A great example of a command center in Nemours Children’s clinical logistics center (CLC)
Hospitals from coast to coast are doing everything they can to bring in the latest and greatest technology and put into the hands of their nursing staff. I’ve worked as an RN in this field for over 18 years and have been a huge advocate of introducing clinicians to the latest high tech equipment available in the market.
I returned to the hospital to assist in both Go Lives and post-assessment (usually 4-6 weeks post-deployment) and couldn’t wait to hear all the accolades and gratitude for placing this highly useful, cutting-edge technology into their hands.
However, that was rarely the case.
I thought I just needed to retrain the staff and motivate them to “just use it” for them to surely see the benefits of this new form of telecommunication. The nurses would usually sit back, let me explain how useful this was to their job, and how this benefitted both them and their patients. I explained that sending the right alarm at the right time to the right clinician was game-stopping. Once I was finished with my company mantra, I would stop and listen to their concerns. I did my best to understand their reasons for not complying with the new procedures that followed the new technology.
The bottom line was the new technology and procedures were disrupting their daily duties.
What were their complaints and how legitimate were their concerns?
What I’ve heard for years, whether it’s regarding new middleware, state-of-the-art end devices, nurse call systems with amazing software, or staff/patient locating devices the complaints had a common thread—regardless of the hospital.
The clinicians’ biggest complaints were that they were being interrupted while trying to comfort a patient, speaking to a physician regarding a patient, dispensing medications, performing a bedside procedure, and so on.
I would fire back, “But you can just ignore the phone ringing in your pocket and let it escalate until someone else takes care of the notification.” Regretfully, what was happening was the notification often went unattended and ignored because the other nurse was just as busy and attending to their patients’ needs. The alerts/alarms would often end at the Charge Nurse phone because they had patients of their own and were just as busy as the other nurses.
What I’ve read about year after year is the trend in medical errors. You would think, with all this amazing technology, that we would be seeing the trend heading in a downward spiral. So what’s up? For one, there are numerous studies that show no one can efficiently multitask. Think about any job you’re trying to perform and you are constantly interrupted while trying to complete that task. Something is going to suffer, and it shouldn’t be the nurse trying to perform the task—and it certainly shouldn’t be the patient receiving a procedure, medication, counsel, etc.
What’s the answer???
Technology Cannot (and Should Not) Replace The Clinician
I saw very early in my career how excited CEOs or CNOs were to remove staff from the floor and introduce technology. We all made the mistake of thinking that the latest in software, where rules are created around each alert/alarm, was so intelligent that it could relieve staff of sitting in front of monitors and notify the staff when something was happening with their patients. Great for the bottom line and safe for patients, so what could go wrong? Thus, alarm fatigue was created by too many unnecessary, intrusive, or non-actionable alarms that interrupted patient care and staff functions.
I then moved into the nurse call system and again I realized that around 60% of nurses are NOT required for request made by patients. Then why are we notifying them? I noticed how most of the companies in this field tout that they can promise better patient outcomes, improved HCAHPS, reduction in healthcare costs, and happier staff. But is that really true? What are the costs of medical malpractice suits? What are the costs to patients who are on the receiving end of medical errors?
The answer is we can’t always replace staff with technology. Period. We still need the eyes, ears, training, and judgment of human interaction. We need to push for Centralized Command Centers that are either localized within the hospital or placed off-campus. There must be a human connection when answering a patient call (triage) or viewing a telemetry monitor. We need trained humans interacting with notifications coming from our patients.
We need to send the right notifications to the right person who can respond in a legitimately timely fashion—and squash unnecessary, non-actionable alarms from medical equipment.
The funny thing is, I have worked with some amazing nurses in medical technology fields who, 10 years ago, said to me, “This is a really bad idea. We can’t just send alerts/alarms out to edge devices and think this is going to be a viable solution to improve healthcare to our patients.”
Eighteen years later, and I finally “get it.”
Suzanne West is an independent clinical consultant with over 20 years’ experience in healthcare, including emergency department, ICU and cardiac critical care. She has an extensive background in clinical consulting and management for companies such as Critical Alert, Medhost, Emergin-Philips, Vocera, and Extension. Her expertise is in maximizing workflow efficiencies and enhancing hospital communication. She partnered with hospital leadership to meet their patient safety, quality and staff satisfaction goals in promoting strategic business plans by following a proven methodology of clinical discovery, planning, implementing, training and post-assessment. Her free time is spent with her husband and family camping, kayaking and golfing.