Continuity of care hasn’t always been an issue for hospitals. It’s a fairly recent challenge, caused by increased specialization among healthcare professionals, a growing (and rapidly aging) population, and a variety of other healthcare trends. Thankfully, there are modern solutions for this modern problem — or more specifically, there are mobile solutions.
Why is continuity of care so important? What stands in the way? And how can mobile technology help close the care team communication gaps that threaten patient safety and can tank the patient experience?
Not so long ago, patients were usually admitted by the same general practitioners who treated them in an outpatient care setting, and nurses worked the same 8-hour shift most every day. With just a few familiar faces on each inpatient’s care team, it was easy to keep everyone in the loop. But in recent years, those loops have gotten wider.
Now many primary care providers no longer treat their patients in hospitals, so most inpatients are treated by hospitalists, and their regular doctors get looped back in after they’re discharged. Three-quarters of U.S. inpatient care centers now staff hospitalists, according to the Association of American Medical Colleges (AAMC). These doctors help coordinate patients’ medical care, but they can also complicate continuity of care. During a single five-day stay, a patient on hospitalist service can be transferred between different doctors an average of 15 times, the AAMC estimates.
That’s a lot of cooks in the kitchen, and this figure doesn’t even include the variety of specialists who might be part of a complex patient’s care team. Bedside nurses also rotate more regularly than they once did. Many nurses now work 12-hour shifts three days a week, so patients get new RNs every couple of days.
Modern care teams are crowded and often disconnected. Members work different shifts in different departments in different wings of the hospital. Yet, they’re all responsible for the same patient. To ensure quality care, there must be continuity of care, which requires timely communication. That’s why innovative hospitals are equipping care teams with mobile solutions that let them communicate across channels and share information in real time.
Large care teams can be beneficial for patients, especially medically complex patients with numerous diseases to manage. Multiple heads are better than one, especially when those heads all have different specialties and unique insights. But unless hospitals have procedures and tools in place to ensure continuity of care, each patient hand-off is an opportunity for communication breakdowns that could compromise the patient’s health and safety.
There are many opportunities for miscommunication and misunderstandings. In the average teaching hospital, there are more than 4,000 hand-offs each day, according to the Joint Commission, which notes that “inadequate hand-off communication is a contributing factor to adverse events … including wrong-site surgery, delay in treatment, falls, and medication errors.” In fact, the Joint Commission estimates that 80 percent of serious medical errors stem from care provider miscommunication during patient hand-offs.
Those errors come at a great cost, both to the patient and the hospital. Communication failures are a factor in 30 percent of malpractice claims made against U.S. hospitals and medical practices, according to the 2015 CRICO Strategies National CBS Report. Over the course of five years, communication failures resulted in 7,149 harmed patients, 1,744 deaths, and $1.7 billion in malpractice costs.
On the flip side, studies have shown that sustained continuity of care leads to greater patient satisfaction, decreased readmissions and emergency room visits, and improved receipt of preventive services — all of which save hospitals money under the Affordable Care Act (ACA). Last year, the Centers for Medicare & Medicaid Services (CMS) penalized 800 hospitals for patient safety incidents by reducing their Medicare reimbursements for fiscal year 2019. Likewise, 2,593 hospitals recently had their Medicare payments reduced due to excessive readmissions, which will cost them a combined $563 million over the next year.
The stakes are high for continuity of care, and as hospitals seek to bridge communication gaps and improve access to health information, most are finally making the move to mobile.
Roughly 90 percent of U.S. hospitals are investing in smartphones and secure clinical communications solutions, according to Spyglass Consulting. Sixty-eight percent are using middleware to integrate mobile solutions with their hospital’s legacy systems — which enables their teams to communicate not only with each other, but with the databases and machines they need to do their jobs efficiently and effectively.
Mobile clinical workflow solutions can improve care team communication, interprofessional collaboration, and continuity of care — with features like:
1. Multichannel Communication
Nobody in a hospital has time to waste, but that’s exactly what happens when care teams are forced to track down colleagues, play phone tag, or beep each other and wait for calls-backs. To effectively collaborate on patient care, they need multichannel, real-time communication options — the kind they have in their personal lives on their personal devices, but cannot (and hopefully are not) using at work.
Of course, some healthcare professionals can use these solutions, because their hospitals provide them with smartphones and HIPAA-compliant communications solutions. But many hospitals are stuck in the past communication-wise. They might have cutting-edge equipment and top-rate physicians, but clinical communication still involves landlines, overhead paging systems, and beepers. In fact, 90 percent of hospitals still use beepers, according to HIMSS Analytics. These outdated, inefficient communication systems cost the average hospital $180,000 per year, roughly 45 percent more than the price of a smartphone-based solution.
Mobile solutions don’t just cost less; they do far more. Care providers no longer have to find an available landline phone, page someone, and wait for a returned call. Instead, they can call their each other directly to discuss patients’ medical care. For quick questions or FYIs, they can send secure text messages. Or if they need a face-to-face consult, they can initiate a video call. No more waiting, no more paging, no more communication gaps.
2. Role-Based Messaging
When everyone on the care team has a smartphone and access to a secure communications solution, it’s easy for them to share important information, ask questions, and collaborate on care plans. But being able to contact someone is only useful when they know who to contact. With doctors, nurses, and specialists on rotating schedules, the answer is not always obvious.
Say a patient’s health starts to decline in the night. He’s recovering from brain surgery but also has heart disease, so when his blood pressure goes up and he suddenly becomes confused, the nurse needs to contact several doctors — a hospitalist, a neurologist, a cardiologist. Before she can reach out to any of them, she needs to know who is on call for the night. She looks up the schedule, finds the doctors’ phone numbers, and places her calls. All the while, she’s crossing her fingers and hoping the schedule is up-to-date and that she’s not about to wake up the wrong person.
None of that would be necessary if the nurse was using a clinical communication solution with role-based messaging — which maps rosters of clinical staff to defined roles. This way, the nurse doesn’t need to know who’s on call. She can simply call or text “cardiologist” or “neurologist” and get her message to the right person, then get back to helping her patient.
3. EHR Integration with Notifications
Continuity of care might be harder to maintain with large teams, but it’s certainly possible. As long as everyone has access to the same up-to-date information, interprofessional collaboration can improve quality of care and health outcomes. That’s what makes electronic health records (EHR) so valuable — everything clinicians need to know about a patient is in one place. In fact, the Joint Commission recommends “use electronic health record (EHR) capabilities and other technologies — such as apps, patient portals and telehealth — to enhance hand-offs between senders and receivers” as a way to reduce medical errors and improve continuity of care.
Yet, if the EHR is hard to access or the information is out of date, it’s not as helpful, and if the medication list isn’t accurate, it can even be dangerous. When care teams have secure smartphones, they can access EHR from anywhere. They don’t have to search for an available desktop to look up information or to add new notes. They can do it from the bedside on their devices. Better yet, if EHR is integrated with clinical workflow solutions like TigerConnect, clinicians can even receive automated notifications — for example, when lab results come in or when a patient record needs to be reviewed.
4. Medication Management Safeguards
Mistakes can happen, especially with multiple doctors prescribing medications and multiple nurses administering them. Medical errors are now the third leading cause of death in the U.S., according to Johns Hopkins, and they cause 250,000 deaths annually.
Many of these mistakes can be prevented with mobile clinical workflow solutions. If the order from one physician doesn’t make sense, the patient’s nurse or another physician can send a quick message to clarify. Better yet, if the hospital has also integrated medication management apps onto smartphones with barcode scanners, the app can alert nurses to potential medication interactions or errors.
For example, say a nurse is about to give a patient her nightly meds. She scans the patient’s wristband and the drugs she’s about to give. Suddenly, two alerts pop up. One warns about a possible drug interaction between a new medication the cardiologist prescribed earlier that day and another medication she’s been on for a while. The system suggests that the nurse wait at least two hours between the two medications to avoid negative effects. More importantly, the system lets the nurse know that the insulin syringe he’s loaded has twice as many units as he was supposed to give. He realizes that he was looking at the patient’s morning insulin dosage, rather than her evening dose, so he squeezes out the extra medication and gives the patient the correct dosage — possible crisis averted.
Care teams aren’t just crowded and disconnected. They’re also very busy, so it’s easy for mistakes to happen or for important information to fall between the cracks. That’s less likely to happen when they have multichannel communication options, automated alerts, and digital safeguards in place to ensure patient safety and satisfaction. In other words, when they have smartphone-based communications and clinical workflow solutions. To learn more about the 5 Most Dangerous Patient Handoff Gaps get your free eBook today!
Tags: health services, long term, health information, health care professionals, Continuity of care, medical home, care setting, medical care, primary care, Quality of Care, Clinical Communications, Care Team Collaboration, Patient Care