By Paul Coyne DNP, MBA, MSF, RN, AGPCNP-BC and Elizabeth Saxler Chang, MSN, RN
Nurse-physician communication is one of the most difficult challenges for patient care units today. This is especially true for orthopedic surgical patients with complex, multi-stakeholder care plans and various post-operative care transitions. At New York’s Hospital for Special Surgery (HSS), the world’s leading academic medical center focused on musculoskeletal health, we faced significant challenges in ensuring effective clinical communications for our patients and orthopedic care teams.
We learned many valuable lessons, made a few mistakes and achieved great results throughout our journey. Today, over 450 hospital-distributed smartphones are used by HSS personnel, including nurses, post-op nurse practitioners, pharmacy, and security. Here is our story.
Clinical Communication: Common Needs and Unique Challenges
Like many organizations, our nursing professionals and various clinical departments are often limited in their ability to communicate promptly. Pagers had their limitations – they negatively impacted productivity and caused patient care delays. Time spent waiting for a page, calling the desk, trying to get the nurse and using personal mobile phones were common concerns for everyone involved. Other needs that led us to implement a clinical communication platform included:
- Desire to increase responsiveness between clinicians and providers
- Need to add context to communications for triaging most critical messages requiring action, especially during care transitions
- Ability to incorporate multiple care team members
- Investigating communication issues through an audit trail
For HSS specifically, the ability to communicate with multiple stakeholders and expedite the discharge process is an acute concern. Our care team includes post-op nurse practitioners, physical therapy, occupational therapy, case management, transport and security. We carefully documented all challenges and arrived at conclusion that a clinical communication platform was needed.
Plan, Adopt and Mobilize
We derived several important lessons during the planning and adoption phase. These included new insights for nursing, IT and other HSS departments that may move to mobile communications in the future.
Think broadly: Even if you are just starting with nursing teams, other departments will ultimately seek similar capability. Consider a facility-wide strategy versus a siloed, departmental approach. Viewing medical records on mobile devices is not optimal for some use cases.
Ensure buy-in: Before implementation, all stakeholders need to be on board with use of the new platform. This buy-in is critical to making a new technology solution successful.
Communicate expectations: Clearly articulate the benefits over previous methods, as well as goals and timelines for the move from pagers to monitors to mobile devices. Nursing began by first moving from pagers to the clinical communication platform on traditional monitors. The move to mobile devices came later, in October 2018. By using a stepwise approach, nurses learned the system first, then moved to using the application on smartphones.
Be prepared with IT support: This kind of project requires the full support all departments and a truly collaborate effort with operations and IT from kick off, to product selection, through go-live. Make sure to double check roles and access to the application by having each user log in with an individual username and password at the end of training sessions and before go-live. This alleviates many of the implementation issues related to incorrect profiles or user logins.
Conduct hands-on training: Computer-based training and screen shots of the platform were not ideal education methods prior to go-live. Dedicate adequate time for hands-on application training on mobile devices.
We found that a phased approach was best for our organization to avoid overwhelming staff with too much change all at once. Starting with the clinical communications app on the desktop gave nursing staff the confidence and familiarity to take the next step by going mobile.
Three nursing goals achieved
We had three goals for this project: advance nurse efficiency, increase nurse satisfaction and fill EHR messaging gaps to support better patient care. Less than two years after the initial implementation of our clinical communication tool, we have accomplished these objectives. Due to this and additional complementary software applications on our mobile phones, surveys conducted with nursing staff pre- and post-implementation revealed the following improvements:
- 19 percent increase in nurse satisfaction with devices used to document and communicate
- 23 percent increase in nurses satisfaction with ability to communicate with prescribers
In addition, the use of the smartphones helps nurses spend more time with patients and expedite bedside communications with prescribers. Nurses access the clinical communications app, EHR, call-bell system, clinical alarms and telephone communications from the mobile phones that are passed from nurse to nurse at shift change. Devices are docked at the nursing stations and users log in to all applications at the beginning of the shift, which streamlines the process.
We currently have 450 smartphones in use across the hospital, and the program continues to expand in scope and coverage. Even our non-patient care teams are now asking to go mobile.
Ongoing evaluation of our technology has been crucial to ensuring we continue to have an optimal mobile platform. Each day, new companies are bringing healthcare mobile applications to market, existing applications are adding new functionality, and installed applications are receiving upgrades. While it is challenging to remain aware of the intricacies of this rapidly changing technology landscape, it is critical that clinical leaders do so. For it is the only way that frontline staff will be given the optimal tools and be truly able to focus on performing the most important job of all: caring for the patient.
About the Contributors
Paul Coyne, DNP, MBA, MS, RN, APRN, AGPCNP-BC is Assistant Vice President of Clinical Informatics and Advanced Practice Nursing at Hospital for Special Surgery. He is a board certified-adult gerontology nurse practitioner and has been recognized nationally for his contributions to nursing and healthcare technology, most recently receiving an Edison Award for his work with Inspiren.
Elizabeth Saxler Chang MSN, RN is Manager, Clinical Informatics at Hospital for Special Surgery. Elizabeth holds a Master’s degree in Nursing Informatics from New York University, a Bachelor’s degree in Biology and Bachelor’s degree in Nursing from the University of Minnesota, as well EPIC certification.