September 2015

Bring Nurses Back to the Bedside
By Rhonda Collins, MSN, RN
For The Record
Vol. 27 No. 9 P. 10

Communication-related failures are a major source of inefficiency and poor patient experience, costing the health care industry approximately $12 billion every year, according to various sources. Breakdowns in communication are also the third-leading cause of death and accidental injury in hospitals. Therefore, it's essential that health care organizations identify gaps in communication and care coordination to improve patient care, safety, and satisfaction while reducing avoidable risks and readmissions.

With rampant alarm fatigue and fragmented or outdated technology, processes, and protocols, hospital leaders must create a communication platform that enables care teams to securely communicate the right information to the right person at the right time. A unified communication and performance strategy will result in better care team collaboration, increased workflow efficiency, and more direct care delivery at the patient's bedside.

Too often, nurses spend valuable time tracking down supplies, medications, or other care team members, filling out paperwork, and searching for test results. In fact, studies have shown nurses may spend less than two hours of a 12-hour shift on direct patient care. Yet, when nurses spend more time at the bedside, studies show that patients are less likely to fall or suffer from infections or other adverse outcomes. Additionally, medication errors decrease with nurses on hand and patients report being more satisfied with their care, a critical concern as reimbursement continues to move toward a more value-based payment model.

With mounting pressure to improve quality, safety, efficiency, and performance, hospitals must embrace new technologies to drive operational efficiencies and hardwire human behavior. Real-time communication using smartphones, hands-free wearable badges, and other mobile devices allows nurses to reach the right person at the right time on the right device with the right information in the right place—from anywhere. In addition, when health care providers use the mobile device of their choice, they are more likely to adopt the changes associated with a new technology solution or process.

In fact, there's a growing demand for bring your own device programs in clinical settings. However, there are risks associated with these programs when organizations use the devices to access, store, and exchange patient information. Whether or not it's sanctioned by the hospital, approximately 92% of physicians use their own devices to text patient information to other care team members, according to a Spyglass Consulting Group study.

Such behavior is dangerous to a health care organization's well being. In fact, according to a Spyglass Consulting Group report, the transmission of short text messages is an unsecure communication method, placing facilities at risk of HIPAA violations, data breaches, and annual fines of up to $1.5 million.

Hospitals must address this issue with a HIPAA-compliant communication platform that securely connects care teams instantly via voice, text, or data regardless of their device or location. The enterprise solution must provide flexibility, allowing physicians, nurses, and other employees to work via their preferred devices without compromising data security and integrity.

The Five Rights
Communication is a critical part of care coordination but is by no means simple. The majority of new technology solutions are specific to one function or device and are thus incapable of integrating with each other or an EHR. As a result, sharing information becomes complicated and frustrating for care teams, a situation that can significantly impact patient outcomes. In fact, studies have shown correlations between provider stress and increased communication gaps and medical errors.

The "Five Rights" of clinical communication—reaching the right person, at the right time, on the right device, with the right information, in the right place—are critical to improving both operational efficiency and patient outcomes. These tenets allow the entire care team to work together seamlessly and securely, regardless of specialty, device, or location.

An enterprisewide communication platform is needed to improve quality, safety, and responsiveness, not only in the hospital but also beyond the clinical walls, to ensure effective communication with primary and extended care teams. Additionally, enabling smarter ways to securely communicate and exchange information across all devices—from wearables and smartphones to tablets, desktops, and EHRs—makes it easier for care team members to connect and collaborate at every touch point in the patient experience.

As part of an enterprisewide commitment to improving patient experience, the University of Chicago Medicine (UCM) implemented a mobile solution that brings nurse leaders to the bedside to capture, track, and address patient feedback and requests in real time. Using a care rounds application on iPad devices, the practice of nurse leader rounding is hardwired and conducted more efficiently and with greater accountability.

As a result, UCM has increased patient and family satisfaction, experiencing a 12.4-point increase in its Hospital Consumer Assessment of Healthcare Providers and Systems' overall rating of care mean score. Within four months of implementing the mobile solution, UCM nurse leaders conducted more than 12,000 patient rounds, capturing more than 2,800 positive comments about staff and 400 patient follow-up requests that initiated proactive, interdepartmental teamwork.

Standardized communication and processes enable more efficient workflow, freeing up nurses so they can devote more time to direct patient care, which increases patient safety and satisfaction. Studies have shown that better communication also helps patients gain trust and confidence in their care team, and helps nurses feel more connected, according to a November 2014 article in HealthDay.

Closing the Communication Gap
Two of the biggest mistakes hospital leaders make during the implementation of a new technology are not investing enough time and resources to educate care team members on the project's value, and failing to provide proper training. Even the most innovative and intuitive communication platform is useless if the adoption rate is poor. Administrators must plan for adequate training and knowledge transfer to ensure physicians, nurses, and patients are best served by the technology.

While health care providers may know how to use their personal devices to text, make calls, and check e-mail, secure communication applications require ongoing training to master certain nuances and encourage continued use.

The best leadership provides the necessary support, encouragement, and commitment that will allow care teams to learn, embrace, and adopt the technology as part of their everyday routine. Without care team education and buy-in of the solutions, full compliance is nearly impossible. If staff members don't know how to use these tools, all of their benefits are lost.

With the right investment and a focus on the "Five Rights" of clinical communication, hospitals can easily and securely keep nurses and care teams in sync at the bedside and across sites to improve patient care, safety, and satisfaction.

— Rhonda Collins, MSN, RN, is chief nursing officer for Vocera Communications, a provider of real-time, intelligent communication solutions for mission-critical mobile environments.