When St. Rita's Medical Center in Lima, Ohio, found itself facing a number of incidences of broken communication, Herbert Schumm, MD, vice president of medical affairs at St. Rita's, found that the root cause stemmed from not being able to verify if physician contact was ever attempted or completed. "It came down to a 'he said, she said' situation, and there was no way to verify what exactly happened," Dr. Schumm says. Here Dr. Schumm shares six ways St. Rita's was able to improve clinical quality and operational efficiency through first improving hospital-wide communications.
1. Consider a physician's preferences and schedule. Allowing physicians to control how and when they are contacted by fellow staff members not only helps ease physicians' frustration of being called during off-duty hours but also gives staff members and physicians a way to be contacted in a more efficient manner. At St. Rita's, every physician's schedule is entered into a system. This way, calls are directed to the physician based on where he or she is at a certain time of the day.
"Some physicians prefer to be contacted by their cell phones, home phones, through their office phone, and some are more comfortable with just voice mail. Some physicians, depending on their specialty, may also work in certain units," Dr. Schumm says. "For example, an obstetrician may want calls from the labor and delivery units to come to their cell phone but calls from rest of hospital to go to their office. Physicians can also set up voicemail boxes for messages that aren't necessarily urgent that they can retrieve whenever they want. This allows them to manage calls and prioritize better."
2. Use a standard process for communication between physicians and staff. St. Rita's first tackled the issues of broken communication among physicians and staff by implementing a standard process and procedure for establishing communication. In order to accomplish this, they installed healthcare information technology from PerfectServe that allowed the hospital to standardize how calls are made to physicians.
"We have one way to contact a physician, no matter where a staff member is calling from," Dr. Schumm says. "PerfectServe's technology allows the staff members to just call one number, and based on the physician's schedule the right physician should be notified no matter where they are."
3. Take advantage of the opportunity to re-educate physicians and staff on calling protocols. Many hospitals struggle with maintaining a high level of communication among staff members and their physicians. Creating a system of accountability can help maintain better communication and ensure phone calls are delivered and returned in a timely manner. Dr. Schumm suggests to hospitals that struggle with medical staff who don't return phone calls to implement a monitoring system for repeat offenders.
"Our staff goes to any physician who has trouble returning calls or pages and request they be put in a mode that monitors if they are responding to calls," he says. "This gives them a chance to correct the problem. We were not using this as a 'gotchya,' but rather we're making it a part of our conversation about how the entire medical staff can improve communication."
4. Log call histories to improve communication performance. Tracking calls allows St. Rita's administrators to handle breakdowns in communication in its early stages before they become bigger issues. Dr. Schumm recalls one example of when a physician approached him about a situation where a nurse claimed she had called him several times but never received any missed calls on his cell phone.
"Because we track our calls, I can log on and see if any phone calls were indeed made to that physician," he says. "Interestingly, what we found commonly happens is a nurse will ask the clerk to place a call to a physician, who then gets caught up doing something else. In this particular case, the physician hadn't been called. By tracking phone calls we can look at the process and identify what went wrong."
Logging calls has also helped St. Rita's identify other communication breakdowns in the hospital, such as staff calls that are made to physicians in various department when a patient does not have a physician at St. Rita's. Often these patients are also uninsured, says Dr Schumm, which may mean the physician will not be reimbursed for his or her services with the patient. Dr. Schumm says although the goal is to spread staff calls equitably across the departments, some department members occasionally complain about an unfair overload of staff calls. "Our call logs help us see how many staff calls each department gets. This allow us to go back and see if the numbers verify an overload of staff calls," Dr. Schumm says.
5. Put together a rapid response team. St. Rita's assembled rapid response teams for each department of the medical center. These rapid response teams are responsible for providing immediate care in emergency situations, which prevents longer wait periods for patients in need to expert care. St. Rita's rapid response teams usually consist of the critical care nurse and a hospitalist.
"If a staff member notices something is not right with a patient and needs additional help in caring for that patient, the staff member can call one number to get in touch with a rapid response team," Dr. Schumm says. "Instead of waiting for a response from a more specialized on-call physician that may not be readily available at that moment, calling the rapid response team brings those resources immediately to the bedside."
Dr. Schumm adds that forming similar rapid response teams in other departments, such as a STEMI team for heart attack patients or a trauma team for emergency department patients, can help streamline communications and more quickly provide immediate care.
6. Create a HELP hotline. Creating a HELP hotline is an easy proactive measure to take to improve communications throughout a hospital. St. Rita's staff and physicians who experience trouble contacting another employee can connect with a receptionist after typing H-E-L-P on a phone keypad. The helpline receptionist facilitates by helping the staff member get in touch with who he or she is trying to contact.
"Anytime anyone can't get what they need or be in touch with someone they need, they can go to the helpline, and a lot of the time it's a new physician that comes on our staff who, despite orientation, still has difficulty managing calls," Dr. Schumm says. "We also track our help line calls to see if there are any trends for quality review cases. It helps us know who called who and essentially recreate what happened to investigate a communication problem and rectify it."
Learn more about St. Rita's Medical Center.
1. Consider a physician's preferences and schedule. Allowing physicians to control how and when they are contacted by fellow staff members not only helps ease physicians' frustration of being called during off-duty hours but also gives staff members and physicians a way to be contacted in a more efficient manner. At St. Rita's, every physician's schedule is entered into a system. This way, calls are directed to the physician based on where he or she is at a certain time of the day.
"Some physicians prefer to be contacted by their cell phones, home phones, through their office phone, and some are more comfortable with just voice mail. Some physicians, depending on their specialty, may also work in certain units," Dr. Schumm says. "For example, an obstetrician may want calls from the labor and delivery units to come to their cell phone but calls from rest of hospital to go to their office. Physicians can also set up voicemail boxes for messages that aren't necessarily urgent that they can retrieve whenever they want. This allows them to manage calls and prioritize better."
2. Use a standard process for communication between physicians and staff. St. Rita's first tackled the issues of broken communication among physicians and staff by implementing a standard process and procedure for establishing communication. In order to accomplish this, they installed healthcare information technology from PerfectServe that allowed the hospital to standardize how calls are made to physicians.
"We have one way to contact a physician, no matter where a staff member is calling from," Dr. Schumm says. "PerfectServe's technology allows the staff members to just call one number, and based on the physician's schedule the right physician should be notified no matter where they are."
3. Take advantage of the opportunity to re-educate physicians and staff on calling protocols. Many hospitals struggle with maintaining a high level of communication among staff members and their physicians. Creating a system of accountability can help maintain better communication and ensure phone calls are delivered and returned in a timely manner. Dr. Schumm suggests to hospitals that struggle with medical staff who don't return phone calls to implement a monitoring system for repeat offenders.
"Our staff goes to any physician who has trouble returning calls or pages and request they be put in a mode that monitors if they are responding to calls," he says. "This gives them a chance to correct the problem. We were not using this as a 'gotchya,' but rather we're making it a part of our conversation about how the entire medical staff can improve communication."
4. Log call histories to improve communication performance. Tracking calls allows St. Rita's administrators to handle breakdowns in communication in its early stages before they become bigger issues. Dr. Schumm recalls one example of when a physician approached him about a situation where a nurse claimed she had called him several times but never received any missed calls on his cell phone.
"Because we track our calls, I can log on and see if any phone calls were indeed made to that physician," he says. "Interestingly, what we found commonly happens is a nurse will ask the clerk to place a call to a physician, who then gets caught up doing something else. In this particular case, the physician hadn't been called. By tracking phone calls we can look at the process and identify what went wrong."
Logging calls has also helped St. Rita's identify other communication breakdowns in the hospital, such as staff calls that are made to physicians in various department when a patient does not have a physician at St. Rita's. Often these patients are also uninsured, says Dr Schumm, which may mean the physician will not be reimbursed for his or her services with the patient. Dr. Schumm says although the goal is to spread staff calls equitably across the departments, some department members occasionally complain about an unfair overload of staff calls. "Our call logs help us see how many staff calls each department gets. This allow us to go back and see if the numbers verify an overload of staff calls," Dr. Schumm says.
5. Put together a rapid response team. St. Rita's assembled rapid response teams for each department of the medical center. These rapid response teams are responsible for providing immediate care in emergency situations, which prevents longer wait periods for patients in need to expert care. St. Rita's rapid response teams usually consist of the critical care nurse and a hospitalist.
"If a staff member notices something is not right with a patient and needs additional help in caring for that patient, the staff member can call one number to get in touch with a rapid response team," Dr. Schumm says. "Instead of waiting for a response from a more specialized on-call physician that may not be readily available at that moment, calling the rapid response team brings those resources immediately to the bedside."
Dr. Schumm adds that forming similar rapid response teams in other departments, such as a STEMI team for heart attack patients or a trauma team for emergency department patients, can help streamline communications and more quickly provide immediate care.
6. Create a HELP hotline. Creating a HELP hotline is an easy proactive measure to take to improve communications throughout a hospital. St. Rita's staff and physicians who experience trouble contacting another employee can connect with a receptionist after typing H-E-L-P on a phone keypad. The helpline receptionist facilitates by helping the staff member get in touch with who he or she is trying to contact.
"Anytime anyone can't get what they need or be in touch with someone they need, they can go to the helpline, and a lot of the time it's a new physician that comes on our staff who, despite orientation, still has difficulty managing calls," Dr. Schumm says. "We also track our help line calls to see if there are any trends for quality review cases. It helps us know who called who and essentially recreate what happened to investigate a communication problem and rectify it."
Learn more about St. Rita's Medical Center.