EHR integration with communication devices can dramatically improve caregiver efficiency, patient care and satisfaction while reducing errors and attendant patient risk.
So says Liz Michael, vice president of patient care services and chief nursing officer at Stillwater Medical Center, a 117-bed acute care not-for-profit hospital in Oklahoma. Michael was presenting at the 2016 HIMSS conference in Las Vegas.
Typically, hospital communication challenges include bring your own device (BYOD) issues, care team communication and collaboration, alarm fatigue for patients and staff and EHR integration and communication. The challenges at Stillwater, Michael says, centered around inefficient mobile collaboration and a cumbersome physician computerized prescription order entry (CPOE) system.
Nurses and respiratory therapists at Stillwater are highly mobile, so a key improvement was to route patient call requests directly to nursing staff instead of the nursing station. These requests can be escalated directly to other staff when caregivers were tied up at the bedside for extended periods.
"We integrated our nurse call system with our mobile hands-free communication system, which helped to improve staff responsiveness to patient needs and requests," Michael says. This also "cut out the middleman," Michaels says, in which nursing station attendants were out looking for specific coworkers.
CPOE system integration with mobile hands-free devices likewise improved timeliness and reduced errors attributable to handwritten orders. In the old workflow, physicians wrote paper orders, secretaries entered orders into the CPOE system and sent to designated printers in different departments for filling. "The process proved very inefficient because of the physical distance from the printer, which made it difficult to quickly obtain and fill order requests," Michael says.
Integrating the CPOE with existing communication systems allowed for timely notifications for new events to be sent directly to care team members on their mobile device. Alerts include patient room number, the priority, the procedure and category that does not include the patient's name or other information that would violate patient privacy regulations.
Benefits have accrued to physicians who can more confidently move throughout the facility with the knowledge that caregivers will respond to patient needs in a timely fashion. Workflow efficiencies keep staff with patients instead of checking orders or returning to the nursing station. Stillwater has also been able to expedite bed turnover with environmental service and sanitation staff.
Hard results at Stillwater notably include improved patient safety and satisfaction, nurse responsiveness and workflow efficiency. Michael says she is proudest of HCAHPS responsiveness scores that improved from 74 percent to 82.4 percent and pain management HCAHPS scores that jumped 15 percent to more than 81 percent. Team satisfaction has also improved and missed or lost orders have decreased.
Looking ahead, Stillwater plans adding more physician order sets to the communication queue to direct more information directly to nurses. Getting more wireless access points to more areas of the facility is another ongoing priority.
According to the Joint Commission, hospital communication related failures are the third highest cause of death in the U.S. following heart disease and cancer. A University of Maryland study found that $12 billion is wasted annually in U.S. hospitals as a result of communication inefficiencies. Also communication inefficiencies are a known impediment to patient experience and CMS revenue reimbursement.
In 2008, medical errors cost the United States $19.5 billion, Michaels says. Communication improvements are one quick path to lowering costs and decreasing errors while improving patient outcomes and satisfaction. It has also satisfied health records requirements under the HITECH Act.
"As the speed of communication increases, so does coordination of care," Michael says, a quote she credits to Chris Roark, Stillwater's CIO Chris Roark. CPOE and communication improvements at Stillwater have already gone a long way to improving inefficiencies and cut costs, she says.
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