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Getting the Message on Patient Hand-Offs

December 29, 2011
by John DeGaspari
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How one hospital improved its patient care efficiency

Like all hospitals, Ingalls Memorial Hospital, a 380-bed not-for-profit hospital in Harvey, Ill., recognizes the importance of caring for its patients in a timely manner. Yet a few years ago the hospital was experiencing some difficulties in throughput—specifically, transitioning the patients across the hospital, from the emergency room (ER) to the inpatient setting.

“Things got backed up,” explains Paul Zielske, R.N., director of patient care with responsibility for the ER and critical care. “The ER gets full; patients come into the ER and get tired of waiting, and many leave the hospital,” he says.

In 2008, the hospital did an assessment, and identified a problem with the way the hospital handled patient hand-offs from one department to another. At the time, the hospital replied on faxed reports from the ER to the patient floors. Often those faxes did not get through, due to lost or unread faxes at the other end or malfunctioning machines, Zielske says.

The hospital looked at various IT solutions, and finally settled on a message solution (Vocera Care Transition, supplied by Vocera Communications, Inc., San Jose, Calif.). One advantage of voicemail is that it is an asynchronous system, explains Zielske. The ER clinician calls in a report to the voicemail, and the solution alerts the floor nurse that a message is waiting. The floor nurse sees that there is a waiting message, and can listen to it at his or her convenience. The system also allows the floor nurse to verify receiving the report.

“The floor nurses don’t have to stop what they are doing; they can work in their own timeframe, listen to the report, and then the patient is moved. It’s a very satisfactory process,” Zielske says.

Zielske says the hospital also uses the voicemail solution for shift reports, which were previously provided on cassette tapes at the end of one shift, and listened to by nurses beginning the new shift. That method resulted in unnecessary overtime to listen to the report on tape, he says. Zielske says the time savings between shift changes was the equivalent to “a couple of FTEs.”

Time savings were also significant in patient throughput, he says. The hospital estimates a 50- to 60-minute savings per patient in the time from admission to to the ER the time the patient is transferred to the inpatient setting. Zielske adds that the hospital also saw significant time saving in terms of overall measures, including lab work, x-rays and when the doctors see the patients. Zielske says the overall ER length of stay dropped from 340 minutes in average to 100 minutes. He estimates that prior to 2008, about 9 percent of patients left without being seen by a physician. That has dropped to about 3.5 percent, he says.

Zielske adds that the process is visible, and he has access to data reports on users at each step. “I can listen to reports make sure they are giving correct information to the floor, so basically everything is visible at a moment’s notice. That’s very important when you are trying to refine processes,” he says.

Zielske sees the key benefits are better throughput and better quality reporting. The ability to treat more patients has resulted in a significant increase in billable revenue, he says. “The first year we enacted this in our throughput measures, we saw a 6 percent increase in our volume. Prior to that year, we had two years of declining volumes. We were going downhill, because people were avoiding us and going elsewhere,” he says.