By Angela Kauffman
Smartphones, tablets, and other mobile devices are as ubiquitous in hospitals as scrubs and hand hygiene dispensers. According to a survey of nurse managers and IT decision-makers, within the next four years, 97% of nurses will use mobile devices at the bedside.
Hospitals recognize that integrated smartphone platforms have become integral to patient care and safety. By facilitating real-time connections and information sharing among caregivers, they help resolve some of healthcare’s most intractable, harmful, and costly problems: communication failures, delays, and errors.
- Data from The Joint Commission, the Department of Defense, and other agencies show that communication failures contribute to 50%–80% of the most serious and harmful patient events.
- According to a study published in JAMA Internal Medicine, “Approximately one-quarter of hospital readmissions are potentially preventable. … High-priority areas for improvement efforts include improved communication among health care teams and between health care professionals.”
In a 2017 survey of 600 global healthcare IT decision-makers, 90% said they would benefit from an enterprisewide mobile device initiative. Based on our experiences with hospitals in the forefront of clinical communications, including three of the top six in the U.S. News and World Report 2019 list of best hospitals, we have identified five attributes common to most successful smartphone strategies.
Interdisciplinary work groups or committees provide strategic direction and oversight
When we introduced smartphones in hospitals in 2008, IT departments typically had sole responsibility for their rollouts and management. But with the advanced capabilities of today’s smartphones and an increasing emphasis on clinical communication, leading hospitals are forming cross-functional working groups, comprised of IT and clinical leadership (CMOs, CMIOs, CNOs), informaticists, physicians, and nurses, to head their strategic smartphone initiatives.
The overarching goal of these groups is to improve clinical collaboration by helping nurses and physicians communicate and share information in real time. Succeeding in these efforts requires not only the sponsorship and commitment (time and resources) of executive leaders, but also buy-in from everyone affected by practice and process changes.
Forming subgroups also is often necessary to develop strategies that address the most pressing communication challenges, such as communication overload or the absence or disregard of standardized processes. At Johns Hopkins Medicine, for example, an interdisciplinary alarm committee with representatives from every care unit meets regularly to understand how alarm fatigue impacts nurses, physicians, and patients.
Clinical workflows determine smartphone practices and functionality
Workflow improvements are a key objective for any mobile communications strategy. Smartphone workgroups can begin to accomplish this by mapping current workflow and communication practices and talking to care team members about their needs and problems. Informaticists and educators should work closely with clinicians to understand how smartphones intersect with and affect workflows, identifying opportunities to share data and expedite better care. For example, some hospitals are using smartphones to let nurses securely share photos with wound care specialists or to provide nurses and physicians with instant access to drug information, reducing medication administration errors.
Since changes are always difficult and often resisted, an effective approach for introducing smartphones is to test new workflows and functions with a group eager to try something new. This helps the implementation team learn about barriers to adoption before starting any large-scale smartphone rollouts.
Patient-centric care directories help standardize systemwide communications
Well-designed smartphone directories are a strategic imperative and a key to fast, efficient communication. Directories can be organized according to service-based teams assigned to each patient with unique numbers for various team roles (such as nurses, physicians, pharmacy specialists, and case managers). This simple, patient-centric structure ensures that messages are sent to the right person.
Directories should provide clear visibility into the chain of command and workflow. When they are standardized across units, departments, and systems, clinicians and staff can minimize miscommunication during handoffs (the transfer of care responsibility) and signouts (the transmission of patient information). These communication mistakes are a leading cause of preventable errors and cause adverse clinical events in various settings.
Strategic initiatives leverage technology integration to improve patient safety
Smartphones and apps can provide clinicians with data from EHRs, biomedical devices, and hospital pharmacies and laboratories. Hospitals are leveraging these integrated capabilities to safeguard patients, most often focusing on how to reduce the harm associated with clinical alarm systems, one of The Joint Commission’s 2018 Hospital Patient Safety Goals.
A top priority for alarm management is to send only appropriate information to nurses’ smartphones, since recent studies estimate that about 90% of alarms in various critical care settings are either false or clinically irrelevant. The alarm committee at Johns Hopkins, for example, created custom filters based on the alarm level (e.g., advisory, warning, crisis), type, and other conditions to ensure timely, meaningful notifications without overburdening caregivers.
Applications of smartphone strategies to enhance patient safety have unlimited potential. They can include improving response times to pediatric seizures (UCSF Medical Center at Mission Bay in San Francisco) and fall and slip events (UW Valley Medical Center). A recent survey of nurse managers found that mobile devices cut medication administration errors by 61% and preventable medical errors by 46%.
Physicians are gradually becoming part of a unified mobile communication network
Every bedside nurse knows the frustrations of trying to find physicians and waiting for their call-backs. Physician shift scheduling today is where nurse scheduling was five years ago—a manual process that often requires nurses to contact call centers to reach the on-call physician.
Mobile communication leaders are resolving this problem by linking smartphone platforms with sophisticated, rules-based physician on-call scheduling platforms. Such strategies must 1) account for the complexities of physician-nurse relationships and workflows, and 2) enable rapid physician responses, typically through apps on their personal smartphones for secure text messaging. The goal is to have one unified, dynamic directory that reflects who is available, busy, or offline and makes it easy for clinicians to connect with the right person.
Executive and clinical leaders will need to become more involved in mobile communication as it becomes an even more powerful conduit for clinical collaboration at the point of care. By developing and deploying patient-centric and workflow-driven smartphone strategies, hospitals can bring together the right people and the relevant information they need to provide timely, appropriate care.
About the Author
Angela Kauffman helps leading hospitals take full advantage of advanced smartphone platforms as the manager of product marketing and partnerships at Voalte.