The Evolution of Nurse Call

June 4, 2020 Kathleen Harmon

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Implementation Design to Optimize Your Investment

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Welcome to the first blog in our five-part series on clinical communication and collaboration technology convergence.  Today, we explore the transformation of nurse call implementation strategy over the past decade and share emerging best practices to maximize the value of your nurse call investments. 

Getting nurse call functionality and workflows right is critical to improved patient engagement and satisfaction, care quality, and safety. Historically, health systems have selected and deployed nurse call systems with a heavy focus on meeting regulatory and enterprise standards, basic life safety, and way finding needs. This led to nurse call technology being viewed simply as a must have system typically owned by Clinical Engineering. The elevation of the Nursing Informatics specialty in more mature health systems, and the continuing trend of merging Information Technology with Clinical Engineering, has brought significant improvements to clinical workflow and patient experience in technology deployments. This shared governance approach has led to workflow-driven implementations that are closely tied to organizational goals. Outcomes are measurable and impactful, are embraced by the frontline care team, and commonly include:

  • Reduced falls per the ability to deliver immediate verbal safety reminders to the patient’s pillow speaker
  • Improved care team responsiveness driven by the care team setting their own service standards
  • Reduced exposure to isolation rooms via the ability to cancel a nurse call event on a mobile device

While this outcomes-first trend has begun to take hold, the majority of health systems we observe still demonstrate the following:

  • Nurse call standardization and upgrade is a priority based on vendor-reduction initiatives or replacement of non-supported legacy systems — sometimes 15 or more years old. However, process redesign is not owned by a defined clinical or informatics operations team
  • A formal strategy exists for implementing nurse call optimization to improve clinical workflow and patient experience, but the funding and resources to execute are not yet in place
  • A cohesive nurse call optimization and upgrade project is in progress, but has stalled based on competing funding or resourcing needs

In all of these cases, the organization remains in a position of unrealized value from its nurse call systems.

Why is nurse call optimization important right now; especially considering the COVID-19 pandemic and the resulting financial and care delivery disruption?

With the shift to an enterprise approach across all IT systems, including communication and collaboration, EMR interoperability, and patient engagement technologies, nurse call projects must be included in the equation. It is critical for Nursing Informatics roles to lead design and optimization efforts across all of these systems. Without clinical leadership, the following common challenges can emerge:

  • Customization of processes by department, long accepted to avoid the challenge of gaining consensus on clinical standards, are no longer possible or logical
  • Multiple systems delivering similar functionality create significant fragmentation and confusion for the clinical team, and in turn, for the patient and family. A flashpoint for this issue occurs when a health system is attempting to upgrade and optimize nurse call at the same time as interactive patient systems and/or in-room voice recognition capabilities. The patient may be left with three to four different pathways to reach to the care team during a stay, driving dissatisfaction and potentially impacting safety
  • The primary care team does not leverage the full set of the nurse call system’s available tools for service reminders based on a “get the basics installed and move on” mindset, leaving value unrealized
  • Alert fatigue, alert fatigue, alert fatigue. Every new nurse call system comes with a promise of “workflow automation through timely reminders.” The lack of a clinically-relevant, comprehensive framework for assessing and prioritizing new alerts types can be rejected by the care team, immediately derailing the project
  • A lack of clarity on how traditional nurse call processes, such as issue resolution, should be retained or redesigned in the post-COVID world of significant increases isolation patient populations

When Nursing Informatics leadership is involved early and often, nurse call workflow design and planning is based in a firsthand understanding of clinical and operational impacts which optimizes functionality and increases adoption and care team satisfaction.  A critical first step is determining desired clinical outcomes and implementing a process to measure pre- and post-implementation impacts to patient satisfaction, staff engagement, quality, and safety. In an outcomes-first approach, it is important to consider:

  • Nurse call workflow design is not one-size-fits-all.  Specialty areas and unique staffing models require variability. Specifically, the ED and OR where assignments are unique and often geographically based. And the ICU where primary nursing care is common, and the patient population is less engaged with nurse call per the criticality of their conditions  
  • Extending escalation times. Rather than escalating at 30-60 seconds, extending that time further allows the primary caregiver adequate time to respond
  • Prioritizing urgency of need to minimize the number of care givers who are interrupted.  Only headwall or bathroom emergencies should alarm multiple caregivers
  • Patient and family education about pillow speaker workflows, response expectations for each differential button, and how the patient and family can play an active role in their care
  • Cancelling on answer vs. in-room for isolation areas. Once the caregiver verbally validates patient need, the nurse call alert can be canceled vs. the caregiver needing to enter the patient room to cancel the alert source
  • Using the set service option to remind caregivers to close the loop on the patient request

Designing nurse call system implementation per the above gives primary care roles the opportunity to address patient need, supports closed loop clinical workflows, and provides a strong foundation for meaningful reporting on rounding compliance and variable acuity trends. 

When nurse call system implementations are done right, health systems see increased patient satisfaction based on active engagement and empowerment. Nurses and support teams are more deeply engaged and take ownership of patient-to-care team communication by fully utilizing nurse call investments to support workflow, manage interruptions, and limit on-device time by visually/audibly triaging.   

In part 2 of our series, we will discuss the importance of EMR alignment with nurse call and the impacts to clinical communication workflows.

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