As value-based care takes hold, providers are aiming to shave costs, and often, that means shorter lengths of stay for patients. Shaving time off a patient’s stay puts a premium on hospitals’ ability to communicate patient care needs across the continuum of care.
Improving communication was a key initiative at the Hospital for Special Surgery, a large academic medical center focused on musculoskeletal health located in New York City.
Enabling a physician-led clinical communications strategy is the subject of an educational session at HIMSS18, entitled, “Standardizing Clinical Communication Improves Patient Care,” scheduled for 10 a.m. on Thursday, March 8 in the Sands Showroom of the Las Vegas Convention Center.
The facility sought to improve and standardize care team collaboration and coordination of care, but found such improvements difficult without intentionally using technology, says Nick Wirth, director of operational excellence for the facility.
Reporting to the organization’s CEO and COO, Wirth leads multidisciplinary teams to eliminate waste and redesign operations while optimizing the patient experience. He also leads outpatient transformation initiatives for 150 surgeon offices and the department of medicine to improve patient throughput, and physician documentation efficiency.
Also presenting at the session is Peter Grimaldi, assistant vice president for the physician assistant department at HSS.
Reporting to the organization’s vice president of operational excellence who, in turn, reports to HSS’ CEO and COO, Wirth helped lead an effort to consolidate and sync all inpatient and outpatient clinical communication, including the related aspects of provider scheduling, coverage and on-call assignments; make care coordination patient centric and standardized; and phase out pagers.
“Above all, HSS desired to create a higher level of patient safety,” he says. “While HSS’ acute EHR system is the source of truth for the patient’s medical record, HSS needed a platform to bridge the gap between the record and notifying the provider about actionable items.”
Exchanging messages between different care team members—particularly to reach the right care provider assigned to the patient—was a challenging process. The answering service in use by HSS impeded communication because it often was not able to triage messages based on criticality nor could it always identify which clinician should be contacted for a message.
“The result was an endless cycle of unproductive conversations, creating time-consuming, unnecessary steps frustrating providers and patients,” says Wirth. Pagers carried by physician assistants and residents were similarly inefficient and incapable of triaging and prioritizing routing of messages quickly to the right provider, he adds.
The organization eventually piloted and adopted technology that enabled quick and secure communication and texting, deploying it first to internists and hospitalists in late 2016 before rolling it out throughout the organization last year. Response times for messages decreased dramatically, with the average time for the entire rapid response team to read a message clocking in at under two minutes.
Also, the average monthly discharge time dropped to 67 minutes in December 2017 from 90 minutes the previous January, and average length of stay at the facility in the second half of the year fell to 73.3 hours, down from 76.9 hours in the first half of the year.
The educational session at the HIMSS conference chronicles the effort at HSS to redesign its communication systems to solve identified problems. It will describe to attendees how to evaluate the drivers for a physician-led clinical communications strategy, for both practice and hospital enterprise deployment, and how to garner the level of support needed from hospital leaders, physicians, nurses and other clinicians across multiple hospital units to successfully develop and implement a clinical communications strategy.
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