25-08-2017, 09:32 PM
Role of Wireless Communication in Patient Response Time: A Study of Vocera Integration with a Nurse Call System
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ABSTRACT:
The goal of this paper is to investigate the use and impact of wireless Voice over Internet Protocol (VoIP) communication technology developed by Vocera communications and used by clinicians and mobile workers in a healthcare setting. Of particular interest for this study was the impact of a newly installed component of the Vocera system, the Vocera Messaging Interface (VMI), which enables connectivity between external systems and the Vocera system via the Vocera Server. We focused on a specific VMI application used in the healthcare industry that directly integrates Vocera with Nurse Call Systems. In this Vocera Nurse Call Integration (NCI) application, bedside calls from patients using the hospital’s Nurse Call System trigger messages that are sent directly to the primary care giver. Primary care givers can read or play messages and either speak a command or respond to the call to the patient’s pillow speaker via the PBX/Nurse Call system. The primary objectives of the paper were to measure the effect of using NCI on response times to patient requests and to analyze qualitatively the benefits of using the Vocera Solution.
This paper focused specifically on communication between caregivers and patients. This data gives the relationship between integrating the Nurse Call System with the Vocera System and the time required for a caregiver to respond to a patient request. In addition to this, a qualitative analysis of the use of the system for clinician-to-clinician and clinician-to-external communication outside of the Vocera NCI use is conducted.
In June 2005, the Center for Health Information and Decision Systems (CHIDS) was contracted to conduct a research study at St. Agnes Hospital in Baltimore, Maryland by Vocera Communications, Cupertino, California. St. Agnes purchased the Vocera Communications System in 2003 and has been deploying it in stages in terms of functionality and units since that time. It is currently deployed in a variety of units and is used by many types of clinicians and staff members, including but not limited to nurses, administrative staff, technicians, and physicians. Vocera and St. Agnes, with assistance from an independent consulting group, conducted a ‘Benefits Study’ in December of 2003. This study yielded important findings related to the time savings and financial benefits resulting from the implementation of the core Vocera system. However, this study did not examine the impact of the Nurse-Call or PBX integration. The study conducted by CHIDS investigates two phenomena: Vocera Nurse-Call Integration system (NCI) and non-NCI utilization.
INTRODUCTION
Communication has long been recognized as a critical factor in healthcare. There are few service organizations that require the extensive degree of interaction between highly trained and skilled staff members and the large percentage of mobile workers as is required in the healthcare environment. Clinicians and hospital staff recognize the value of timely communication and the importance of effectively accessing knowledge and expertise. Hospital executives manage the need for timely communication by co-locating key medical staff and by adopting prove communication technologies. In the early 1980’s, the presence of a pager on someone’s belt marked his/her role as a physician. Now, in many instances, cell phones have taken the place of the pager, but there are limitations to cell phones. These include dead spots in coverage, rooms where cellular technology cannot be used, and the ever-present limitation of being primarily one-to-one devices with limited ability for broadcasting messages. New technologies are being utilized within healthcare delivery systems that improve communication between peers, between the patient and clinician, and between subordinate and supervisor.
With the advent of wireless communications, we now are in a situation where the technology is becoming mature, stable, and easier to use. This ubiquity will ultimately lead to real-time delivery of information to the decision-maker.
In essence, the wireless system acts as the underlying architecture for a hospital-wide information portal.
Vocera Nurse-Call Integration (NCI):
In the simplest terms, the Vocera NCI integration enables a two-way communication link between primary caregivers (i.e., the assigned nurse) and patients. Vocera NCI enables a direct communication link between the existing nurse call communication equipments integrated into each hospital bed and the Vocera badges carried by each nurse. The integration between the existing nurse call system and Vocera is achieved through use of the Vocera Messaging Interface (VMI). VMI can also be used to connect patient monitoring systems, Scheduling software, bed management applications and other systems to the Vocera system. The integration between the Vocera system and the nurse call system gives the caregiver maximum flexibility in responding appropriately to patients’ needs. The specific features that are used at St. Agnes include:
Facility Description:
St. Agnes Hospital is a 300-bed non-profit hospital located in Baltimore, Maryland. It is part of the Ascension Health system and primarily serves Baltimore and the surrounding region. It is a full service community teaching hospital, with approximately 23,000 admissions annually and is classified as a ‘General Medical and Surgical’ hospital. The Vocera Solution was purchased by St. Agnes in 2003 and has been deployed in stages in terms of functionality and units. St. Agnes had deployed its enterprise-wide wireless LAN in the late 1990’s. A separate virtual local area network (VLAN) was also created for transport of wireless voice calls. Our field study began June 28, 2005 and was completed on August 19, 2005—after more than 120 hours of direct observation. Our researchers observed two units, 6 North and 6 South during this time frame.
CONCLUSION:
In summary, we find that the Vocera NCI increases efficiency in the units, observed. We find strong, statistically significant evidence that the Vocera NCI reduced overall time for completing a patient request and that it altered the workflow of the clinicians in a positive way such that reductions of up to 51% in response time were experienced. A simple summary of the observational data both for NCI and non-NCI shows that Vocera is being used in various, creative ways that were not initially envisioned. We expect that new uses will continue to emerge as the system becomes even more integral to the overall workflow.
Using regression analysis, we found strong, statistically significant evidence confirming that the use of the integrated communication system reduced overall mean time for completing a patient request by 51% (potential savings of $37,700 per year per unit) across all observations when controlling for observation type. In addition, an analysis of clinician’s use of the system based on different types of patient requests indicated that it enables clinicians to have more control in prioritizing and responding to requests according to their seriousness. In addition, we found several interesting ‘creative’ and ‘evolving’ impacts of the system.
For example, we found that the Vocera Solution feature of connecting to others through spoken name recognition contributed to a more positive working environment by creating relationships among coworkers.
Overall, the implementation of the Vocera system along with the nurse-call integration system represents a total savings of 5,137 labor hours per year per unit or roughly 2.5 FTEs per unit. This yields an approximate savings of $120,000 per year per unit8. We should also point out that there may be additional efficiencies and new uses as the Vocera NCI becomes more integrated into the workflow process of the staff.