UMCH now uses Vocera Engage Mobile to send broadcast messages to mobile phones instead of using the traditional loudspeaker.
University of Maryland Children’s Hospital (UMCH) recently moved their Level IV Neonatal Intensive Care Unit (NICU) into a new 37,000 square foot space with all private rooms emphasizing family-centered care, lighting control, acoustical control, leadership in Energy and Environmental Design (LEED), among other considerations.
The old NICU was located below Labor and Delivery where the NICU delivery team often responded to emergency deliveries. Even within close proximity, the incumbent alerting and messaging system simply did not support the new physical or workflow needs. The new NICU is located in an entirely separate wing; therefore it was critical that an unfailing alerting, messaging and communication system be procured.
Further, UMCH wanted to improve compliance with The Neonatal Resuscitation Program (NRP) by improving the communication of certain data components (including the following) to promote NRP-based care:
1. Gestational age—Compliance increased from 96% to 99%
2. Presence of Meconium/amniotic fluid—Compliance increased from 38% to 97%
3. Indication for requesting a neonatal resuscitation team (ex. Placental abruption)—
Compliance increased from 88% to 93%
Caregivers also needed hospital-specific data points to improve NRP compliance including:
1. Exact delivery location—Compliance increased from 96% to 99%
2. Person(s) requesting help for closed-loop communication—Compliance increased
from 76% to 100%
3. Urgency of the need for a resuscitation team—Compliance increased from 65% to 99%
With the larger layout—designed without overhead paging—nurses needed reliable and quiet secondary alarm notifications for patient monitoring alarms regardless of location.
Understanding the Solution
UMCH selected Vocera® Engage Mobile to address several needs:
• Reliable, consistent, and compliant communication for L&D nurses to notify NICU
Resuscitation Teams of emergency deliveries
• Efficient collaboration among caregivers in NICU where staff could be spread out and
potentially isolated in private rooms
• Nurses ability to hear and quickly respond to actionable patient monitor alarms
• Tracking and reporting inefficiencies and staff accountability related to NICU
Resuscitation Team response
Engage Mobile, was deployed to Zebra MC40 phones carried by NICU nurses, nursing assistants, and providers. Engage desktop messaging to mobile phones has been extremely helpful in communicating emergent events according to Colleen Driscoll, M.D. Desktop messaging now also plays a critical role in “culture building” as oftentimes group messages are sent to improve camaraderie. Driscoll explains that messages like “Bagels and coffee in the break room!” can help build morale.
Engage has helped eliminate the need for overhead paging. Before 60–80 overhead pages for emergency deliveries alone were delivered monthly disrupting workflows and creating excess noise. Also, overhead pages were hard to understand. For example, “D-wing” sounds like “C-wing”, both of which are places where deliveries occur. UMCH now uses Engage Mobile to send broadcast messages to mobile phones instead of using the traditional loudspeaker. This is useful, as anywhere from 12 to 17 people across campus may need to be notified for emergency deliveries. Acknowledgement of notifications and other reporting has also been helpful in understanding the root-cause of sub-optimal delivery outcomes.
A Multi-Disciplinary Approach
A multi-disciplinarian approach was taken to evaluate competitive solutions and ultimately choose Engage Mobile. Instrumental in the decision-making process were providers, nursing leaders, and biomedical engineers among others. Engage Mobile was deployed for caregivers in the Labor & Delivery unit and NICU.
Due to logistics, the NICU staff didn’t have an option other than to implement the Engage Mobile system on move day. According to Dr. Colleen Driscoll, “It was not what we wanted to do but given the huge time crunch to move to the new NICU it’s what had to be done”, she added. Even though proper system and user acceptance testing was completed prior to go-live, we did not have actual patients to thoroughly understand the exact workflow needed. Consequently, there were customization and modifications made on the spot. More time pre-go-live for users to practice with new systems could have prevented onsite adjustments and enabled users to become more comfortable with the new devices and workflow changes. Dr. Driscoll said, “Despite going live on the day of the move it went remarkably well”. It took scores of clinicians to successfully organize and execute the move of over 30 critically ill babies into a new space with all new systems, devices, storage, etc.
Given the timeframe for go-live there was no time for downtime and so real-time support was critical for success and patient safety. According to Dr. Driscoll, Vocera’s Professional Services team fixed issues quickly and exceeded expectations with outstanding go-live support.
Engage is a customizable, enterprise workflow solution. Specific departmental needs can be met with easy-to-adjust rules and workflows. UMCH will continue to assess its policies and procedures and adjust workflows accordingly as needs arise. Soon UMCH plans to integrate Engage with EPIC to further improve workflows. For example, with an EPICintegrated directory, nurses and providers can search for other caregivers by patient name reducing the time it takes to search for appropriate and available resources.
The hospital also plans to use the Engage-Airstrip live waveform solution. Unlike waveform snippets that other vendors provide, Engage-Airstrip provides secure, real-time waveform tracings for providers using smartphones inside and outside the hospital, improving care team collaboration and response times to critical patient events. Both the NICU and the C-Step unit (adult cardiac unit) will soon test this solution.