Nursing has come a long way. The recent proliferation of wireless technologies in the hospital has changed the face of nursing, replacing clipboards with computers on wheels, and phones with hands-free badges. And it isn't just the gadgets; nurses are more tech-savvy than in the past, and many are carving out key roles on the CIO's strategic team.
As wireless devices become increasingly common and assume a greater role in the care process, the onus is on hospital leaders to select technologies that can improve nurses' work by enhancing communication and workflow efficiency.
“We recognize that technology gives us an opportunity to improve upon the care that we deliver and to make our clinicians' lives easier. So we try to implement technology when we believe it can do those things,” says Daniel Nigrin, M.D., senior vice president for information services and CIO at Children's Hospital Boston.
The first step in doing that, says Fran Turisco, research principal in the Waltham, Mass.-based Emerging Practices Healthcare Group of CSC (Falls Church, Va.), is to identify the biggest hurdles nurses face. “There's a lot of pressure. You have to do things on time and you have to do them right the first time, and the patient has to have a safe, high-quality experience. I think nurses have one of the toughest jobs around,” says Turisco, who co-authored a report in 2008 with CSC Senior Research Analyst Jared Rhoads detailing the challenges nurses face.
According to their research, one of the most significant barriers to care delivery is communication. Nurses, says Turisco, are often placed in the middle of the communication loop, where they constantly receive and place calls to physicians, pharmacy and lab, all while trying to tend to patients.
“So the issue is how you cut out some of the middle men in these communication loops,” she says. “And how do you shorten the timeframe between when a nurse needs to talk to someone and when she actually gets to talk to that person, then either make a care decision or figure out what needs to get done next.”
At University Hospitals Case Medical Center in Cleveland, leadership addressed the problem by rolling out hands-free communication systems from San Jose, Calif.-based Vocera in the NICU. The technology enabled clinicians to call for assistance or answer pages by using a voice recognition button.
With the badges, which run on the hospital's wireless platform, nurses “can call for help or communicate with colleagues across departments,” says Mary Alice Annecharico, M.S., senior vice president and CIO at University Hospitals. The technology, she says, is scalable to expand the system to other units throughout the 1,032-bed academic medical center and tertiary-care hospital. “We're considering using it in the OR and other areas where critical action is required in brief periods of time. It's easy to use, it's instantaneous and it's been a technology improvement that we've been able to deliver with our internal skills and capabilities.”
Turisco says, by facilitating communication with other clinicians, tools like the Vocera badge enable nurses to more effectively manage multiple tasks.
Turisco says the technology enables nurses to prioritize the work that needs attention and classify things in terms of what's critical, what's important, and what can be done in a more reasonable timeframe. And when voice over IP is integrated with monitoring systems or information from laboratory or order systems, Turisco says it is enhanced even more. “It adds an additional layer of information that helps nurses decipher what needs attention now and what must be escalated to a physician,” she says.
Another common theme found throughout Turisco and Rhoads' report is workflow issues. A number of organizations are addressing the problem by deploying patient flow systems to provide nurses with improved visibility of both bed availability and patient status. With these solutions, instead of making several calls and chasing down charts, nurses can look at a screen to find out what rooms are available, how long patients have been waiting to see a physician, and when patients need to be turned.
Some systems even indicate core measures using certain codes. “It pulls all the information that nurses might try to carry around in their heads and puts it at a visual level,” says Rhoads.
According to Eileen Sporing, CNO at Children's Hospital Boston, improving workflow was one of the organization's top priorities when it rolled out the Farmington, Conn.-based Premise Patient Flow Platform in 2008. Since going live, Sporing says, the system has helped eliminate what she calls “time wasters” from the care process. Now, she says, “We know exactly how long it takes to identify where capacity is and how we can get patients moved as quickly as possible. We've eliminated all of the manual processes, and that's been enormously satisfying.”
One of the biggest selling points for patient flow systems, according to Turisco, is the ease of use factor. “It's one of these technologies that you almost think is too good to be true because it's not that hard to install. You can configure it in a short period of time to do exactly what you want.”