In Healthcare you are frequently starting or finishing a shift and need to inform or reach a rotating cast of people who affect your ability to complete your task. Multiply this by dozens of patients across a wide array of circumstances and you have complexity upon complexity that builds upon itself. It reminds me of those kaleidoscope toys you would play with as a child where the picture constantly changes as you twist the cylinder. Except this changing picture results in incredibly serious consequences for patients, caregivers, and the health system.
A recent paper written by Dr. Paul St. Jacques and Mr. Michael Minear on perioperative patient safety describe surgery as such “During the perioperative process of care, clinicians from several different disciplines care for patients in a simultaneous, real-time fashion. A single patient might be treated by five or more nurses, two or more physicians, associated pharmacists, radiology technicians, and blood bank staff. Many other types of support personnel also directly affect a surgical case and, therefore, the safety outcomes. These include patient transporters, sterile supply staff, janitors, schedulers, and others. With the exception of the attending surgeon, all other clinical and support perioperative staff do not typically meet their patients until the time of surgery and have, at best, very limited postoperative follow up.”
This communication complexity has massive implications in cost contribution, poor patient experience, and operational efficiency. At every step of a patient’s journey from pre-admission to discharge, many different people have to tightly coordinate to complete different workflows that can be very nuanced depending on the patient circumstance.
To illustrate this point, let’s take a look at some more specific examples from customers of ours:
Situation A – EMS Integration. A patient suffering from stroke-like symptoms calls 911. The EMS, which is part of the messaging network of its first-choice Level 1 facility, sends a text to determine capacity to admit a potential stroke victim. The facility messages back instantly that they have the capacity and concurrently strikes up their Stroke Team On-Call messaging group for prep to reduce crucial minutes in anticipation of triage once the patient arrives.
Result – Increased stroke admissions and reduced time to triage patient.
Situation B – ED Workflow. Hospital ED suffers from chronically long wait times and capacity constraints resulting high Leave Without Being Seen (“LWBS”) stats. A key bottleneck is identified: the transport process to an inpatient setting which is unlocked and streamlining through automated alerts and real-time messaging between the transport team and the ED charge nurse. Transport time from order to completion is reduced by 45 minutes increasing ED capacity and reducing wait times for new patients.
Result – ED throughput increases unlocking more in-patient admissions and better patient experience through lowered LWBS.
Situation C – External referrals. Primary care physician wants to refer a patient who is suffering mild chest pain but has trouble reaching the Hospital Cardiologist On-Call and instead refers the patient to an out-of-network facility where she has a pre-existing relationship. The Hospital loses out on valuable patient referrals as physicians that are not part of the regular staff have no easy way to refer such patients to the hospital short of tracking down an on-call physician via answering service. The hospital sets up a global messaging network that extends to the referring physician community to allow them to easily locate and communicate a referral opportunity driving increased admissions and valuable revenue to the hospital.
Result – Patient Leakage is reduced and admissions increase.
Situation D – Allied Health Coordination. There is constant confusion on dietary orders and timely delivery of meals to patients. The physicians are increasingly frustrated that patients receive incorrect meals or are not being fed on time. Patient satisfaction numbers dramatically improve once the nutrition service joins the health system messaging network and case managers can coordinate dietary restrictions with nursing staff to ensure the right meals are delivered at the right time.
Result – Improved patient satisfaction and HCAHPS scores because dietary service improves.
Situation E – Discharge Coordination. Hospital is incurring unnecessary expenses related to pharmacy, nurse, and meals because patients that should be getting discharged in the morning are sometimes delayed 5 hours because the specialist, case manager, and PCP have trouble coordinating discharge sign off. The Hospital creates an automated discharge care team once the discharge request is logged in the EHR to dramatically shorten the sign off process.
Result: Average Patient discharge times are reduced to before Noon as care team coordination is streamlined, resulting in a lower length of stay, reduced operating expense, and higher patient satisfaction. Further, readmission rates decline because of tighter care team coordination on discharge checklists and follow up appoint and scrip adherence.
While all of these situations are quite distinct and seemingly unrelated, they share a common denominator – communication. In a modern health system, communication can be a source for massive improvement in care delivery. The central challenge in healthcare is that you don’t know the specific person you are trying to reach to complete your workflow – rather you want to reach a role or job function who directly affects how fast you can respond or effect a patient experience. And you want to do it asynchronously (ie. without having to talk to them in real time) The non-healthcare world doesn’t have this problem because most industries are not shift-based and/or time-sensitive around workflows.
Yet, in spite of these inherent complexities, there is no other industry that creates so many barriers for their employees to reach each other in a simple way nor has done so little to help them solve this problem over the past 30 years while the rest of the world has addressed this problem so thoroughly. Instead, caregivers are often handed pagers, 30-year-old IP phones, faxes or told to use an answering service while also being asked to complete their workflows more quickly and with higher precision.
The EHR was supposed to help combat this. And yes, it is an important contributor of information about a patient, but a high functioning health system must also adopt a dedicated communication solution that spans the entire enterprise. When a health system physician, nurse or allied health professional can reach anyone inside and outside the four walls of the health system by name, title, and job function or role, and create groups around patients, then massive productivity gains can be rapidly unlocked. In every health system I visit, caregivers are dying for such a modern solution. They don’t understand why the administration forces them to carry pagers, wait for faxes and phones from an answering service operator. This may seem obvious, but yet it’s shocking how few health system administrations have prioritized enterprise communication along with data analytics from a communication system to unlock improvements in outcomes and operations.
The good news is that all of the essential pieces to unlock productivity gains through proper enterprise communication are now in place. Nurses across most systems are upgrading their mobile devices to Android and iOS operating systems while Physicians continue to be massive users of smartphones and the EHR and HIE are now installed so information can be shared in digital form quite readily. What is now needed is an enterprise messaging and voice solution to connect these pieces together into a common communication fabric. Health systems just need to prioritize enterprise communication as an essential tool to improve care delivery for the 21st century.