- The number of alarms and alerts can become overwhelming to nursing staff, causing burnout and high turnover rates.
- How clinical collaboration platforms unify communication and reduce interruptions and alert fatigue.
- Common outcomes from implementing a clinical collaboration platform, including faster clinician response time and a reduced number of unnecessary readmissions.
Unified communication has special meaning for nurses working in acute settings. And today’s clinical collaboration platforms (CCPs) provide unified communication that helps reduce the interruptions nurses deal with daily. Nurses carry the burden of “one more thing,” whether it’s another row in a flowsheet or one more regulatory requirement that makes sense for nurses to fill out—because they are always available. They can work with as many as eight patients over a twelve to fourteen-hour span. And acute care nurses deal with a broad range of interruptions. Nursing isn’t like it used to be in the old days when you got a report from somebody, went on your day, and took care of patients. The demands for a nurse’s attention go well beyond providing patient care in today’s healthcare settings. Nurses walking in to provide patient care also have to interact with multiple levels of technology and respond to myriad alerts and alarms, phone calls, and texts. But suppose your nurses have access to a clinical collaboration platform that unifies Communication, streamlines workflows, and reduces the number of alerts, interruptions, and applications. In that case, they have less to manage and can provide more focused attention to patient care.
Each nurse’s day is full of interruptions.Nurse interruptions include alerts from pagers, physiological monitors, EMR, nurse call systems, patient monitors, interoperable pumps, patient satisfaction tools, phones, best practice alerts, and phone calls from physicians, family members, clinicians—and much more. Each notification and each phone call or text interrupts the delivery of patient care. Distraction and noise can be overwhelming. Nurses in an acute setting are assigned patients in their EMRs at the beginning of each shift. Additionally, they receive patient assignments in the nurse call system. They have to be sure that the alerts and alarms in the patients’ rooms are getting routed to them appropriately. And they have to check all of those settings at the beginning of each shift. They must check all their pump settings and other equipment settings, such as ventilators if they are in an ICU. Each machine for each patient provides alerts when the patient-or the equipment-need attention. The range of distractions, the noise of the monitors going off, and the scope of the demands for a nurse’s attention are driving some nurses out of healthcare altogether. Today, most healthcare systems are trying to retain nursing staff, not lose them to frustration and overload.
Nursing turnover comes at a high cost.The “2020 NSI National Health Care Retention & RN Staffing Report,” noted that hospital turnover remains elevated. The report, published just before the onset of the COVID-19 pandemic in the United States, identifies this as a concern. Elevated hospital turnover levels are “…a leading indicator of future financial pressure, and patient & employee satisfaction.” In addition to the loss of knowledge represented by nurse turnover, the costs to a healthcare system are genuine. According to this research, “the average cost of turnover for a bedside RN is $44,400 and ranges from $33,300 to $56,000 resulting in the average hospital losing $3.6m – $6.1m. Each percent change in RN turnover will cost/save the average hospital an additional $306,400/yr.” The addition of the influx of COVID-19 patients to acute care settings across the United States has added a sense of urgency to the need to retain nursing staff and locate additional nurses. They will help manage a potential surge of patients as the virus spreads.
Unified Communication in clinical collaboration platforms (CCP) reduces interruptions.Unified Communication is one essential aspect of a CCP, also called a clinical Communication platform. CCPs pull all of the disparate Communication streams, tools, and apps into one platform, available on the mobile devices nurses are already using. This reduction in the number of applications and pieces of equipment nurses manage as part of their “Nurses’ tool belt” lessens interruptions to patient care, reduces “alert fatigue,” improves the quality of care, and reduces the potential for nurse burnout. Alert fatigue, also called alarm fatigue, can lead to nurse burnout and to the decision to leave nursing altogether. A study published on the Patient Safety Network found that physiologic monitors in an academic hospital’s 66 adult intensive care unit beds generated more than 2 million alerts in one month, translating to 187 warnings per patient per day. 187 warnings. Per patient. Per day. Think about that. Certainly, numbers like these contribute to nursing burnout. And, according to an article published on MedCity News, even before the COVID-19 outbreak, “63% of hospital nurses reported experiencing burnout, a state of emotional and physical exhaustion caused by long periods of stress.” Consider this, a typical day for a nurse in an acute setting. At the beginning of the shift, the nurse is assigned patients in their EMR and nurse call systems. They are responsible for checking to make sure the alarms in the patient rooms are getting routed to them appropriately, and have to check each of those settings at the beginning of the shift. They also must check all pump settings, again, at the beginning of the shift. Each nurse is responsible for responding to inquiries from the charge nurse, clinicians, family members, and other related departments. And the interruptions include more than equipment monitor alarms. Phone calls and texts coming in, while necessary, can disrupt critical activities such as scrubbing a line to start an IV antibiotic—the phone rings. The nurse cannot see who is calling and has to step away from the activity, remove gloves, check to see who the call is from, decide about taking the call, and any subsequent action and then re-sterilize to finish the IV. Then, that nurse may have lost track of the medication or the dosage, distracted by the phone call or the text. So now, it’s time to recheck the EMR to verify the medication and dosage. Multiply this type of activity by eight patients over an entire 12-hour day, and you see a pattern. There is cause for concern since interruptions, in general, can equate to patient safety issues. So streamlining all of this communication into as few applications as possible, and reducing the number of Communication channels a nurse has to check on their phone, putting all of that in one place means they can communicate with and about their patients in a more seamless fashion. Just because we can, does not mean we should. Just to clarify, the value that the clinical collaboration platform with its unified Communication functionality brings is enormous. But its equally important to take a hard look at who is getting which alarms and messages. Just because we can flood a nurse with messaging and alerts, doesn’t mean we should. Part of working to improve the acute healthcare setting—for patients and nurses— is creating streamlined Communication functionality and workflows. When an organization decides to move to a clinical collaboration platform with one unified Communication stream, part of the discussion must look at the system, so the nurse is not just getting a barrage of Communication—but now from one platform or device instead of multiples. Typically, as part of a client’s clinical collaboration platform deployment, we recommend taking a hard look at the numbers and types of messages and alerts going to each role. Is it, for example, important that this particular nurse is the right recipient for a best practice alert about a patient?. Is this the right inundation of communication—or can we identify another resource who might be better as the recipient? A CCP’s unified Communication functionality is a real improvement, but taking the time for discovery before deployment can make things even better—substantially reducing the number and scope of interruptions. CCPs and unified communication can change the nursing experience. A real clinical collaboration platform, with its unified communication functionality, allows nurses to:
- Use one device for HIPAA compliant texting, voice communication, critical alerts, and access to on-call schedules and teams across your entire system.
- Stop wasting time chasing down colleagues.
- Find the right clinician at the right time and recover time lost to inefficient communication.
- Get back to why you got into healthcare: Helping patients.
- Place voice calls with confidence.
- Know who is on call
- Trash outdated and inaccurate paper on-call schedules. Have the confidence to know they can reach any role in any service area across all facilities in their system when they need them.
KLAS lists outcomes of clinical collaboration and Communication deployment.The industry-standard research firm, KLAS, has recently published its “Clinical Communication Platforms 2020—Advanced User Insights.” The research leverages in-depth and on-site interviews with advanced clinical communication users for technology-enabled workflows, including advanced nurse workflows. According to KLAS, while “…a communication platform can be perceived as expensive, especially when shared smart devices are deployed, the problems it eliminates make it worth the cost—advanced users identify poor communication as a significant cause of medical errors. (KLAS, page 5) The survey listed the following outcomes experienced by study participants in the deployment of their clinical collaboration and communication platform of choice. Outcomes included:
- Fewer phone call interruptions
- Improved patient satisfaction or clinical outcomes
- More efficient and timely communication workflows
- Replacement of SMS with HIPAA-compliant asynchronous messaging
- Faster clinician response time
- Decreased length of stay
- Decreased wait times (includes reduced discharge times, bed tracking, patient/clinician communication)
- Reduction in noise (i.e., overhead paging)
- Strong adoption by end-users
- Improved pain management
- Reduced unnecessary readmissions
- Closed-loop between clinicians & communication documentation
- Communication across the care continuum
- Elimination of pagers (improved communication workflows, elimination of pager costs)
- Reduction in falls rate
- Consolidation of nurse tool belt (i.e., scanners, cameras, legacy phones consolidated to one smart device) (KLAS, page 7)