Health IT Outcomes
By Amanda Griffith, Contributing Writer
MemorialCare Health System’s new secure clinical communications solution has done more than streamline communications among physicians. It has helped decrease patient wait times and length of stay as well.
Physicians and care teams generate a high volume of communications across the United States’ healthcare systems. A PerfectServe study of three hospitals, representing an aggregate of 774 beds and 54,000 annual admissions, found clinicians initiated more than 680,000 calls and messages to approximately 900 physicians annually. Multiply that by the American Hospital Association’s estimates of 5,686 registered hospitals, 914,513 staffed beds, and 35.4 million annual admissions in the U.S., and the importance of managing this high volume of communications becomes evident.
Without effective, timely communication between physicians and other care team members, the quality, safety of care, and satisfaction of patients suffer. A review of reports from the Joint Commission revealed communication failures were at the root of more than 70 percent of sentinel events. In the acute care setting, these failures led to increases in patient harm, length of stay, and resource use, among other issues. As a result, many healthcare organizations are turning their attention to aligning innovative technologies with the workflow changes needed to improve care coordination, collaboration, and, ultimately, patient care.
Raising The Alarm For Improved Clinical Communication
One of the organizations making these changes is MemorialCare Health System — a nonprofit integrated delivery system composed of six hospitals, multiple medical groups, a health plan, and numerous outpatient health centers, imaging centers, and surgery centers throughout the Southland (Orange County and Los Angeles County). Across MemorialCare Health System, physicians hold informatics meetings to keep dialogue open and ensure they maintain pace with a rapidly changing healthcare industry and its reforms. A committee chair from each of the six hospitals also sits on a corporate informatics committee which meets regularly. It was at one of these sessions in early 2012 that an ER doctor highlighted the need for improved turnaround time on clinical communications. The challenge was how best to enable ER staff to reach attending physicians faster in order to assess and admit patients so the ER could be turned over to treat those still waiting. The issue of problematic time — the time clinicians spend attempting but failing to communicate with the correct provider or searching for information to determine an appropriate provider or phone number — was further complicated by how best to contact the necessary clinicians and what to do if the primary person was not available. “If you look at clinical communications in traditional healthcare today, they’re all outdated,” explains Scott Raymond, RN, BSN, MHA/ INF, executive director of information services, MemorialCare Health System. “If you think about it, communications are generated from a phone call inside the clinical area to a physician within a practice, so it’s the old telephone game. Pick up the phone. Find the physician caring for the patient. Look up the phone number. Dial out to the physician’s practice or exchange. With so many hand offs, it’s no wonder clinicians can’t reach colleagues in a timely manner.”
Secure Texting Is Not The Solution
Without a system for direct paging, texting, or calling physicians, Raymond knew he needed to find a solution that could help enhance clinical communications no matter the care environment. Clinicians had initially asked for a secure texting offering, but Raymond and his team quickly determined that was not a viable option. “Secure texting would have been great, except our nurses used legacy Cisco VoIP phones, with everyone using their own to dial out and receive calls,” notes Raymond. “Plus, we worried about the physicians who didn’t have a smartphone or who wanted to use their exchange or current practice line. We couldn’t just implement a one-size-fits-all solution, particularly for a mostly voluntary clinical staff.” After researching numerous options, Raymond chose PerfectServe, a secure clinical communications platform that could encompass phone, web portal, and other options and would uniformly meet the needs of clinicians across the healthcare organization, no matter their preferred contact method. With PerfectServe, calls and messages route automatically and securely according to each clinician’s precise instructions. PerfectServe assembles and maintains the communications workflow, call schedules, and contact preferences for every medical staff member every moment of every day. With PerfectServe, call centers, answering services, Post-It Notes, Rolodexes, Web directories, binders, and lists are eliminated, along with any potential for a communications breakdown. “We knew some physicians are conservative about adopting new technology and, if we didn’t find a solution that took this mindset into account, we’d only have limited success,” explains Raymond. “PerfectServe differentiated itself because it allows physicians to set preferences outside of the hospital, so clinicians control how they are contacted, on a variety of communications vehicles.”
Communications Platform Streamlines ER Throughput & Patient Flow
Since it operates on a SaaS model, the clinical communications platform proved easy for the IT department to implement. With a command center dedicated to engaging physicians, talking to office managers, and entering profiles and schedules into the system ahead of time, go-live didn’t mean flipping a switch but instead was as simple as informing clinicians what number or extension to dial or which Web portal to access on a certain date. As a result, clinicians needed only minimal training and, from the IT department’s perspective, implementation became practically seamless. To gauge the technology’s success, MemorialCare Health System conducted a couple of internal case studies to determine the organization’s communication cycle time. Before implementation, Raymond and his staff followed nurses through the communication cycle of multiple handoffs and found it took an average of 45 minutes to secure a physician to complete the process. After implementation, Raymond and his IT team used lean “spaghetti” diagrams to study clinicians’ movements to track efficiency. The result? MemorialCare Health System experienced an average 50- to 60-percent decrease in wait times (about 14 minutes). A few months later, that average dropped to just six minutes. “If you think in terms of ER throughput, length of stay or availability of beds, utilizing a secure clinical communications platform lets patients, in theory, leave the hospital sooner and more satisfied,” explains Raymond. “It’s a soft ROI, but we’ve absolutely reduced length of stay and diversion time and have reduced outliers in terms of both time and volume.”
Future-Proofing Communication Strategy Enhancements
Since 2012, MemorialCare Health System has experienced additional benefits beyond improving its ER call panel and eliminating unnecessary delays in care. PerfectServe’s TeamAlert, for instance, knows which staff members are on duty and who is covering, so if a team member doesn’t respond to an alert within a specific time period, TeamAlert automatically sends notification again to the individual. If there is still no response, it will automatically notify other members of the team. With the clinical communications platform as a foundation, MemorialCare Health System plans to continue to build upon the layers of efficiency and streamlined operations so everyone across its 250 sites can experience the same positive results. “At my core, I’m a nurse, so anytime I consider a new technological initiative for the health system, I’m always thinking about the impact it will have from a patient and patient care perspective,” says Raymond. “I’ll always do whatever I can do to bring our clinicians into the 21st century. Improved access and more efficient and secure communications are just the beginning.”
