Last week I took the CareSight product development team to visit two of our local hospital customers so that they could see real patients and real hospital rooms in action. Our customers are both medium sized facilities just outside NYC, but both are very different. One is in a more urban city setting (very mixed clientele), the other in a well-to-do suburb. In spite of very different demographics, both are working hard to deliver high quality care to their patients, and both laser focused on keeping the number of patient calls (nurse calls aka call bells) to a minimum.
As with many things in the hospital world, their approaches to solving the same problem are very different.
Not surprisingly, one common thread is that both customer’s nursing and patient experience teams have zeroed in on rounding: the simple, yet practical notion that if nursing proactively visits with patients more often, they will make fewer requests, which will lead to better hospital stays, and improved satisfaction scores.
Results have been mixed (at least based on HCAHPS scores alone), but per staff at both hospitals, they are making progress. There’s much at stake (reimbursements are formulaically keyed to publicly available survey results), so there’s no shortage of fine-tuning and tweaking going on in support of these efforts.
As an analytics service provider to hospitals, we have an interesting lens into the day-to-day activities as shown to us through patient call systems and the devices that the hospitals are using to notify nurses. Under a microscope (and often without context) we see where the calls are coming from, the types of calls, their frequency, the duration, the calls that are ignored or forgotten about, and how staff are responding (or in some cases not). In our analytics clean room, sometimes things don’t look so great. The data is great, but it turns out that it only tells part of the story.
Something to Be Said for Simplicity
Our suburban customer is focused on tracking:
- Staff interactions (how quickly calls are responded to)
- Escalations (when the first assigned staff member doesn’t respond and the call notifies their backup, or their backups’ backup)
- The number of calls that timeout and have to be resent (overtime)
As a result, from the reporting standpoint they have been struggling with what’s the right amount of data to give to managers and how frequently so that they are not overwhelmed (recently they changed to once a week).
Our “city” customer is keeping it simple. On any given shift they just want to know how many calls were made. Yes, they’ve thought about variations because of census, special needs, and levels of acuity, but by they’ve decided that to keep their eyes on a simple prize that everyone can understand. So every morning (weekends included) each unit’s nurse manager (and assistant) and the directors look at their numbers delivered in a succinct email. At the beginning of a new month, they look at the entire last month, and they also look at the prior 6 months for trending purposes.
The hospital is in the midst of a multi-year nurse call upgrade, so part of the house is on the new Rauland Responder 5 system, while the rest is in the process of being upgraded from Responder 4. Below is a snapshot of the Responder 5 locations for the last 6 months. For now, the trend is decidedly downward.
What I Wasn’t Thinking About
This customer has very short call durations, regardless of the call volume (not actual loudness, but number of calls). Meaning a patient placing a bedside call from a pillow speaker or call cord will get a human response 77% of the time within 10 seconds. 80% of the time in less than 20 seconds. You might think that this would be a measure of success, and while it may be part of the formula, it’s not the whole story.
Nurses at the city hospital carry phones that are tied to the nurse call system (the suburban facility handles notification via Vocera badges), but operationally they never completely transitioned to having the care givers be the first responders. Instead, the calls go the unit coordinator at the desk (unless it’s an emergency call of some type), and if there is none on shift whomever is at the nurse’s station.
The benefit of this approach is that someone answers all the time, and usually very quickly. It turns out that when there is a bottleneck fulfilling a patient’s need, it because of the hand-off between the unit coordinator the RNs and the nursing assistants (aides). On a related note, I was told by the Director of Telecommunications that nurses are writing their wireless telephone extensions on patient white boards, and encouraging them to call directly on their nurses’ wireless phone if they need something.
And that’s where the raw nurse call numbers come into play. Fewer calls are fewer calls. Whether its because of proactive rounding (no need to call), or the call being triaged by the unit coordinator, or personalized attention by the covering nurse, these efforts are an indication of a coordinated effort of responsive attention.