Improving Point-of-Care Communication, Part 2

Yesterday, I set the stage for the point-of-care technology switch-up at the 806-bed stage for Sarasota Memorial Hospital, Florida’s second largest acute-care public hospital. After dissatisfaction and low utilization of its communications badges and discussions in its clinical documentation and IT committee, which is mostly made of nursing staff, Sarasota Memorial decided to pilot a smartphone communications solution (from the Sarasota-based Voalté) in April for 60 days starting with one floor with 25 devices. Before go-time, Baker and the committee agreed that success would be measured by utilization and device management. Nurses would pick up the smartphones at the beginning of their shifts, and log in to the software. From there, they could send either a pre-populated text request or create their own. The smartphone would also be wired into the hospital’s private branch exchange (PBX) (from the Fairfield, Calif.-based West-Call Nurse Call System), so nurses could get voice calls and pages too. Integration with the hospital’s middleware (Emergin), as well as its WiFi network went relatively seamless, says Baker.“In retrospect I came to the realization that if people don’t find value in something they won’t use it, so we asked for a subjective assessment by nursing of using this technology,” says Baker.The software also allowed clinicians to provide direct feedback to the engineers to help fine-tune functionality. Nurses sent texts suggestions about enlarging fonts, and coming up with standard texts they could select for common uses.After successful adoption, realities around nurse call came into focus. It became evident that the provider who was assigned to a patient and received a page, might not be closest to the patient. To streamline this, Sarasota Memorial decided to route all pages through a central coordinator, who would then route the page to the closest caregiver.Mobile Device SecurityAs iPhones are much more expensive than the previous badge technology, security is paramount. Clinicians have to check the smartphone in and out, and they are made to be useless outside the hospital. The messaging is operating on a closed system, so there’s no need for encryption. What Baker calls a “dumbed down iPhone” because the device only has access to the communications software and ePocrates, rather than a full suite of services like a normal iPhone would. Because of the Sunshine Law, Sarasota Memorial archives all texts between care providers for seven years.After the pilot, Baker deployed 75 phones in other nursing areas, including critical care and all ER staff, including physicians and techs. He also implemented mandatory training from Voalté. Sarasota Memorial then put further deployment on hold and did a $1 million upgrade to the organization’s wireless network to support the communication devices.Sarasota Memorial hasn’t done a comprehensive ROI analysis yet, but its vendor is in the process of synthesizing data from time and motion studies performed at the hospital. Early results are that nurses respond more quickly to patients’ needs, patient flow between units has improved, and overhead paging has been reduced by 78 percent.“The immediate comment, an hour after they started using it, was how quiet the emergency room,” Baker says. “Bottom line most of the overheard paging on those floors went away, so their quiet scores under HCAPS went up.”Future iPhone ImplementationsFurther deployments have come from anesthesiologists and surgery. “They came up with the idea since we do have a perioperative documentation system in place that they would benefit from getting automated messages from the system when the patient is ready, the case is done, each one of those steps so they know where they need to be.” Other ideas for deploying mobile communication devices include issuing Apple iPod Touches to hospitality and transport, who still use the badges. Not everyone needs a mobile device, so health unit coordinators who are mostly anchored, but still needed to talk to mobile clinicians, use a desktop app that lets them send texts to the mobile devices.Now the Voalté solution is deployed on more than 400 iPhones and 200 desktop computers and supports over 1,500 registered users on day to day and 205,000 messages per month. Since the texts aren’t about clinical patient data, they are not stored in Sarasota Memorial’s EHR, provided by the Chicago-based Allscripts. Baker is looking forward to his EHR vendor developing a mobility app for nursing so they can chart vitals at the bedside and in the future administering barcode medication management.