Butler, Pa.
258-bed community hospital, a unit of Butler Health System
Project: Speech recognition for IV nurses
Faced with a nursing shortage, hospitals across the country are looking for ways to leverage information technology to help nurses practice more efficiently and improve the quality of care delivered. One way I.T. can lend a hand is by simplifying some of the repetitive tasks nurses must complete throughout their shifts.
To help nurses who install intravenous lines better manage their repetitive documentation tasks, Butler Memorial Hospital took the extraordinary step of working with a vendor to co-develop a new real-time bedside documentation system that uses speech recognition technology. Now nurses can document their tasks by simply dictating into a headset, with their notes automatically populating a clinical information system. The new approach to documentation also provides nurses with verbal cues of which case to handle next.
In recognition of its groundbreaking effort, the hospital was named winner of the 2009 Health Data Management Nursing Information Technology Innovation Award.
How It Began
The project began almost by accident, when the hospital was investigating using a speech recognition system from Vocollect Healthcare Systems Inc., Pittsburgh, designed specifically for long-term care units. In reviewing the technology, Thomas McGill, M.D., vice president of quality at Butler, compared notes with nurses and determined that it had great potential for helping nurses deal with repetitive tasks in other departments.
Rather than first tackling the fairly complex, large implementation at the hospital's skilled nursing unit, the team decided to seek out a smaller-scale pilot for testing. That led them to the IV application, which involved less data and a simpler interface.
The hospital approached Vocollect about their idea, and found the vendor was interested in investigating additional health care applications for its speech recognition application. The software, initially developed for use in warehouses, had been modified for use in long-term care. It accommodates a far more limited vocabulary-about 300 words-than other speech recognition programs, such as those that some doctors use to dictate their notes.
"The nurses didn't need a powerful speech recognition system because the input terms they use are menu-driven," says Nancy Rimer, R.N., a clinical supervisor.
Representatives of the company came to the hospital twice to "shadow" IV nurses and study their work habits. For example, they observed that the nurses routinely documented the same information for each patient using a paper form on a clipboard. Then a unit clerk entered that data manually into a clinical information system. The IV nurses worked closely with the vendor to modify the Vocollect technology to meet their specific documentation needs.
The six-week pilot project last year involved six nurses who documented IVs for about 200 patients in one medical/surgical unit using the technology they nicknamed EVA.
Each nurse spent about 30 minutes training the system to recognize her voice for the narrow list of terms they routinely use when documenting an IV start or change. In addition to a headset, the nurses wore a very small, wireless computer that they tucked into their pocket or clipped to their belt. The speech processing occurs in the tiny device, which then wirelessly transmits the data to a server.
When they started work, they turned on the thin client device and spoke "EVA on" to start the speech recognition software. Then they spoke "next task" to get an audio cue on the next patient to treat, including their location.
Either during or after the insertion of the IV, nurses dictated notes about the task specifying the location of the IV, such as "right hand," and the size of the needle used, among other details. Once the nurse stopped speaking, the system gave her the verbal cue "documentation incomplete" if the notes lacked information required by the hospital's protocols.
Upon completing documentation, she could ask the system to repeat her dictation to check her work. She then spoke "next task" and got an audio message of where to proceed to the next patient. If a new patient was added to her work list as a priority task, the system would alert her to that case, Rimer says.
During the pilot, all the nurse's notes were automatically loaded into a clinical information system from Meditech Inc., Westwood, Mass. The hospital used an interface engine from Iatric Systems Inc., Boxford, Mass., to make that connection. To make the Vocollect technology work better, the hospital upgraded its wireless network to eliminate dead spots, McGill says.
Results
By using the new technology, IV nurses completely documented their tasks in the clinical information system 100% of the time, compared with 40% using the old, more manual process, says Cindy Esser, R.N., director of emerging technologies. This more complete data will help the hospital's efforts to conduct research on the cause of IV complications, including infections, McGill says.
The system streamlined the tasks involved, replacing the use of pagers, phones, computers and paper charts with simply dictating into the headset, Esser says. And by saving time on administrative tasks, including retyping handwritten notes on a computer, the nurses now can devote more time to treating patients instead.
Later this year, the hospital expects to roll out the technology for its entire IV nurse team on all floors, McGill says. Then, it hopes to use the devices in physical therapy and respiratory therapy as well as long-term care.
About the Award Competition
This is the fourth year that Health Data Management has sponsored the Nursing Information Technology Innovation Award competition. The co-sponsor is CARING, a national nursing informatics association.
The award recognizes a team of nursing professionals at a hospital, clinic or other caregiving site. It recognizes innovation and excellence in using information technology to directly improve the quality of care or promote the effective use of nursing resources.
Some 41 organizations submitted detailed essays to be considered for the award. A panel of judges reviewed the essays and selected one winner. The judges were:
* Howard J. Anderson, executive editor, Health Data Management.
* Diana Boyer, R.N., vice president and CIO at Columbia Regional Hospital, Columbus, Ind. The organization was the winner of the 2008 award.
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