bring order to hospital communication chaos
TRANSCRIPT
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BRING ORDER TO HOSPITAL COMMUNICATION CHAOS
Real Solutions to Common Communication Problems
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LET’S GO BACK IN TIME
Hospital communications used to be a lot simpler:
Find a Key Phone Number
Look for number you needed on a grease board
Change an On-Call Schedule
Revise paper charts in on-call schedule binder
Find a Doctor
Dial 0 and the operators would connect you or send a page on your behalf
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TODAY: ISLANDS OF INFORMATION
Communications across healthcare have become progressively more convoluted.
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PROBLEM: DISCONNECTED ISLANDS OF INFORMATION
Systems/Applications SENDING
• Patient movement• Employee directory• Building security and
monitoring• Electronic medical records• Critical lab and radiology
results• Patient-specific monitors• Nurse call• And more
Devices RECEIVING
• Smartphones• Cell phones• Desk phones• Wi-Fi phones• Pagers• Voice badges• Tablets• Email systems• LED boards• And more
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SOLUTION: CONNECT THE ISLANDS
Flexibility of inputs
Flexibility of outputs
MODES OF INTEGRATION
• SMTP• HL7• API• URL
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PROBLEM: OVERWHELMED NURSES
Heart monitors
Physician consults
Nurse call requests
Ventilators
Pulse oximeters
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TYPICAL NURSE CALL WORKFLOW
Change in patient status or patient pushes nurse call
button
Beep in the room or at a central nurse’s station
indicates need for follow-up
Appropriate nurse tracked down, nurse walks to
patient’s room to assess and assist
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SOLUTION: SINGLE SIGN-ON CAPABILITY
Staff assignment software with a single sign-on capability filters, prioritizes, and routes all patient alarms and alerts to a nurse’s mobile device
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PROBLEM: ALARM FATIGUE
alarm conditions per day - per bed350
• Bad data or sensor• Not set to actionable levels• Duplicate alarms• Thresholds too tight•Many false positives• Closed doors make it difficult to hear alarms
85-99% of alarms are non-actionable
http://www.aami.org/htsi/SI_Series/Johns_Hopkins_White_Paper.pdf
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• Reduce accidents and falls (and unreimbursed costs of associated care) by speeding response to requests for assistance
• Handle patient concerns and requests quickly with less overhead paging – promotes quiet healing and high patient satisfaction scores
• Escalate requests automatically to keep response times down
HOW SPOK CLINICAL ALERTING HELPS
MEET SAFETY GOALS
SOLUTION: CLINICAL ALERTING
JOINT COMMISSION COMPLIANCE
FALLS, ACCIDENTS (AND COSTS) PATIENT SATISFACTION SCORES
COMBAT ALARM FATIGUE
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PROBLEM: MISSING HANDOFF POINTS
Test results only matter if they’re received, and they may be going to the wrong person or too slowly if your hospital doesn’t have standard communication processes in place
Journal of the American College of Radiology Volume 8, Issue 11 - November 2011 Pages 776-779
MOST COMMON PROBLEMPatient didn’t receive test results
SECOND-MOST COMMON PROBLEMClinician didn’t receive test results
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SOLUTION: DIRECT THE FLOW OF INFORMATION
Blood panel ordered on
patient
Critically low potassium
triggers alert to physician for
immediate action
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SOLUTION: DIRECT THE FLOW OF INFORMATION
Actionable alert for room 203 sounds in the
telemetry room
With one button, telemetry tech
forwards alarm to patient’s nurse
Nurse receives alarm on mobile device,
accepts alert, immediately triages
patient, and launches Code Blue
Coordinated, life-saving treatment is
delivered to the patient quickly
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PROBLEM: INFO ISN’T GOING TO THE RIGHT PEOPLE
LABRESULTS
ROOM TURNOVER REQUESTS
PAIN MGMT
INQUIRIES
SUPPLY REFILL
REQUEST
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SOLUTION: INTEROPERABLE COMMUNICATION
Patient in pain calls for nurse
Nurse receives message, hits call-back number embedded in
message, and is connected with
patient’s pillow speaker
Nurse notifies physician that a
new prescription is needed.
Physician enters order remotely.
Nurse is able to quickly deliver
pain relief
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SOLUTION: SPOK MOBILE
• Device diversity
• Escalations for unanswered messages
• Full integration with the hospital directory & on-call schedules
• Receive alarms and alerts from nurse call, patient monitors, Lab, Radiology, and EMR systems
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PROBLEM: LACK OF SUPPORT FOR DIVERSE DEVICES
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SOLUTION: SUPPORT DEVICE DIVERSITY, PREPARE FOR URGENT SITUATIONS
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• Advises average 90-minute “door-to-balloon” time
– American Hospital Association
– American College of Cardiology
• All hospitals must track this metric
• ‘Code STEMI’ at Spok customer IU Health Goshen Hospital
– 129-minute average
– Time wasted with extra calls
– Uncertainty about who should do what
EXAMPLE URGENT SITUATION: CODE STEMI
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THE CODE STEMI ALERT: BEFORE SPOK
Manual Paging
Manual Phone Tree
Wasted Time
Unconfirmed Responses
RESPONSE TEAM• Cath lab staff • House supervisor• ICU shift
coordinator/nurses
• Attending cardiologist• Cardiovascular
coordinator• ER director• Cardiovascular director
• ER shift coordinator• X-ray/imaging
technicians• Lab technicians
Heart Attack Balloon Successful
Over communicate to ensure proper response
Inefficient phone trees among 30
people
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THE CODE STEMI ALERT: WITH SPOK
Heart Attack Treatment Successful
Staff Respond w/Availability
Use Spok e.Notify to Deploy Code
Spok e.Notify Manages Response & Escalation
RESPONSE TEAM• Cath lab staff • House supervisor• ICU shift
coordinator/nurses• Attending cardiologist• Cardiovascular
coordinator
• ER director• Cardiovascular
director• ER shift coordinator• X-ray/imaging
technicians• Lab technicians
Spok e.Notify• Logic for on-call calendar• Auto escalations based on
responses or non responses from staff
• Eliminates manual calling trees and messy escalations
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THE RESULTS
• Reduced average door-to-balloon time from 129 to 68 minutes
• Improved response time and patient care
• ER operator or house supervisor sends code STEMI notification to 30 staff
• Staff members respond with status
• Escalations and follow-ups as necessary
• Process review after each event to improve wherever possible
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PROBLEM: HARD TO REACH COLLEAGUES
Spyglass Consulting Group Health Care Study: Healthcare without Bounds:Point of Care Communication for Physicians. November 2014Point of Care Communication for Nursing. March 2014
Spyglass Consulting Group Health Care Study: Spok Secure Messaging Survey. September 2013
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SOLUTION: MAKE CLINICAL CONNECTIONS EASY
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PROBLEM: UNPROTECTED PERSONAL HEALTH INFORMATION (PHI)
1.2MAverage cost of a healthcare data
breach per organization
Of healthcare organization security
incidents result in lost PHI
60% 20%Of healthcare leaders
expressed HIPAA, HITECH concerns for devices lost, stolen,
or hacked
https://www2.idexpertscorp.com/resources/single/third-annual-benchmark-study-on-patient-privacy-data-security/r-generalhttp://cloud.spok.com/IG-AMER-Mobility-Strategies-2014.pdf http://www.himss.org/News/NewsDetail.aspx?ItemNumber=42944
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SOLUTION: SECURE, ENCRYPTED MESSAGING
• Provide security for ePHI
• Meet HIPAA and HITECH Act guidelines with a business associate agreement (BAA)
• Encryption via SSL connection – application, as well as data during transit and storage— Text, images and video files
• Remote device wipe and automated message removal
• Application screen lock and access code
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PROBLEM: NO AUDIT TRAIL
Reducing litigation expense is a major driver for communication systems with reporting capabilities• Est. 98,000 U.S. patients die
each year due to medical errors, often communication errors
• “Of malpractices cases... 75% are communication related”
http://www.ncbi.nlm.nih.gov/pubmed/23204547
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IN REVIEW
The right INFORMATION: Clinical alerts and test results
The right PERSON: Reaching hospital staff and on-call providers
The right DEVICE: Smartphone, tablet, pager, Wi-Fi phone
The right TIME: Speed and effectiveness
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