Physicians, Nurses, and IT Leaders Collaborate to Advance Care Team Communication and Patient Satisfaction
“We're a community hospital. We serve in a rural region about 30 minutes away from the Indianapolis Metropolitan area. With hospitals our size, there can be stigma that because you're small and not a tertiary center, you're not able to provide first class patient care,” said Linda Wessic, COO, CNO and Vice President at Major Health Partners (MHP). “At MHP, that couldn’t be further from the truth. Our outcomes prove that our patients have access to all of the advantages and innovation found at large urban hospitals, combined with genuine personal service.”
Community Hospital with Big Innovation
When the community and population grew in southeastern Indiana, so did MHP. In 2017 the hospital more than doubled in size, added services, and brought the outpatient lab, provider practices, and all acute, ambulatory, and specialty services under one roof. Additionally, the emergency department (ED) doubled in size.
More capacity meant more staff, and leadership was tasked with building a culture of trust and collaboration among 1,100 plus employees. Expecting more than 1,000 patient visits a day, it was critical for MHP to find a communication solution that made it fast and easy for nurses, physicians, and other care team members to connect.
One year after the hospital opened and communication was standardized, MHP reported a 7.7 percent increase in average on-time surgical starts and improvements in key patient experience metrics. Patient satisfaction with physician encounters in the ED increased 5.5 percent; and for nurse interactions, satisfaction increased 8.1 percent. Overall satisfaction with the quietness of the hospital improved by 8.4 percent.
When hospital leaders measured how long it now takes the ED to triage, assess, and treat a patient before deciding on admission or discharge, they were pleased to discover the new communication system decreased door-to-decision time by 2.6 minutes. This improved workflow involves collaboration across several departments, including the ED, laboratory, imaging, respiratory, and registration, and it impacts wait times and patient experience.
Removing Hassles, Improving Clinical Workflows
Opening a new hospital can pose many challenges and opportunities. For MHP, a top strategic priority was identifying and scaling a single technology solution for all care team communication and collaboration.
“Our state of communication pre-move was complicated with multiple, disparate methods that included overhead paging, desk phones, Vocera® Badges, cell phones, HIPAA-compliant apps, pagers, and even the ‘yell down the hallway’ approach,” explained David Augsburger, Director of Clinical Integrated Technology at MHP. “It was an environment that created barriers and hassles for staff with no global strategy for communication, which led to each unit fending for themselves.”
MHP leadership decided it was time for a comprehensive platform that would simplify and standardize communication across every department. They understood that the right solution would improve staff connections and trust, increase operational efficiency, reduce interruption fatigue, and improve the patient experience.
Keeping Care Teams Connected in a Decentralized Environment
“Key to our new facility design was moving away from the large centralized nursing stations that we previously had, and building decentralized workstations,” Wessic recalled. “We knew that with the right communication technology platform, we would be able to implement a decentralized model while keeping our care teams closer than ever.”
After mapping clinical workflows, identifying gaps, and understanding clinicians’ preferences, the clinical and IT leaders set out to find a reliable, device-agnostic solution. These leaders also wanted a solution that would provide contextual information to make alerts, notifications, and messages more meaningful.
Designing a Sustainable Communication Strategy
MHP already had hands-free Vocera Badges in place prior to moving to the new hospital. The strong relationship between MHP and Vocera team members helped hospital leaders make their choice for purchasing the Vocera Platform enterprise-wide.
“Before selecting the Vocera Platform, we considered several factors that had limited us in the past. We needed a solution that would help us serve patients now and, in the future, as well as one that could easily expand as we grow,” said Augsburger. “Vocera was the ideal choice.”
The Vocera Platform is a single solution that enables secure text messaging, hands-free communication, alert and alarm management, and interoperability with more than 140 clinical and operational systems. To date, MHP has integrated Vocera technology with two nurse call systems, the hospital’s telephony system, and its electronic health record (EHR) system.
“We had a unique opportunity to build a new facility, which required a complete redesign of our processes. Countless hours were spent with a Vocera consultant who helped us design the most efficient and effective clinical workflows, while keeping the patient front and center,” explained Augsburger.
The secure communication platform supports both corporate and bring-your-own-device policies, so physicians, nurses, and other care team members can use the mobile device
of their choice to securely connect and collaborate with colleagues. Clinicians don’t need to worry about phone numbers or device type when trying to reach other team members. The intuitive Vocera Platform lets them connect by simply saying a person’s name, role, group, or patient room number—making it easy to reach the right person, on the right device, at the right time.
“We have eliminated so much of the wear and tear—physically and emotionally—on our care teams,” said Wessic. “No longer is the focus on running around, trying to find the right person. With Vocera, the care team is taken care of and they can focus on what they signed up to do—provide the best patient care.”
Depending on the patient care situation, care team members can choose to communicate using the hands-free Vocera Badge or the Vocera secure messaging app on a smartphone or workstation web console. Nearly all physicians at MHP now use the Vocera app to communicate and collaborate with clinical care team members.
The Vocera secure messaging app isn’t the first HIPAA compliant app that MHP leadership attempted to roll out to physicians. However, it is the first that has had superb adoption.
“The secure messaging app from Vocera is certainly physician’s preferred choice when it comes to smartphone apps,” explained Wessic. “We’ve tried several other systems in the past, and adoption was dismal.”
“One of our proudest accomplishments is creating a clinical communication platform that our physicians actually want to use,” said Augsburger. “Physicians have been quick to leverage stand-out capabilities of the new system, including the ability to securely share test data and patient exam details in real time."
“A photographic record of EKGs or patient exam findings can be sent to consultants who are not present at the bedside,” said Cary Zietlow, MD, Hospitalist at MHP. “It’s as easy as routine texting to incorporate the opinion of remote specialists into the assessment plan of a patient. I feel at ease knowing that a photo taken through Vocera secure software is not saved to my phone.”
Widespread Positive Impact
The immediacy of connection has made day-to-day operations much more efficient at MHP. “Prior to Vocera our communication went through a bottleneck that occurred in the switchboard or with the telephone operator,” recalled Wessic. “For example, if you needed Dr. Smith, you would call the operator to have them page the doctor. Dr. Smith would then call the operator back, and the operator would then transfer that call back up to you. By the time all of that happened, you may be with another patient.”
Since moving to its new facility and implementing Vocera technology, MHP has been able to eliminate the need for a communication liaison. Additionally, the need to overhead page has been eliminated, helping to provide a quiet, healing environment for caregivers and patients. Care team safety has improved, too.
“We’ve had nurses in dangerous situations where they need security in the room immediately,” Wessic said. “Because we are all on the Vocera system, anyone can get help with the push of a button.”
In a new hospital more than double the size of the previous facility, MHP clinicians are connecting faster and more easily using a single communication platform—one that integrates with the EHR, telephony, and nurse call systems to simplify and improve clinical workflows.
“Our hospital is physically bigger than ever, and yet, the relationship between care team members has never been stronger,” said Wessic.
Accelerating Success for a Future of Caring
“We are blown away by the successful design and deployment of our enterprise-wide mobile communication strategy, powered by Vocera,” said Augsburger. “And we aren’t stopping here. We will continue making state-of-the-art improvements to our new mobile ecosystem.”
Next up, clinical and IT leaders at MHP are working with the Vocera team to add more contextual information about patients and clinicians, or real-time situational awareness, to each message. Real-time situational awareness enables the care team to make betterinformed decisions with actionable patient data at their fingertips. Too many messages without meaning can lead to alarm or interruption fatigue and clinician burnout. To minimize the number of routine, non-actionable messages buzzing and beeping at clinicians, and to protect valuable time with patients, MHP plans to implement the Vocera alarm management solution. Alarm and alert notifications are delivered based on intelligent clinical rules established in collaboration with your facility. Each alarm is paired with relevant patient data to inform and accelerate patient care. Users can receive alarm and alert notifications on a smartphone or on the Vocera Badge, a wearable, hands-free communication device.
“The ease of using a mobile device can lead to too many non-helpful texts or communications,” said Dr. Zietlow. “So, it is important for hospital staff to understand that typical texting rules are probably not applicable in a clinical setting.”
Alarm management enables prioritization and filtering of patient event notifications. It sends only actionable notifications, accompanied by relevant patient, caregiver, and event context so caregivers can respond faster and collaborate better. Working in coordination with staff assignments, the intelligent alarm management solution enables routing of messages to specific team members based on location, role, assignment, or other customized rules.
Additionally, to facilitate more holistic workflows, MHP plans to expand and improve upon its EHR integration and implement a two-way integration between its Vocera solution and a new EHR system—making it even easier to close the loop on critical communications.