How Baptist Health Hardin Re-Visioned ED Clinical Communications
During HIMSS21, the annual conference of the Chicago-based Healthcare Information & Management Systems Society, held this year on August 9-13 at the Sands Convention Center in Las Vegas, Deanna Parker, R.N., the assistant vice president of emergency services at Baptist Health Hardin in Elizabethtown, Kentucky, spoke on Tuesday, August 10 on the topic of “Improving Communication, Patient Care and Staff Well-Being.” As the session’s description noted, “When Baptist Health Hardin doubled the size of its ED, the hospital also added more team members and implemented a new communication system. Change management in these circumstances would be tough in any area of a hospital, but emergency medicine is one of the most stressful types of care. It took a multidisciplinary approach, empowering staff to design the new space and select special features.” The description invited HIMSS21 attendees to “Learn how ED leaders, clinicians, and others evaluated and deployed a voice-controlled communication system, while onboarding new team members and serving patients in the midst of a $15 million construction project. Their strategic approach to deployment and training was executed so well that within four months, patient satisfaction scores and leave without being seen (LWBS) rates already showed improvements. When COVID-19 hit in 2020, the ED was well-prepared to communicate quickly and safely because the hands-free devices they use work under personal protective equipment (PPE), which also helped the team preserve this valuable resource.”
The emergency department at Baptist Health Hardin is the busiest emergency department in the entire state of Kentucky, with an estimated 74,000 ED visits in 2020. And Baptist Health Hardin is the fourth-largest in the state in terms of endoscopies; fifth in total outpatient volume; sixth in outpatient surgeries; eleventh-businest in baby delivers; and fourteenth-largest in inpatient volumes.
Among the outcomes for the Hardin ED and for the clinicians and patients in the hospital were the following:
> The ED was made quieter and calmer
> More effective preparation for incoming trauma patients
> Care team members no longer experience the frustration of not hearing a call or text message or calling and waiting for someone to respond
> Employees feel safer knowing that the touch of a button on the Vocera Badge will instantly alert security or safety personnel to their location and enable responders to hear what is going on
> Left without being seen (LWBS) rate in the ED dropped significantly - from 4.6 to 1.4 percent within the first four months
> Patient experience scores in the ED improved in several categories, including a 3-point increase in its overall patient satisfaction scores; HCAHPS scores for the ED related to “staff caring for patients as a person” improved from a Top Box score of 56.6 in 2017 to 63.4 in 2018; HCAHPS scores related to “doctors informing patients about treatment” in the ED jumped from 53.3 in December 2017 to 77.1 in May 2018
Deanna Parker is the assistant vice president of emergency services at Baptist Health Hardin. In this role, Parker is responsible for overseeing operations of the ED, which sees more than 73,000 patients a year. She is also responsible for managing the Sexual Assault Nurse Examiner (SANE) Program. Working closely with leaders and multidisciplinary team members across the organization, Parker is driving technology innovations across the ED to improve patient care, safety and experience, while also elevating staff communication, collaboration, safety and well-being. Prior to joining Hardin Memorial Health, Parker was the director of nursing over medical surgical and intermediate inpatient areas at Jewish Hospital, where she was responsible for global operations of three medical surgical units, two mixed acuity units, and five intermediate units, as well as the dialysis department and primary stroke program. An RN for 14 years, Parker holds a master’s degree in both healthcare administration and business administration from Webster University and graduated magna cum laude from the University of Kentucky, earning a bachelor’s degree in nursing.
Later the next day, Parker sat down with Healthcare Innovation Editor-in-Chief Mark Hagland to discuss the initiative that she has been leading at Baptist Health Hardin and to share her perspectives on what’s been learned so far.
Tell us a bit about the origins of the current initiative.
What had initially started the search is that we’re a community hospital, but we’re the largest ED in the state; planning to see 75,000 people this year. Elizabethtown is in central Kentucky. We tend to be that hub for emergency care. We get a lot of trauma. I’ve been there almost five years but my position was a new role.
It was a county-owned hospital; that changed in September 2020; that’s when we became Baptist. The ED was seeing over 70,000 patients in an ED built for 40,000. So we went through a $15 million renovation project. And I had to say, instead of 15,000 square feet we’re over 30,000 square feet, and I can’t see where the staff members are. And either a staffer would say, I couldn’t hear the ding, or I didn’t have the wireless bandwidth to call.
Physical space, so, difficulty finding them. But also, with the smartphone device, the nurses would say, it wasn’t working for me, which really created some conflict between nurses and physicians. It was an us-versus-them mentality, thus, the culture change needed. And even with texting, they felt they’ were having to send one text over here, another, over there. And the ED had 25 percent growth in a few years. And we were losing staff. So we ended up selecting Vocera; the staff wanted to be in the middle of patient care, and with their solution, you initiate communications just with your voice. So if I’m if I’m the primary nurse, I can call the Room 10 nurse, saying, ‘Room 10 nurse,’ and she can just say ‘yes’ to answer.
I thought nurses preferred smartphones because they had too many devices?
I can tell you that the staff at our ED, with Vocera on their lanyard, they don’t need anything else to function. And it’s less cumbersome than digging something out of their pocket. Another win was that our patients perceived when they answered their cellphones, that they were taking a personal call. Also, when patients come in, and see us using those, we let them know that’s how we communicate. Physicians, the radiology staff, the lab staff, nurses, transport people, environmental services, security guards, anyone who works in the ED, has to wear one.
I explain all this by using the metaphor of a wagon wheel, and all the spokes have to connect. And our ability to get the patient from door to CT is not meeting standards, so what do we do?
So the great thing is that we were able to create what we call a broadcast. We have designated administrators. So we want the critical care nurse, the physician at the bedside, it lets our respiratory therapist know—everyone who needs to be at the bedside, is alerted. So if we have an alert from EMS that a potential patient stroke patient is coming in and they’re coming in in 5 minutes, we can do an alert, and the entire team will be there. The same thing is true with cardiac arrest. Same thing with trauma; we’re right off the I-65 and Bluegrass Parkway, so we see a lot of car accidents.
But the clinical outcomes piece completely changed; but also being that busy, our ability to see patients more quickly. The patient experience in emergency medicine is, how long am I going to be here? And there are patients who leave without being seen. It always makes us wonder, did a patient leave who needed to be seen? That’s the “left without being seen” rate. We had been at 6 percent. The national benchmark used to be 2 percent; the Emergency nurses Association has upped that to 3 percent because of struggles with EDs. But we made it to 1 percent. We did have a little bit of a spike because of COVID. We had to completely change our processes. When CDC started to make their recommendations about separating patients, we literally changed things. We took our main entrance off the garage and said, go left if you have no respiratory symptoms; if you’re coming in with respiratory systems, you’ll go right. It would not have been feasible to do that without Vocera. Because we were taking staff out of the department, away from physicians.
But we knew we had to do something. We were the busiest ED in the state. And so we had to find a way to separate for the safety of all involved.
We stopped that because we were seeing improvements, but we’ll be reopening it up now, because Hardin County is surging pretty badly with COVID. A nurse is able to triage out of that area and still be connected with the charge nurse, and communicate with them about where they’re placing them. With COVID initially, we were able to use a tent and still stay connected with Vocera. It’s hard to put into words how nimble it’s made us. Number one, you never plan for a global pandemic. And initially with COVID, PPE was in short supply. We were even having to wash single-use gowns. With the Vocera device, it can be under your PPE [personal protective equipment], and you can still hear. Our local news did a news story on it. And we hadn’t even thought about it. Typically, if you go into an isolation room, if you leave and forget something you have to re-dress. So the nurse could call the charge nurse and say, please bring in these supplies. Call Dr. Smith, I’m in all my garb, and I need direction for a patient. So we’ve saved a lot of PPE.
What have been the biggest lessons you and your team have learned on this journey so far?
The biggest lesson learned for me was the importance of staff involvement, in terms of buy-in. People talk about it a lot. But honestly, communication is at the heart of what we do. I sit down with risk management to review sentinel events. And at the root cause, there’s always some type of communication gap. And I’m a nurse. I’m not at the bedside anymore. I just want to support them. They’ve really owned it.
In terms of the practicals, we have a sign-in area, to keep track of the devices. If the physician tries to walk away, we make sure they get their device.
The other lesson learned for me is that for there to be a really excellent implementation, you need good implementation plan from IT; and you need a really good clinician champion. It’s not IT’s job to understand the clinical workflow, but they need to understand your vision, and then they build the workflow with them. And you might have to make modifications. Continually assess your workflows. Healthcare is ever-changing.
And with the pandemic, we had pulled away from some of those things. And now that we’re surging again, we need to think about the fact that COVID is here to stay, and so do we build a COVID alert, so staff can show up in the isolation area already suited up? So just continually tweak the workflows.
Are there any clinical workflow universals?
I think that most any organization is going to understand wanting and needing a workflow for those life-threatening situations. If you have a Code Blue, creating those workflows and leveraging a technology like this really will make it better. Another universal is how it impacts the patient experience. If you can communicate more effectively with the patients, they’re updated, and if some delay happens, we can communicate with them, and that drastically improves the patient experience.