicate with situational awareness is vital in accelerating responses to urgent conditions. Some hospitals, for example, have integrated clinical data algorithms with their communication platform to detect and alert staff when there are early signs of patient deterioration, perhaps due to sepsis or other dangerous conditions – a very time sensitive endeavor. When the “early warning” system is activated, a high-priority message containing situational information is sent directly to available care team members on their mobile devices. This proactive form of communication can result in faster response and treatment of the unstable patient.

Real-time situational awareness is not just a critical factor for effective patient care, it is also central to a hospital’s ability to operate efficiently. As an example, without real-time situational awareness, it is impossible to maximize patient throughput; it is insufficient to know where delays have occurred in the past – you must also know where delays are occurring now. A robust CC&C platform can alert operating room recovery teams, for example, when a surgical case is about to wrap up. When a patient is discharged from the emergency department, the EVS team can be automatically notified and their work updated into the hospital’s bed management system. Better communications among care team members can also speed up hospital discharge processes, allowing patients to go home sooner. When a ward bed is freed up more quickly, it can positively impact ED wait times; empowered by real-time situational awareness, housekeepers and transporters can improve patient flow from admission to discharge.

In summary, leveraging real-time situational awareness has become a critical success factor for today’s healthcare systems. The crucial need to process data without delay and communicate information effectively is driving the importance of the modern clinical communication and collaboration platform, which now forms the core of a “digitally smart” enterprise. Real-time situational awareness has the potential to improve patient outcomes, reduce interruption fatigue, decrease the likelihood of patient harm, and make clinicians’ work easier and more efficient. In the age of ubiquitous mobile communications, technology that enables intelligent and contextual communication is becoming the standard of care.

By Benjamin Kanter, MD, FCCP, CMIO of Vocera


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