Smartphones Usher In New Era Of Nursing Care

Edited by Jennifer Dennard, Health IT Outcomes

Adopting mobile communication technology has helped nurses at Frisbie Memorial Hospital better coordinate care and improve workflow between units.

Rochester, NH-based Frisbie Memorial Hospital is an 88-bed acute care community hospital serving New Hampshire and southern Maine. Its clinical staff of 425 manages 44,550 in-patient, emergency room, and surgical patients a year. The organization maintains 17 primary care offices, two internal medicine offices, two general-care walk-in facilities, and one walk-in facility devoted to occupational care. Sally Reeves, RN, MSM, healthcare project director at Frisbie, explains how mobile communication technology has helped the hospital’s nurses improve workflow, better coordinate care between units, and provide a more soothing environment for its patients.

Q: What communication challenges caused you to seek out new mobile technology?

Reeves: The hospital communication technologies already in place, such as tethered and cordless landline phones, mobile pagers and unit-wide paging systems, walkie talkie-type devices, and in-room nurse call systems, proved to be inefficient in light of the personal, mobile communication technologies available on the consumer market. Off duty, we could quickly send and receive text messages, but on the floor we were faced with a general delay in reaching the right caregiver in a timely manner. We were also faced with an overall lack of conversational privacy and a high level of noise.

Our four-floor, 24,000-square-feet tower expansion in 2008 was perhaps the biggest impetus. It added a tremendous amount of real estate to the hospital. It also coincided with our decision to move to all-private rooms and to transition in the tower to decentralized workstations. We eliminated the traditional central nursing station, instead giving one unit four workstations. We were then faced with the problem of reaching the correct person at these new stations. You’d call in to a central workstation to speak with the unit coordinator, who would then transfer your call to the appropriate sub-workstation. If you were lucky, the nurse you were trying to reach picked up the phone. More often than not, however, that nurse had to be told the call had come in. That convoluted and time-consuming process was the breaking point.

It was then we began looking for a new technology that could eliminate the communication delays and frustrations we had been experiencing. After our initial research, we looked carefully at three vendors. We ultimately selected the Voalté One for iPhone product because the application combined the use of voice, text, and alarm capabilities on one platform. It offered a way for staff to quickly reach the correct person at the point of care via a mobile device they would always have with them. Based on the secure texting capabilities of the Voalté One for iPhone technology, I was confident we could reduce our communication times from upwards of 5 to 10 minutes to mere seconds.

Q: How did the new communication technology benefit your organization?

Reeves: It has dramatically improved our ability to reach the right person in a timely manner. You no longer have to go through a unit coordinator. You no longer have to guess what unit a staff member is on because now they’re in the Voalté directory, listed by who’s working and signed on. The quick-messages feature has also helped us improve workflows. Staff can create prefilled texts with messages they routinely use, such as “I need help in …,” and then they just fill in a room number. The decrease in noise around the hospital has been an added bonus. Texting, obviously, is much quieter and offers a greater level of privacy than the overhead paging system did.

The smartphones have helped increase the proactive communication between departments to coordinate care. Different units now text back and forth to better manage patient care. This has had a tremendous impact on coordination between our ambulance service and the ER. Paramedics can now communicate directly with the ER charge nurse and physician in charge of incoming ambulances to ensure that all necessary rooms are set up when the ambulance arrives.

Direct access to staff members, be they providers, nurses, or ancillary service providers like respiratory therapy, is of huge benefit to patient care. Our communication guidelines state that a Voalté phone call must be answered immediately because it’s considered high priority. A text should be responded to within 5 minutes, though it never takes that long. We saw an amazing shift in communication method when we went live with our first round of Voalté phones in late 2010. Previously, we had between 500 and 700 phone calls going through on a weekly basis. After we went live, we dropped to 100 phone calls a week, with 60,000 text messages. Plus, as with any iPhone, our staff now can look at message color to determine if texts have been received. That brings enormous peace of mind.

We saw an increase in staff satisfaction as a result of the new phones based on surveys we conducted before and after implementation. We also saw a 6 percent increase in HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores relating to patients getting help as soon as they wanted it, after pressing their “call button.”

Q: What implementation best practices and lessons learned would you share with other health systems?

Reeves: A facility’s Wi-Fi has to be optimal. You need to be aware of structural obstacles that might interfere with Wi-Fi service, particularly if you have an older facility. We discovered that a room formerly used for radiology still had lead lining in the walls, which prevents Wi-Fi access. These are all things that were discovered during our initial Wi-Fi assessment.

It’s also important to make sure your communication priorities line up with your budget. We didn’t give everyone a Voalté phone at first. We took a look at our budget and prioritized who needed the phones the most at that particular time. Our initial adoption in late 2010 included 90 phones for all of our inpatient units, which included nurses, aids, supervisors, respiratory therapists, ER staff and providers, and all of our surgical and anesthesia services. We added all of our ancillary services in June 2011 and then our ambulance service five months later.

You also need to make sure your hospital policies are up to date and made available to all parties involved. These could include anything related to HIPAA compliance and mobile phone policies.

We also make sure to explain to patients and visitors why we are using the phones. We’re not surfing the Web or playing games. We want them to be aware that these phones are part of their care, so we have developed posters and tabletop cards for hallways and patient rooms, as well as scripts staff can use to orient new patients to the phones.

I should add that it’s not just patients and visitors who need convincing — some staff members will as well. There was definitely an age gap when we started using the phones. Our younger staff was very happy because they were already familiar with iPhones, but we had several older people say they wouldn’t use them. They quickly changed their tune, however. About two weeks into our use of the phones, they realized they were out of the loop because they weren’t in on communications taking place via the phones.

The phones have become indispensable. They are shared, so when a shift is leaving, the next person coming on is waiting, hand out, for a phone. They’re literally in use 24 hours a day, with the exception of a rare, hospital-scheduled downtime for IT maintenance. We had a 30-minute downtime just three months after implementation, and I’ve never heard such uproar from our users. You would think 30 minutes was a lifetime!