How Hospitals are Using Smartphones to Raise HCAHPS Scores

By Angela Geraets, BSN, RN, CCRN

Hospitals are embracing smartphones as a solution to minimize problems caused by communication failures, delays, and errors, which contribute to 50%–80% of the most serious and harmful patient events. One survey of nurse managers and IT decision-makers found that, within the next four years, 97% of nurses will use mobile devices at the bedside.

Most people recognize the importance of fast, efficient communication in improving patient care and safety. Yet many hospital leaders are unaware that integrated platforms for mobile clinical communication also can improve the patient experience. A survey of 600 IT decision-makers at healthcare organizations worldwide found that:

  • 96% using smartphones, tablets, and other mobile devices saw an increase in patient experience scores
  • Of those, 32% said their scores rose drastically

In the United States, the use of smartphones can positively affect patient responses to three questions from CMS’ Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys, which determine up to 2% of a hospital or health system’s Medicare payments:

  • During this hospital stay, after you pressed the call button, how often did you get help as soon as you wanted it?
  • During this hospital stay, how often was the area around your room quiet at night?
  • How often did you get help in getting to the bathroom or in using a bedpan as soon as you wanted?

This article will show how integrated smartphone platforms are improving the patient experience and will cover recent technology developments that will further advance the speed, efficiency, and value of mobile clinical communication solutions.

What matters to patients? Quiet rooms and faster response times

According to HCAHPS surveys, hospital noise has been the top complaint of not only patients, but also staff and visitors. The constant buzzing and beeping of alarms and paging systems negatively affects patients’ sleep and can slow their recoveries. A noisy environment heightens the stress levels of nurses and other caregivers and can distract them from their tasks.

Studies show that the high frequency of clinically irrelevant alarms also can reduce trust and cause caregivers to disable or ignore the alarms, which is why reducing harm associated with alarm systems is one of The Joint Commission’s National Patient Safety Goals. Yet despite these problems, nearly 80% of hospital-based clinicians rely on pagers for patient care–related communication.

Numerous studies also have found that nurses’ response to call lights is a key driver of patient satisfaction. This isn’t surprising, given that the top three reasons patients call their nurses are for pain medications, alarm warnings, and bathroom assistance. Communication problems also can keep patients waiting hours for nurses to contact the right physician or get lab results. And the more time nurses need to resolve these issues, the less time they can spend at the bedside.

Clearly, how patients evaluate their hospital experience has a lot to do with their interactions with nurses and other caregivers. As Adrienne Boissy, chief experience officer at the Cleveland Clinic, noted at a recent conference on patient engagement and experience, “We have to design for what matters most—not just for our patients, but for our clinicians … we must digitize moments that can be, and humanize moments that must be.”

Fewer devices, less noise, more satisfied patients

Transitioning from pagers to a comprehensive smartphone platform often immediately benefits both clinicians and patients. After Sarasota Memorial Hospital became the first hospital to use smartphones for clinical communication, its number of overhead pages fell by 78% and patients were asking why the hospital was so quiet.

Before Avera Health in Sioux Falls, South Dakota introduced its smartphone platform in 2013, supervising nurses were lugging around three pagers and a Cisco® mobile phone. In addition to being incredibly cumbersome, these devices delayed response times because nurses had to rely on one-way beepers and the availability of a phone on both ends. Today, nursing staff, pharmacists, licensed professional staff, and others in Avera hospitals can communicate instantly using text messages and file sharing. In addition, almost 1,000 Avera providers in more than 50 physician and advanced practice provider groups use an app that connects with the platform on their personal smartphones.

“Physicians can immediately identify and communicate directly with the bedside care team,” says Candice Friestad, DNP, MSN, MBA, RN, director of clinical informatics at Avera Health. “And because physicians can assign themselves to patients, or roles or teams, anyone on the care team can quickly and efficiently reach the proper physician.”

As expected, the shift to smartphones also resulted in better patient experience. According to Judy Blauwet, DNP, MPH, BSN, FACHE, Avera’s chief clinical information officer, “We have improved the overall patient experience at our hospital, and we know that because of our patient satisfaction scores.”

Many other hospitals report positive feedback from patients and higher HCAHPS scores after implementing a comprehensive communication platform for secure text messaging, alarm and alert notifications, and voice calls. For example, when UW Medicine’s Valley Medical Center in suburban Seattle switched to smartphones, one family member told a nurse, “It’s nice to have a quiet hospital that feels like a hotel for a change. Maybe my dad can get some rest.” The hospital’s renal respiratory unit became the facility’s first unit to receive a 99% rating on a patient satisfaction survey.


A faster, more connected future

The next evolution of smartphone platform capabilities, which is already in progress, involves 1) linking external and internal physicians to hospital smartphone directories, and 2) enabling caregivers to access and share more robust and clinically relevant data.

According to one survey, more than 75% of physicians are using mobile health in their practice on a weekly basis, primarily for staff communication. University of Kentucky HealthCare is strengthening connections between its providers and staff by integrating physician on-call scheduling software with its smartphone platform. Its unified smartphone directory enables nurses to easily find and call or text on-call physicians from various departments and groups, and it has reduced the time it takes to reach a provider from eight minutes and 13 seconds to just over a single minute.

Smartphone platforms are becoming more closely integrated with patient monitoring systems; EHRs; admission, discharge, and transfer (ADT) systems; and departmental systems throughout the hospital. This allows care teams to quickly receive up-to-date patient information. At Avera Health, for example, a patient’s lab results such as heparin levels and lactic acid levels are sent directly from the EHR to the smartphones of the patient’s bedside nurse, respiratory therapist, and pharmacist.

Though many incidents can affect the patient experience, often the biggest factor is the patients’ perceptions of their everyday interactions with caregivers, particularly nurses. Smartphones empower these clinicians to communicate more quickly, accurately, and efficiently and make better decisions. Importantly, they also free up nurses to spend more time with patients. Just as many people today manage most of their tasks on their phones, so too might smartphones one day become a nurse’s all-in-one tool for managing patient care.

Angela Geraets is clinical solutions manager at Voalte, where she helps hospitals set up their smartphone directories and optimize clinical workflows for the benefit of patients and staff.