Three Pearls of Wisdom from the First COVID-19 Surge

September, 2020

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Tufts Medical Center (Tufts) saw its first COVID-19 case in early March 2020. As the associate chief nursing officer of clinical informatics, I have insight into many different departments across this 415-bed hospital in downtown Boston. Observations in various departments during the COVID-19 surge lead me to some pearls of wisdom. My hope in sharing these is that my experiences will benefit others in their response to the next pandemic or emergency.

Tufts has been using Vocera technology since 2014. The Vocera smartphone app is used enterprise-wide by our physicians, nurses, and leadership. The wearable Vocera Badge is primarily used in our operating room, labor and delivery, and some medical surgical units. We recently noticed additional opportunities to leverage the Vocera Platform.

Pearl 1: Baby Monitors Need Monitoring

The COVID-19 crisis hit us fast, and we had to move overflow COVID-19 patients into isolation rooms located in an area of our hospital that did not normally care for intensive care unit (ICU) patients. We needed a way to facilitate communication between clinicians and/or patients in isolation rooms, and clinicians working outside of those rooms.

We experimented with setting up baby monitors inside the isolation rooms, but quickly learned that baby monitors require continuous monitoring. A clinician outside an isolation room had to constantly watch the baby monitor for a potential request from the patient or care team member inside the isolation room. If that clinician needed to step away, the care team member inside the room would have to wave, knock, or use the patient call light system to get someone’s attention. If no one observed the call for help, the team member in isolation had to exit the room and doff personal protective equipment (PPE) to find assistance – wasting PPE and risking self-contamination.

Pearl 2: There is a Safe, Efficient Way to Communicate in Isolation Rooms

Clinicians working inside and outside our isolation rooms trialed the Vocera Badge. The nurse inside the isolation room wore the Badge under PPE, which allowed them to safely communicate with the care team outside of isolation even if they had no direct line of visibility. The nurse inside the isolation room no longer needed to leave the room and doff PPE to request assistance or additional tools.

The Badge eliminated the need to knock on windows, jot down requests and questions on white boards, or stick paper notes to windows to communicate with support staff outside the isolation room. We have found the Badge to be the safest and most efficient means to communicate under PPE and in isolation. The technology helps frontline staff at Tufts save time, preserve PPE, and avoid self-contamination.

Pearl 3: Standardize Communication Technology

While we heavily rely on Vocera technology at our hospital, there were pockets of clinicians who were not trained to use the Vocera Badge when COVID-19 hit. We had to redeploy many clinicians to support our COVID-19 units, and some were not familiar with how the device worked and how easy it is to use.

Bringing clinicians into care environments that are new to them can be a stressful experience, especially as they respond to a patient surge associated with a pandemic. Providing care in an unfamiliar setting can affect the normal ease of clinical workflows and communication – cognitive load and emotional burden can become even higher.

If all care team members are trained on and comfortable with the same communication technology, we can help ease the burden of having to learn new ways of communicating when clinicians are shifted into new care delivery environments. Delivering the best care and following the right protocols is what our clinicians want to focus on – the last thing we want them worrying about is how to safely communicate.

Training clinicians to use the Vocera Badge is easy. However, teaching anyone to use a new technology during a pandemic surge is just not realistic. Tufts is committed to training staff to use the Badge, which has improved communication and is building confidence for communication challenges that may arise during future patient surges.

As other organizations prepare for a potential patient surge, I recommend giving all clinicians a common tool, like the Vocera Badge. It will help staff communicate safely and efficiently. Now is the time for nurses to innovate and embrace technology as we face new healthcare challenges.