How To Improve On-Call Cardiac Response Times at a Multi-Campus Hospital

Background

A Michigan-based, multi-location hospital implemented PerfectServe Clinical Collaboration to reliably improve communication across its campuses. PerfectServe automatically identifies and provides an immediate, secure connection to the right care team member for any given clinical situation at any time. The health system is a leader in stroke and cardiothoracic specialty care.

Challenging the Status Quo

To further focus its efforts on reducing the amount of time between a heart attack patient’s arrival at the hospital and the time they begin receiving treatment, the hospital began to look more closely at the cath lab team and protocols for notifying on-call team members.

Standards for the door-to-balloon time suggest that a healthcare team must proficiently deliver percutaneous coronary intervention in 90 minutes or less—a protocol the hospital team already performs efficiently, typically delivering treatment in 70 minutes or less. Improved door-to-balloon time is a measure of quality that requires the teamwork of several disciplines—one of which is care team communication, an area the hospital recognized could be improved with a more efficient on-call notification system.

Prior to implementing PerfectServe, on-call cath lab physicians at the hospital relied on notifications from pagers activated by an internal contact center system, which is still a standard process for many healthcare facilities today. With this process, operators were provided with an on-call schedule that outlined which physician should be called for an emergent cardiac case.

“[The previous] process ate crucial minutes and seconds in the critical door-to-balloon time. The operators were limited by the technology they had, resulting in increased wait times.”

– Clinical Manager

Cath Lab Team Assesses Communication Landscape

Monday through Friday, the cath lab department is staffed from 6 a.m. to 6:30 p.m., with 24-hour coverage on weekends and holidays. The on-call team picks up the off hours and typically consists of four clinical members in addition to the interventional cardiologist on call. In the operator/pager system, a silo was created by paging only these clinical team members—creating a disconnect with other members of the patient’s care team who would benefit from receiving status updates around the patient’s care in a critical situation.

Upon accepting the notification, on-call staff are required to be at the hospital in 30 minutes or less. However, the operator/pager system hindered staff response time with frequent holds, often causing staff to begin making their way to the hospital to meet the requirement before they’d spoken with the operator. Upon reaching the operator while en route, many times they would find out that they were not required to report until later—a waste of personal time for physicians and all other team members.

After identifying room for improvement in the on-call process, hospital leaders realized that continuing to use the operator/pager system was not the most effective way to manage these critical communications. So began the search for new options.

Solution Found in An Existing Tool

A few years before, the hospital team connected with PerfectServe to build on the original deployment, which had already been implemented across both campuses. The team opted to add care team alerts, a module of PerfectServe, to provide immediate notification of emergent clinical events and promote rapid care team response.

PerfectServe worked with the hospital to determine that care team alerts were the best solution, and ultimately laid out a strategy for the cath lab notification implementation. The strategy was customized to the hospital’s infrastructure, workflows, and physician schedules and preferences.

After the cath lab care team alert went live, leadership worked with approximately 20 cath lab physicians to educate them about the new communication process, teaching them how to use and integrate the technology into the on-call routine. Due to focused training and standardization, the hospital saw high adoption rates and growing enthusiasm as physicians experienced the broad impact of the now-streamlined on-call alerts.

A More Effective Notification Procedure

With care team alerts from PerfectServe, each team member’s role has an associated on-call schedule. This schedule allows team members to change their individual schedules in real time within PerfectServe—allowing for more timely, accurate, and effective communication. A physician’s schedule can change in the blink of an eye, and the flexibility to adjust it in real time allows other care team members to always view accurate scheduling information, avoiding confusion and potential wasted time.

If an emergent procedure is needed, a member of the patient’s care team initiates the notification process to the on-call cath lab team via PerfectServe’s desktop application, or by calling PerfectServe. On-call cath lab physicians receive the notification directly on their mobile devices and can immediately check the details, respond and make their way to the hospital without spending additional time calling back and potentially being put on hold.

Unlike before, each notification is also sent to ancillary members of the patient’s care team; they also receive updates about the alert and information associated with it (e.g., type of response, time of arrival, etc.). Since many clinicians are involved in a cardiac case, the notification process helps drive coordination among the full care team—a critical part of providing exceptional patient care.

Faster Patient Care, More Transparent Communication Across the Care Team

To date, results have been overwhelmingly positive and have driven improved, more efficient communication in the on-call notification process. By eliminating manual components of the alert process, the hospital has decreased the chance that an error will be made or that records will be incomplete. Often, when the operator was juggling multiple sites at once, information that was put off to be recorded later was never captured at all. PerfectServe’s care team alerts provide automated reporting, ensuring the right people are contacted and the alert is accounted for.

PerfectServe’s care team alerts are also automatically escalated to appropriate backup contacts when necessary. In each case, alerts are sent to first-tier clinical contacts multiple times within a certain time period. If there is no response, an alert is then sent to an assigned backup contact, typically a manager or team lead, informing the individual that no contact has been made and allowing adjusted action to take place. This feature ensures that no matter the situation, the call will receive a response in a timely manner.

Continuous quality improvement ensures the growth and consistent evolution of a process that works
—redefining the standard of care. The integration of PerfectServe care team alerts in the hospital’s communication processes has significantly improved the cath lab team’s response time.

Door-to-balloon time is an important indication of quality; on-call physicians need a streamlined and efficient solution that not only saves time, but enables their response and action to be communicated to the broader team. PerfectServe’s automated workflows have transformed the hospital team’s communication efficiency while improving patient care.