Even before the size of our emergency department at Hardin Memorial Health doubled, the staff faced a formidable communication challenge. Our clinicians were tasked with using a cumbersome smartphone that wasn’t conducive to a fast-paced environment. As a result, usage of the app was low.
In an ED, clinicians need to be hands free to multi-task and deliver fast and effective patient care. If nurses and physicians have phones in their pockets, they may not hear a call or see a text immediately. Even if they do hear it, they are often too busy to stop what they are doing, dig out the phone, login, read the message, and respond. Delayed responses and phone tag between team members was starting to impact patient flow and ED wait times.
With an impending expansion that would double the ED’s square footage and increase the number of exam rooms from 27 to 65, hospital leaders and staff knew the smartphone approach would be even more challenging. Hardin Memorial Health has approximately 200 ED visits a day, including many trauma cases. Clinicians could not afford to text and wait or spend valuable time looking for one another in a much larger space.
The solution was a hands-free, voice-controlled communication system implemented when the new ED opened in January 2018. Using light-weight badges suspended on a lanyard around their necks, clinicians can quickly connect with an individual using voice commands such as “call Room 101 nurse” or “call respiratory therapist.” The system is also used to activate specific emergency teams by saying “call code stroke” or “call code blue.” Each person assigned to those specific teams can receive the call on their wearable device, and act immediately, which can alleviate phone tag and improve care team collaboration. With hands-free communication, care team members can exchange vital information with each other or request help without stopping care delivery or leaving the patient bedside, which can be critical in emergency situations.
One day, for example, victims of a multiple-car accident arrived in our ED. While providing hands-on care to one trauma patient, a physician was asked to help treat another critical patient. Using his voice-controlled communication badge, the doctor provided guidance to the second patient’s nurse in another trauma room while continuing to resuscitate his patient. Because of the efficient, hands-free nature of the communication system, care teams were able to deliver effective and safe care to both patients with positive outcomes.
In prep for different kinds of emergencies, the team at Hardin is using the communication system to empower care teams with the resources they need before trauma patients arrive. When an EMS provider notifies of the ED of the arrival of an ambulance with a critically ill or badly injured patient, the recipient of this call can broadcast a message to a specific code team, such as “call STEMI team.” Assigned members of this team get the alert on their communication badges and can quickly assemble to the right trauma room with the right supplies so that they’re ready when the patient arrives.
Using voice-controlled badges has made it much easier to meet patients’ needs in a timely manner. Four months after deploying the hands-free communication system, our left without being seen (LWBS) rate dropped significantly. Between January and April 2018, the LWBS rate decreased from 4.6 to 2.5 percent. In May 2018, the hospital reported its highest monthly ED volume ever, and the LWBS rate was 2.2 percent, compared with 5.6 percent in May 2017.
And that’s just one metric. Our patient experience scores in the ED have also improved in several categories. Four months into 2018, the hospital reported a 3-point increase in its overall patient satisfaction scores, and HCAHPS scores for the ED related to “staff caring for patients as a person” improved from a Top Box score of 56.6 in 2017 to 63.4 in 2018. Perhaps the most impressive improvement was HCAHPS scores related to “doctors informing patients about treatment” in the ED, which jumped from 53.3 in December 2017 to 77.1 in May 2018.
Hands-free communication has made a tremendous difference in the ED for our patients, their families, and our team members. In addition to measurable outcomes, there have been notable improvements in qualitative results. Nurses and physicians can collaborate more easily and are more satisfied with the voice-controlled solution. Frustration from not hearing a call, or calling and waiting on each other to respond is gone. In addition, wearable devices also help our employees feel safer knowing the touch of a button will dispatch security or safety personnel. Because of these use cases, interest for the technology has piqued across the hospital.