The University of Kansas Health System: How more than 1,000 smartphones helped the nation’s first certified comprehensive cardiac care center standardize clinical communications

At any large hospital, patients are cared for by teams of physicians, nurses, pharmacists and other specialists. A “handoff” occurs during each transfer of responsibility for care, and a “signout” happens each time patient information is transmitted.

These handoffs and signouts can inevitably result in miscommunication – a leading cause of preventable errors that have been linked to adverse clinical events in various settings. To meet the Joint Commission’s requirement that all health care providers "implement a standardized approach to handoff communications,” the University of Kansas Health System has consolidated care team communications, including alarm/alert notifications, on the Voalte smartphone platform. In a 2017 news release, the Joint Commission cited our ability to standardize channels for communication handoffs as a criterion for awarding us its first Comprehensive Cardiac Center (CCC) Certification.

We began deploying smartphones in our units in 2014. Today, Kansas Health physicians and staff use more than 1,000 of these HIPAA-compliant devices (both shared Apple® iPhones with Voalte One and providers’ personal smartphones with the Voalte Me app) throughout the hospital and offsite locations. Following is our approach for using the smartphones to standardize communications and address challenges in alarm management.

Why We Made the Change
The University of Kansas Health converted to our smartphone system because we knew that better, more information-rich communications would improve patient safety and the quality of care. It would reduce not only the risk of clinical errors caused by missed or erroneous communications, but also unnecessary interruptions and distractions for our providers, which in turn would give them more time for patient care. Texting capabilities, for example, lets them resolve questions by phone instead of having to track down and talk to several different people.

Improving inefficient communication workflows also would positively affect patients’ experiences. For example, a smartphone system that would expedite caregivers’ responses and shorten wait times helps ease patients’ frustrations and anxieties. In addition, smartphones with alert notifications reduce the constant beeping of alarms, which adds to patients’ stress and make it difficult for them to get the rest they need.

Creating a Standardized, Global Communications Platform
To build a strong foundation for deploying smartphones throughout the health system, we established two committees – telecommunications and alarms management – which included nurses, physicians, IT professionals and ancillary staff. Their goals were to:

• Gain a complete understanding of communication workflows and clinical and staff needs
• Standardize communication practices
• Meet caregivers’ information needs without overwhelming them with irrelevant data
• Drive physician and staff adoption of the new technology

A Unified, Patient-Centric Care Directory
One key to standardizing communications was to standardize roles and nomenclature in the smartphone directory. Our committees held numerous whiteboarding sessions to understand the details of various communication workflows, individual responsibilities and information needs. Working with Voalte, we created a directory organized according to the service-based teams assigned to each patient.

Different roles (such as nurses, physicians, pharmacy specialists and case managers), were assigned unique numbers, and only one team member at a time can log in. With the directory, nurses no longer have to memorize phone numbers or extensions, or get them from someone else. Texting greatly reduces delays caused by call-backs, missed connections or phone tag. And group texts also facilitate handoffs to other units.

Other benefits of faster, more efficient communications with our smartphone system include:
• The directory provides clear visibility into the chain of command and workflow
• Clinicians can now easily connect with the pharmacists who are dedicated specialists, such as those in oncology or infectious disease for different patient types
• Physicians do not have to carry several devices to connect with their care teams
• Alarm notifications expedite response times
• Group texting can provide alerts on what to do if a problem occurs; for example, if a medication needed to be removed, we could send a photo of its label
• Role-based assignments strengthen security by restricting access to patient health information

Engaging and Empowering Nurses Reduces Alarm Fatigue
From the outset, our clinical education team worked closely with nurses. One area of particular focus was clinical alarms, which are on the Joint Commission’s list of Hospital Patient Safety Goals. We felt our smartphone system would help us address alarm overload and fatigue, which can prevent caregivers from responding appropriately to alarms. This occurs when hospitals have a high volume of alarms that do not require any action. For example:

• In a study at one hospital, nearly 90 percent of more than 12,000 arrhythmia alarms were false positives.
• One unit at a Boston hospital averaged 12,000 alarms a day.
• Another report notes that only 10 percent of alarms at a typical medical/surgical U.S. hospital were actionable.

Our smartphone system helps reduce alarm fatigue and improve response time by sending alerts to the right nurse with the patient’s name and room number. It also features an escalation pathway so if a primary nurse is unavailable, messages immediately go to the back-up nurse and then the charge nurse when necessary.

We also reduced fatigue by empowering nurses to make alarms more clinically relevant and actionable. Within specified guidelines, our nurses can change alarm settings to account for patients’ differences without having to get orders from a doctor. For example, if a patient is frequently setting off ventricular tachycardia alarms but not having problems, the nurse can adjust the settings so the alarms weren’t constantly going off. On one of our units, non-actionable alarms decreased by 30 percent.

Three Key Lessons
There’s no simple, step-by-step formula for a large-scale smartphone implementation. But here are three big-picture takeaways from our experiences that might be helpful to other hospitals.

• Upfront planning requires a holistic perspective to fully understand clinical and communication workflows and the information needs of all caregivers.
• Clinical and IT training are critically important, including “train the trainer” efforts to onboard new employees or residents on communication and workflow protocols.
• Ongoing oversight is necessary to ensure that everyone consistently follows standardized communication practices.

Though we’ve successfully connected our care teams and streamlined clinical communications, we’ve only begun to tap the full potential of smartphones as a real-time tool for collaboration at the point of care.

Nikki Harvey, MSN, RN, is Cardiovascular Clinical Nurse Specialist at the University of Kansas Health System.

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