Empowering Nurses, Enhancing Care

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Nurses have many responsibilities. They handle a number of administrative duties, but they’re primarily charged with providing high-quality care for their patients—the kind of care that requires an abundance of collaboration and support. A 2018 time and motion study revealed that in four hours, nurses spend around 32 minutes communicating with patients and family and 51 minutes communicating and coordinating with members of the care team.¹

That’s 34.6% of a nurse’s time each day spent communicating, with only 16% spent on direct patient care.

Nurses are responsible for communicating with patient family members, ancillary staff, care coordinators, and multiple consulting specialists. That’s a lot to handle, and unfortunately,
technology aimed at streamlining nurse communication has often missed the mark and compounded the problem. When asked to identify factors contributing to patient care errors, “nurses cited communication issues with physicians as one of the two most highly contributing factors.”²

The American Academy of Nursing Workforce Commission’s Technology Drill Down project found that nurses are frustrated by siloed, task-specific technology that requires workarounds and isn’t user friendly.³ In response, cutting-edge clinical communication technology has been created and refined to fill in gaps and return nurses to the bedside.

Deployed strategically, an integrated clinical communication and collaboration solution can eliminate many nonclinical tasks and empower nurses to deliver faster, more attentive patient care.

After helping hundreds of thousands of clinicians improve patient care through optimized communication, PerfectServe created this step-by-step guide to help organizations improve collaboration, streamline important clinical workflows, and refocus nurses’ time on exceptional patient care.

Current State of the Clinical Communication Market

Value-based care initiatives are driving requirements to converge secure text, interactive patient care technology, nurse call, alarms, notification platforms, call/ transfer center technology, and even the EHR to support collaboration within and beyond the inpatient setting.

In leading organizations, clinical communication and collaboration platforms are often the cornerstone of broader initiatives to overcome care coordination challenges, improve transitions
in care, and satisfy new patient experience expectations.⁴ Advanced clinical communications solutions check a lot of boxes: They address collaboration at an enterprise scale, consolidate and integrate siloed applications, help reduce vendor footprint, generate cost savings, and simplify clinical workflows to make it easier to provide patient care.

The following table covers a broad spectrum of functionality associated with clinical communication platforms. Items may represent:

• Core Functionality (C)
• Integration (I)
• Core or Integration, Depending on the Vendor (C, I)

Step 1: Begin With the End in Mind

Start by challenging your assumptions about communication and collaboration. Attempting to automate your existing communication processes without first exploring opportunities for improvement would limit the potential of any new technology.

Ask yourself the following questions:

• What communication challenges exist today in your organization?
• Could any of the challenges you currently face be solved with better communication?
• Have you had any adverse patient outcomes as a result of poor or missed communications? 
• What outcomes would you like to achieve throughout your organization?
• What are the key nursing drivers in your health system?
• How do you want your clinical communication solution to improve patient care processes, reduce unnecessary steps, and maximize patient and clinician satisfaction?

Years of research and experience working with hospitals and health systems have revealed the following goals as top priorities for nurse leaders.

“When healthcare professionals communicate effectively—conveying critical information in a timely or easily understandable manner, clearly spelling out orders or instructions, and answering questions thoroughly and thoughtfully—they deliver safer and higher-quality care.”

– James Merlino, MD⁵

Accelerate Decision-Making to Reduce Care Delays

In contrast, drawn-out and/or error-prone communication can delay treatments such as medication delivery, testing, and therapy. The consequences of a care delay can range from negligible to severe and may include an extended length of stay, exacerbation of illness,⁶ late OR start times, clinician overtime, sentinel events, and more.

Communication-related care delays may involve:

• Difficulty finding or interpreting the on-call schedule.
• Errors in the schedule leading the nurse to contact the wrong provider.
• Issues relaying information through office staff or the answering service.
• Trouble locating the nurse on the unit when a clinician calls back.
• Not knowing if a message has been received and acted upon.
• Restarting the communication process or escalating to another provider when a message is not returned.

An effective solution will reduce care delays by ensuring the correct care team member is immediately reached in every clinical situation. Streamlining message delivery eliminates errors and reduces communication cycle time (the average time it takes to receive a response from a care team member after sending them a message).

Automating the communication process can reduce response times from an average of 45 minutes to 15-20 minutes.⁷

Increase Referrals by Optimizing Transfer Center Operations

Pro Tip:

Evaluate your current transfer processes by surveying your nurse supervisors and bed control personnel, estimating the potential impact of process improvements on your organization’s referral rates, and using current referral statistics to calculate corresponding revenue.

30%

Decrease in
Readmissions

Pro Tip:
Identifying your target readmission reduction rate depends on historic program effectiveness. Organizations that have had limited success should strive for a 20-30% reduction.12 Calculate estimated savings based on the average readmission cost per patient.

Patient perceptions of six out of 10 key HCAHPS topics can be addressed by improving care team communication:

• Nurse Communication
• Doctor Communication
• Responsiveness of Hospital Staff
• Pain Management
• Quietness of Hospital Environment
• Understanding of Care Post-Discharge

The best way for organizations to capture positive patient perceptions is to text message patients with links to complete surveys on their phone. With 96% of adults on cell phones11 and texting the number one cell phone activity, text messages that link directly to surveys can drive more patient participation.

Reduce Readmissions

The nationwide quest to avoid preventable readmissions employs a variety of strategies to engage patients postdischarge, the most common being for nurses and care coordinators to call patients at home to collect assessment data and reinforce educational materials. But with the escalating frequency of robocalls, patients are increasingly likely to ignore unexpected calls, creating a frustrating game of phone tag between nurses and patients.

A clinical communication solution that includes automated text messaging with patients can reinforce treatment instructions while encouraging specific next steps (e.g. filling a prescription or scheduling a follow-up visit). Two-way texting can be used to gather patient responses and monitor key health indicators (e.g. blood glucose levels). An advanced solution can even highlight responses outside of the expected range, flagging patients at higher risk for readmission so nurses can focus their outreach efforts most efficiently.

Powerful benefits of patient texting include better care plan adherence, decreased readmissions, more satisfied patients, reduced labor costs, and the enhanced ability of nurses to practice at the top of their licensure.

Step 2: Define Important Workflow Enhancements

Technology vendors may look similar on paper, but the right clinical communication solution will simplify a wide range of communication-related workflows by eliminating steps and speeding up processes to improve clinician and patient satisfaction. Organizations looking to optimize mobility and care team efficiency should focus first on the workflows most in need of improvement.

True efficiency only comes from a comprehensive solution. Avoid purchasing narrowly focused technology built to address limited challenges. Skim past the ambiguous feature lists and examine the use cases, which can help you envision specific scenarios and map out desired workflow improvement goals.

The degree to which a clinical communication solution can simplify your communication likely depends on the flexibility of its rules engine and routing mechanisms. The solution with the right capabilities will:

• Offer several nursing workflow improvements
• Remove extra steps from the following communication processes

Step 3: Identify Required Integrations

Clinicians will only use new technology that delivers significant workflow benefits—ease of use, faster care, increased patient throughput, better outcomes, etc. That means your clinical communication solution needs more than basic secure messaging functionality. To best support adoption, compliance, and unified communication, your solution must integrate with the following key hospital systems and devices to simplify workflows right from the start.

EHR

Nurses spend a great deal of time communicating and documenting, making integration between the clinical communication platform and the EHR critical. Patient lists and care team assignments support accurate routing, and new orders and results often serve as the impetus for action. Tight integration with Epic, Oracle Health, and other EHRs saves nurses countless hours that would otherwise be spent toggling between applications, searching for data, and manually typing information into text messages.

Embedded Messaging

Embedding the clinical communication platform directly in the EHR allows staff to initiate clinical communication powered communication without leaving the EHR environment. This automatically ties patient context into the message to reduce the amount of information clinicians have to enter manually. Likewise, staff can launch the mobile EHR app from the clinical communication application with deep links to review information or document care, eliminating the need to toggle between applications or leave one solution to open another.

Use Case

A nurse receives a message through the clinical communication app that the physical therapist would like to visit patient Smith in room 404 to begin rehabilitation in 30 minutes. The nurse taps a deep link to launch the mobile EHR app directly from the message and reviews the medication administration record. Since the patient’s last pain medication dose was four hours ago, the nurse visits patient Smith to assess her level of pain. The nurse decides to administer another dose of pain medication to ensure that patient Smith can maximize the value of her physical therapy. She then replies to the physical therapist that pain medication has been delivered and patient Smith is expecting the visit.

STAT Order Notifications

The ability to access the EHR from any location creates opportunities for order entry without concurrent communication between doctors and nurses. Integration with the EHR enables the automatic notification of all appropriate personnel about new STAT orders to minimize care delays.

Use Case

While rounding on a patient, a physician writes a STAT order in the EHR for intravenous potassium. The pharmacist and the patient’s nurse receive an alert through the clinical communication app on their smartphones that includes the patient name, room number, and STAT order details. The pharmacist and nurse can both prioritize the new order and expedite the delivery of the potassium.

Critical Laboratory and Radiology Results

The Joint Commission’s National Patient Safety Goal 02.03.0113 requires organizations to report critical results of tests and diagnostic procedures on a timely basis. Unfortunately, some organizations struggle to measure compliance and meet their goals. Integration with a modern clinical communication solution helps ensure that results are immediately delivered to the appropriate provider (either the ordering physician or the covering on-call provider), escalated within specific timeframes if necessary, and documented for auditing purposes. Automated routing saves lab and radiology technicians countless hours each month.

Use Case

A patient’s blood culture results reveal a serious bacterial infection. The ordering provider has handed care off to her partner for the evening, so the clinical communication platform automatically routes the result notification directly to both the covering provider and the nurse caring for the patient. The covering provider acknowledges the alert and adds a note that she will change the antibiotic order in the EHR. All messages are automatically relayed to the laboratory department and the nurse taking care of the patient. System reports help the lab evaluate response times, evolve quality improvement efforts, and provide documentation for The Joint Commission.

Clinical Surveillance Alerts

Advances in clinical surveillance provide hospital staff with early warnings of potential patient compromise including sepsis, respiratory deterioration, organ failure, etc. As algorithms constantly evaluate new information to determine risks, clinical communication technology should rapidly route any alerts to the appropriate clinical staff.

Use Case

The rule-based sepsis screening tool identifies a potential case of sepsis. The clinical communication platform receives a sepsis notification and immediately alerts the patient’s care team about the risk. Since the attending physician is not on call, the alert is automatically routed to the covering physician. The patient’s bedside nurse is performing a sterile dressing change and does not read the message within 10 minutes, so the system automatically escalates the sepsis alert to the charge nurse on the unit.

Nurse Call System

A recent study found that only 52% of bed calls require nursing care; all others can typically be answered by support staff.¹³ If your organization has a next-generation nurse call solution that provides request details, supports task assignment, and enables callbacks from mobile devices, integrating it with the right clinical communication solution will help nurses focus on clinical work while delegating other tasks to the care team.

Use Case

A patient presses the “water” call button. The clinical communication platform receives the request and automatically routes the message to the patient care technician, preventing the nurse from getting distracted by a nonclinical request. Later, the patient presses the general call button and the assigned nurse receives the message. The nurse clicks on the message to call back to the room from her smartphone. She has a quick conversation with the patient to determine if a trip to the patient’s room is needed.

On-Call Schedule

With a modern clinical communication solution, scheduling applications that manage on-call shifts can be integrated to ensure all calls and messages are delivered to the correct on-call provider. If provider groups are using different scheduling tools, the clinical communication platform should integrate with each tool to ensure timely and accurate communication across the continuum.

Use Case

A hospitalist asks a colleague to swap shifts this evening because his child is ill. The swap is completed in the scheduling application. Later that evening, when the ICU nurse messages the on-call hospitalist, the application automatically routes the message to the substitute instead of the originally scheduled hospitalist.

Call Center

Integrating the clinical communication solution with the call center system brings HIPAA compliance and streamlined workflows to the hospital’s switchboard, transfer center, and answering service. Operators can call and send secure messages with patient details directly to the smartphone of the clinician.

Use Case

An operator receives a call from patient Smith’s husband, who would like to speak to the patient’s nurse. The operator sends a text message to the nurse asking if he is available to speak with Mr. Smith. The operator sees the message was read and receives a reply that the nurse is finishing lunch and would prefer to call Mr. Smith back in 10 minutes. The operator responds to the message with Mr. Smith’s phone number. The nurse initiates a call to Mr. Smith 10 minutes later by clicking on the phone number in the text message.

Authentication Infrastructure

Integrating with Active Directory or a single sign-on (SSO) system facilitates easy provisioning of users onto the clinical communication and collaboration platform and allows users to authenticate using their pre-established health system credentials. Active Directory integration also helps users more easily find and contact anyone in the organization by providing the most current names, roles, and contact information for all personnel.

Use Case

At the beginning of the shift, a nurse selects a smartphone from the charger bank and uses her proximity badge to log into the device and the communication platform simultaneously—no need to enter credentials. When the smartphone is returned to the charging station, the nurse is automatically logged out of the system. The system actively keeps track of which nurses are on duty.

Pagers

Some large health systems may want to retain pager technology and/or ease the transition to smartphones by using both pagers and smartphones in tandem. To successfully leverage both device types, a clinical communication platform must be able to send messages to pagers using the appropriate communication protocols while filtering Protected Health Information (PHI) since pagers are unsecure (i.e. they do not require authentication to read messages).

Solutions can allow clinicians working across health systems (and pager networks) to send and receive messages to and from each organization with a single device. Clinicians can be assigned a “pager number” within the clinical communication app to ensure pages are routed to their smartphones.

Use Case

An orthopedic surgeon operates at two organizations: a private surgery center and a large teaching facility. When the teaching facility implements a clinical communication solution, the surgeon wants to eliminate the two pagers she carries (one for each facility), but the private surgery center does not plan to implement the clinical communication solution. She also wants to avoid changing numbers or becoming difficult to reach. The surgeon works with IT to integrate her private surgery center pager number with her clinical communication profile, ridding herself of pagers moving to a new setup where all messages are routed to her smartphone.

Hospital Phone System

Phone system integration allows users to dial and receive calls within the clinical communication application on their smartphone and from any phone on campus or within their network. A clinical communication solution can operate like a Private Branch Exchange (PBX) system, using a Voice over Internet Protocol (VoIP) dialer to allow users to dial four or five-digit department extensions they’ve memorized over the years. The PBX dialing feature prevents users from having to pick up a hospital desk phone to dial an extension or launch the telephone app on their smartphone to dial the full seven-digit phone number.

Use Case

A case manager has left the hospital campus and receives an alert about a critical lab result. To ask a question about the result, the case manager simply dials the lab’s four-digit extension from the clinical communication application where she received the alert.

Alarm Management Technology

Alarm management middleware prioritizes and filters event notifications and relays relevant patient and event context to the care team. Integration with modern clinical communication technology supports appropriate message routing and escalation on the same platform managing other communication activities.

Use Case #1

A patient’s monitor leads fall off. The alarm middleware detects that the leads are off for more than 10 seconds, which triggers an alert to the clinical communication platform. The platform sends a “Leads Off” alarm to the nurse assigned to the patient. The nurse is unable to respond to the alarm within 30 seconds, so the alarm is escalated to the charge nurse. The charge nurse heads to the patient’s room to resolve the issue.

Use Case #2

A confused patient attempts to get out of bed unassisted. The communication platform relays the bed exit alarm to all staff on the unit: “Bed Exit: Room 100.” All available staff members quickly respond to room 100 to prevent a dangerous—and maybe even life-threatening—fall.

Step 4: Select the Right Hardware

The right smartphones have the power to transform nursing workflows for the better. Nurses and other care team members need ruggedized devices that can be thoroughly sanitized, easily carried, and used to access all required applications while appearing professional (so patients don’t think their clinician is playing on a personal cell phone).

Most importantly, clinical devices need reliable connectivity, which can only be assured through careful vetting, selection, and maintenance by the health system. Consider the following aspects:

Wi-Fi Network

One of the most common failure points of a mobile communication strategy is the Wi-Fi network. As more devices tax the system and the volume of data crossing the network increases,14 IT departments must conduct thorough bandwidth testing to identify and eliminate dead spots before adding new devices.

Mobile Device Management (MDM) Software

MDM software centralizes the management of planned and reactive maintenance to minimize downtime, extend equipment life, and reduce budgetary spend. Organizations can use MDM tools to set up and perpetuate updates, upgrades, and patches across all devices, as well as to help identify security issues and seamlessly address them across the entire fleet before major problems develop.

Device Maintenance

Shared devices need their own strategy. Plan for modular charging, efficient maintenance, and regular disinfection. Let patients know the devices are being used for clinical work, possibly with branded device sleeves/battery packs.

Device-Specific Features

Applications function differently when it comes to authentication processes and security measures. It’s important to account for functionality and to consider how a device will function based on an organization’s unique requirements. The table below describes device-specific features to consider when selecting smartphones for clinical use:

Conclusion

Clinical communication and collaboration technology has evolved into a system-wide backbone for all care coordination activities. Nurse leaders can eliminate silos and consolidate important patient care functions into a single solution by taking an outcomes-driven approach to system evaluation, deployment, and measurement of success. Choose a solution that addresses the holistic needs of your organization to reduce care delays, improve patient safety, streamline workflows, and generate a strong return on investment. The right investment into an intelligent nurse mobility platform will maximize any other investments made to expedite care delivery, such as deploying smartphones for nurses.

Evaluate solutions against your organization’s goals for process improvement, desired workflows, and required integrations. The best clinical communication solution will lead to reduced communication cycle times, fewer care delays, improved care performance metrics, decreased readmissions, and, quite simply, better patient care.