Can improving communications among clinicians potentially enhance patient safety, while at the same time dramatically improving clinician satisfaction? The answer to both of those questions is a resounding “yes,” according to clinician and operational leaders at the Hospital for Special Surgery (HSS) in New York.
The 214-bed hospital, whose main campus is located on Manhattan’s Upper East Side, is widely respected, and in 2017 was ranked by U.S. News & World Report as the number-one hospital in the United for orthopedics, and the number-three hospital for rheumatology. The nation’s oldest orthopedic hospital, it was founded in 1863, and attracts patients from all 50 U.S. states and more than 100 foreign countries.
HSS is also, not surprisingly, a very complex organization to run, with surgeons and other clinicians constantly involved in very complicated interpersonal communications.
It is in that context that HSS leaders, including Peter Grimaldi, MS, PA-c, assistant vice president and a practicing physician assistant at the hospital, and Nick Wirth, the hospital’s director of operational excellence, presented on the topic “Standardizing Clinical Communication Improves Patient-Centric Care Coordination and Collaboration,” on March 8 at the Venetian Sands Convention in Las Vegas, during HIMSS18, the annual HIMSS Conference, sponsored by the Chicago-based HIMSS (Healthcare Information & Management Systems Society).
Just before they presented at HIMSS18, Grimaldi and Wirth spoke with Healthcare Informatics Editor-in-Chief Mark Hagland regarding the initiative that they’ve been leading at the Hospital for Special Surgery around improving clinician communications within the organization. As part of that initiative, their team at HSS has been partnering with the Knoxville, Tennessee-based PerfectServe, to implement and optimize telecommunications technology, in order to support HSS’ physician-led journey to standardize clinical communication across its enterprise network, an initiative that has included addressing postoperative care’s extraordinary volume of e-conversations traversing multiple units to create a higher level of patient safety. There are now 3,400 total users on the platform that’s gone live, including 1,300 mobile users, and 700 prescribers. Below are excerpts from that interview.
Can you share with me the origin of this initiative?
Nick Wirth: At the end of 2013, our surgeons spoke with us about the faultiness of their answering services. They were using six to eight answering services across their practices, and none was ideal. So we started looking at this from the outpatient side, knowing we would want to expand this to the inpatient side. So we started out with our physician practices.
Peter Grimaldi: This was a natural extension of a lot of work we’ve been doing around communication. We have the largest orthopedic residency program in the US at HSS, and nine different subspecialty fellowships, and we have 102 PAs under my organization, the frontline staff—and an additional 70 who are private who work for individual surgeons, but who are part of the para team in many ways. With that large a staff, and with the decreasing lengths of stay of patients we’re treating, we really had to improve our communication processes. To evolve away from our dated pager system was an extension of what we were trying to do.
Surgeons and other clinicians are demanding as consumers of technology, correct?
Wirth: Yes, and quite a few physicians and residents and fellows told us at the time, “We’re in 2016 [at the time], but we’re still using a paging system from the last century! And while everyone’s moving to texting, why haven’t we improved this yet?”
Tell me about the building-block steps in this telecom initiative?
Wirth: In 2016, we were implementing an EHR [electronic health record] across the organization, so in February 2016, we decided to implement a new system across the practices that could also be implemented at the hospital, to bring inpatient and outpatient communications together. We knew we had to get through the EHR implementation first. That started our timeline, beginning in February 2016, and extending throughout that year. And then once we got through that implementation, we set up a steering committee focused on communications. It was a large committee that was multispecialty—we had representation across all the different clinical departments involved in direct patient care. So probably 20 people on the committee.
Grimaldi: Yes, between the clinical departments, IT, operational excellence, some of senior executives, more than 20.
And what building-block steps were involved, in practice?
Grimaldi: One guiding principle was that of bringing outpatient and inpatient communications into one platform. The second principle was to centralize all call schedules and coverage assignments in the organization into that platform. You’ve heard that there can be a million different clinical departments with different on-call procedures. We said all calls should go through this platform, so that there’s one source of truth. And the third part is, with that standardization, we also developed a standardization of policy on communications across the organization.
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