On February 2nd, I
was blessed once again as my wife gave birth to the newest member of our
family. After a complication-free delivery and smooth discharge, I was
left with two very memorable experiences. First, I got to witness the
miracle of life begin. There is no more powerful moment than to see a
person appear into the world. Truly breathtaking. Secondly, albeit
a very distant second – I watched the technology and enhanced workflows I
evangelize with our clients come together in a truly elegant way. Nurse
call systems and Electronic Health Record Systems integrating with WLAN phones,
RFID tags standing guard to ensure infant and parent safety, wireless infusion
pumps communicating with the inpatient pharmacy, and fetal monitors offering status to clinicians of the
pending miracle. Bits and bytes, ones and zeroes, floating invisibly through
the air to alert caregivers of critical events. To the untrained eye and
ear, it may not have even been noticeable – but to me, it was tremendously
encouraging.
We have come a very long
way. In the not-so-distant past, the most alerting a clinician would have
had to deal with may have been two phones ringing simultaneously. Now,
there are desk phones, smart phones, nurse call systems, overhead pagers,
alphanumeric pagers, PCs, RFID tags, telemetry alerts, digital signage, etc.
all vying for the attention of a single clinician. With so many events to
keep tabs on, it’s no surprise to hear that an average shift in a hospital
requires a nurse to walk four and a half miles (Mobile Health Alliance).
Of course, it also begs the question – have we over-adopted? With
so many beeps and pings to tend to, won’t the clinician just become
desensitized or overwhelmed by it all? After all, the Joint Commission
has documented just how significant a breakdown in communication can be.
With 62% of accidental deaths and 80% of serious medical errors being
attributed to communication failure, how can so many alerts possibly be good
for patient outcomes? Well, my recent experience demonstrates just how to
achieve the proper balance between too few and too many of them. Not once
did a nurse or physician demonstrate signs of what is known as alert fatigue.
Rather, technology seemed to empower them to be more responsive and more
attentive. Something as ubiquitous in today’s world as a smart phone
became a powerful clinical instrument.
So, how DOES a hospital achieve
this balance? To start, they must dive deep into three categories:
- Alert Management – Consider priorities, delivery assurance, clarity, and saturation points of the alerts
- Capacity Management – Determine how tight parameters are set, what staff is available to address the alerts, and the logistics involved to respond
- Policy Management – Audit assignment logistics, escalation procedures, time-to-respond intervals, and disablement requirements
With an understanding of how a
care unit consumes alerts, hospitals can deliver the right data, to the right
person, on the right device, at the right time, with the right context.
In order to do this, it is important to let the message drive the medium.
A clinical emergency needs to be prioritized over a simple food request, and a
weather alert needs to be delivered in a matter different from, say, a
patient’s discharge notice. Additionally, regulatory issues come into
play:
- HIPAA – Is Protected Health Information (PHI) secure to ensure compliance?
- HCAHPS – Is the alert management program recognizing the importance of noise reduction, responsiveness, safety and overall patient satisfaction?
- Joint Commission – Is the organization poised to address the 2014 safety goal set forth?
Needless to say, this is no easy
undertaking – but with links to patient safety and cases of mortality, it is
absolutely critical. In fact, the ECRI Institute has placed “Alarm
Hazards” at the top of the list of technology hazards for consecutive
years. These alerting technologies available in today’s care unit are not
going away, so organizations need to understand how to use them effectively.
Care units should continually assess their environment, provide gap
analysis to an ideal alert management program, and embrace efficient
technologies to aggregate data, enhance workflow, improve outcomes, and
increase patient satisfaction.