By Dana Peco, MSN, BSN, CCRN
From state-of-the-art clinical command centers to biometrics for patient identification, hospitals are creatively incorporating high-tech solutions into their patient safety efforts. Yet many are still not taking full advantage of a simple tool we all use every day—the smartphone—to address the number one cause of the most serious and harmful patient events.
Based on data from The Joint Commission, Department of Defense, and other agencies, communication failures contribute to between 50% and 80% of these sentinel events. On its 2018 list of Top 10 Patient Safety Concerns, ECRI Institute ranked “Internal Care Coordination” third and “Incorporating Health IT Into Patient Safety Programs” fifth, noting that “like so many preventable errors in healthcare, these risks come down to a failure to communicate.”
Both patient safety and quality care depend on providing accurate, meaningful information to the right person at the right time. Today, smartphone platforms and apps not only facilitate timely handoffs—a cornerstone of patient safety—but also integrate with hospital system software to provide clinicians with data from EHRs, biomedical devices, and hospital pharmacies and laboratories. A recent survey of nurse managers found that mobile devices cut medication administration errors by 61% and preventable medical errors by 46%.
Integrated smartphone platforms are the key conduit for connected health, and a growing number of hospitals have recognized this. Here are some of the innovative ways they are using the “smart” capabilities of mobile devices to not only facilitate timely clinical communications but also empower clinicians with critical patient safety tools and information.
Point-of-care communication backbone for high-tech command centers
One of the newest developments in patient safety is 24/7 monitoring of patients’ vital signs and other physiological data by medical professionals who also can access EHRs and other patient information. By using a smartphone platform with desk-based messenger capabilities, these remote command centers can use patient-centric directories to immediately mobilize nurses and clinical teams at the first sign of trouble.
For example, the Clinical Logistics Center at Nemours Children’s Hospital in Orlando has a staff of paramedics who monitor the conditions of up to 220 patients, including those at Nemours Alfred I. duPont Hospital for Children in Wilmington, Delaware. Their screens display nurse calls and alarms, and paramedics use the center’s smartphone messenger to text the on-call nurse manager if an alarm isn’t answered in 30 seconds. If there’s still no response after 90 seconds, the paramedics call into the room through the speaker system and interact with the patient and family, asking if they can turn on a high-definition camera to view the situation.
The screens at the center also show each patient’s sepsis score. If a patient appears to be in septic shock, the paramedics will use the smartphone’s group text function to immediately contact the sepsis team to assess the patient and administer antibiotics. In emergency situations such as a Code Blue, the platform notifies everyone on the team simultaneously.
“What we are trying to do with the center is as quickly as possible give the right information to the caregiver—acting as a second set of eyes to try to make nurses’ lives easier,” said Stephen Lawless, MD, chief clinical officer at Nemours.
Smartphones are also the clinical communication backbone for Tampa General Hospital, a 1,010-bed nonprofit academic medical center with more than 1,000 shared smartphones connecting caregivers throughout all hospital units. In 2016, the hospital’s BioMedical Device Integration (BMDI) project enabled care teams to receive alarm and alert notifications on their smartphones. It plans to open a 9,000-square-foot care coordination center in 2019, which will continually examine data and recommend actions to reduce delays in patient progression, predict and prevent risk, and balance staff workload. Smartphones will bring the center’s combination of artificial and human intelligence to patients’ bedsides in real time.
New smartphone applications for alarms, medication management, and more
As smartphones more easily integrate with EHRs, patient monitors, labs, and other data sources, hospitals are developing creative solutions to minimize communication failures and expedite appropriate treatment. According to various research reports, hospitals want more from their smartphones than secure messaging, including functions such as EMR mobility, alarm/alert notifications, barcode medication administration, and access to critical lab results.
Here are some of the ways hospitals are using these capabilities to enhance patient safety:
- To reduce response time for pediatric patient seizures, UCSF Medical Center at Mission Bay in San Francisco developed a new workflow protocol that sends text messages to rapid response teams who can immediately take their backpacks of vital medications to patients’ rooms.
- At Memorial Sloan Kettering Cancer Center in New York, smartphones are integrated with Connexall’s alarm management middleware and AirStrip® waveforms that let nurses see what’s on a patient’s monitor. Also, by using suspend alarm triggers and well-designed alarm escalation pathways, the center reduced tachycardia alarms by 78%.
- The University of Kansas Health System consolidated its care team communications, including alarm/alert notifications, using a smartphone platform and apps at its main hospital and off-site locations. Its ability to standardize channels for communication handoffs helped it become the nation’s first comprehensive cardiac care center certified by The Joint Commission.
Other hospitals are using integrated smartphone platforms to:
- Immediately send sepsis alerts to pharmacists and rapid response teams, who might otherwise have to wait an hour or more for blood draw results
- Enable nurses to share photos of wounds with wound care specialists
- Reduce medication administration errors by providing nurses and physicians with instant access to drug information
- Send critical lab results directly to the bedside nurse
Connecting people and information at moments of truth
Information is the lifeblood of patient care, and it is most valuable when used and shared by physicians and nurses. Smartphones, integrated with other patient data, can bring together in real time the right information for the right people at the moments of truth: the time when clinicians’ decisions and actions have the greatest impact on patients’ health.
Dana Peco, MSN, BSN, CCRN, is a clinical solutions specialist at Voalte, which was named 2017 Category Leader in the Best in KLAS: Software & Services report for the Secure Communications Platform segment. Previously, Peco was housewide orientation coordinator, TeamSTEPPS master trainer, and clinical nurse educator at Sarasota Memorial Hospital, after spending eight years as a charge nurse in the neonatal ICU. Peco can be contacted at firstname.lastname@example.org.