A Guide to The Joint Commission’s Communication Goal

A GUIDE TO THE JOINT COMMISSION’S COMMUNICATION GOAL

STATED MISSION

MISSION:

To continuously improve healthcare for the public, in collaboration with other stakeholders, by evaluating healthcare organizations and inspiring them to excel in providing safe and effective care of the highest quality and value.

http://www.jointcommission.org/the_joint_commission_mission_statement/

IMPROVING HOSPITAL COMMUNICATION

NATIONAL PATIENT SAFETY GOALS (NPSG)

Improve the safety and effectiveness of communication among caregivers

NPSG.02.03.01Report critical results of tests and diagnostic procedures on a timely basis

http://www.jointcommission.org/standards_information/npsgs.aspx

NPSG.06.01.01Clinical alarm safety for hospitals and critical access hospitals

THE NEED FOR BETTER COMMUNICATION

http://www.jointcommission.org/Sentinel_Event_Statistics/

5

U.S. hospitals waste more than $12B/year from communication inefficiencies*

A 500-bed hospital is estimated to lose more than $4M/year from communication inefficiencies*

Annual malpractice payouts for communication breakdowns quadrupled 1991-2012 to $91M**

THE COST OF POOR COMMUNICATION

*Agarwal, R., Sands, D.Z., Schneider, J.D. (2010). Quantifying the economic impact of communication inefficiencies in U.S. hospitals. Journal of Healthcare Management, 55(4), 265-82

**Journal of the American College of Radiology, Volume 8, Issue 11, Pages 776 -779, November 2011

TECHNOLOGY THAT CAN HELP IMPROVE MOBILE WORKFLOWS

The right INFORMATION: Clinical alerts and test results

The right PERSON: Reaching hospital staff and on-call providers

The right DEVICE: Smartphone, tablet, pager, Wi-Fi phone

The right TIME: Speed and effectiveness

1

2

3

4

THE RIGHT INFORMATION: CLINICAL ALERTS AND TEST RESULTS

CLINICAL ALERTING: MANY ALARMS PER PATIENT PER DAY

alarm conditions per day - per bed350

• Bad data or sensor• Not set to actionable levels• Duplicate alarms• Thresholds too tight•Many false positives• Closed doors make it difficult to hear alarms

85-99% of alarms are non-actionable

http://www.aami.org/htsi/SI_Series/Johns_Hopkins_White_Paper.pdf

HELPING STAFF RESPOND QUICKLY

Sorting, prioritizing, and routing input sources like

patient monitoring and nurse call to staff’s mobile devices

ALARM MANAGEMENT FOR PATIENT SAFETY & SATISFACTION

•Faster staff response to dangerous changes in patients’ vital status•Reduce overhead paging to promote quiet healing•Handle patient requests more quickly and easily•Reduce accidents and falls•Higher satisfaction

TRADITIONAL WORKFLOW

Nurse tries to fix unsuccessfully and calls

telemetry tech to fix

Nurse hears alarm, runs to patient room, and sees it

is a lead malfunctionPatient monitor alarm

goes off

Nurse puts patient on portable telemetry monitor to continue

patient monitoring until hardwired monitor is fixed

PATIENT ALARM - LEAD MALFUNCTION

CNA or tele tech troubleshoots lead and learns they need to text

biotech engineer

CNA or tele tech receives high-priority alarm on

smartphone and goes to patient room

Patient monitor alarm goes off due to lead

malfunction

CNA or tele tech puts patient on portable

patient monitor until biotech fixes hardwired

patient monitor

WITH

PATIENT ALARM - LEAD MALFUNCTION

High Priority:Lead off alertRoom 203

Nurse and team arrive in patient room quickly and

begin defibrillation

Nurse receives urgent priority

V-fib alarm on smartphone and calls for staff

assistance on the way to the patient room

Patient monitor V-fib alarm

goes off

WITH

PATIENT ALARM - V-FIB ALARM

Urgent:V-Fib alertRoom 203

IMPROVING ALARM MANAGEMENT

• Reduced alarm fatigue improves patient safety

• Better patient response improves patient care

• Improved staff efficiency and satisfaction

• Works with the systems and devices you already use

CRITICAL TEST RESULTS MANAGEMENT: MANY TESTS, MANY RESULTS

http://www.asrt.org/main/standards-regulations/federal-legislative-affairs/state-and-federal-licensure-issues

http://wwwn.cdc.gov/futurelabmedicine/pdfs/2007%20status%20report%20laboratory_medicine_-_a_national_status_report_from_the_lewin_group_updated_2008-9.pdf

RADIOLOGY TESTS

LAB TESTS

Approx. 400 million radiology exams are done in the U.S. per year

Approx. 6.8 billion lab testsare done in the U.S. per year

RESULTS ONLY MATTER IF THEY’RE RECEIVED

Of test results specifically cited as a factor in a malpractice case:

Journal of the American College of Radiology Volume 8, Issue 11 - November 2011 Pages 776-779

“Of malpractices cases ... 75% are communication related.”

MOST COMMON PROBLEMPatient didn’t receive test resultsSECOND-MOST COMMON PROBLEMClinician didn’t receive test results

TRADITIONAL WORKFLOW

After some phone tag, Radiologist speaks with the ordering physician

about the patient

Results are critical

Radiology tech attempts to contact ordering

physician

Physician recommends patient has chest x-ray

Treatment begins

COMMUNICATION BREAKDOWN

CRITICAL TEST RESULTS

WITH

Results are sent immediately to the

physician’s device and includes audit trail

Results are critical

The patient’s physician must be notified

Physician recommends patient has chest x-ray

Attending physician takes immediate action

Results are entered into Spok

CRITICAL TEST RESULTS

CLOSED LOOP FOR CRITICAL TEST RESULTS

• Increase patient safety and satisfaction

• Meet regulatory requirements• Speed patient discharge• Reduce liability• Improve physician productivity

THE RIGHT PERSON: REACHING HOSPITAL STAFF AND ON-CALL PROVIDERS

THE RIGHT DEVICE: SMARTPHONE, TABLET, PAGER, WI-FI PHONE

SMARTPHONES IN HEALTHCARE

IT teams want to meet physician requests while

ensuring security and reliability.

Clinicians demand consolidated messaging on their smartphones.

SMARTPHONES IN HEALTHCARE

• Communication ranks in the top three causes contributing to sentinel events (as reported to the Joint Commission)

• The Joint Commission says texting is unacceptable for treatment orders– Cannot verify identity of sender– Need to keep the original message as validation

for medical record entry

WHAT’S MISSING WITH STANDARD TEXTING

• Staff directory integration• Prioritization of critical messages• Separation of patient and personal• Audit trails and escalations• Security for electronic protected

health information (ePHI)

SPOK MOBILE™

Secure, encrypted receipt of messages on smartphones

and tablets

Message to anyone in your organization’s directory with

traceable communications

Improve efficiency and workflows via better information

sharing at critical points

SECURITY AND ENCRYTION: PROTECTING SENSITIVE INFORMATION

• Provide security for ePHI• Meet HIPAA and HITECH Act guidelines

with a business associate agreement (BAA)

• Encryption via SSL connection – application, as well as data during transit and storage— Text, images, and video files

• Remote device wipe and automated message removal

• Application screen lock and access code

WHAT DIFFERENTIATES SPOK MOBILE?

Technical differentiators• Option for premise or hosted in cloud • Device diversity– Smartphones, tablets, desktop / laptop

• Escalations for unanswered messages

• Programmable templates• Receive alarms and alerts from

nurse call, patient monitors, Lab, Radiology and EMR systems

THE RIGHT TIME: SPEED AND EFFECTIVENESS

• Advises average 90-minute “door-to-balloon” time– American Hospital Association– American College of Cardiology

• All hospitals must track this metric• ‘Code STEMI’ at Spok customer

IU Health Goshen Hospital– 129-minute average– Time wasted with extra calls– Uncertainty about who should do

what

AVERAGE DOOR-TO-BALLOON TIME: A KEY METRIC

BEFORE SPOK

Manual Paging

Manual Phone Tree

Wasted Time

Unconfirmed Responses

BEFORE Spok® e.NOTIFY = 129 MINUTESTIME TO COMPLETE THE PROCESS:

START

RESPONSE TEAM• Cath lab staff • House supervisor• ICU shift

coordinator/nurses

• Attending cardiologist• Cardiovascular

coordinator• ER director• Cardiovascular director

• ER shift coordinator• X-ray/imaging

technicians• Lab technicians

Heart Attack Balloon Successful

Over communicate to ensure proper response

Inefficient phone trees among 30

people

THE CODE STEMI ALERT: WITH SPOK

Heart Attack Balloon SuccessfulStaff Respond w/Availability

Use Spok e.Notify to Deploy Code

Spok e.Notify Manages Response & Escalation

RESPONSE TEAM• Cath lab staff • House supervisor• ICU shift

coordinator/nurses• Attending cardiologist• Cardiovascular

coordinator

• ER director• Cardiovascular

director• ER shift coordinator• X-ray/imaging

technicians• Lab technicians

Spok e.Notify• Logic for on-call calendar• Auto escalations based on

responses or non responses from staff

• Eliminates manual calling trees and messy escalations

BEFORE Spok e.NOTIFY = 129 MINUTESTIME TO COMPLETE THE PROCESS:

START

WITH Spok e.NOTIFY: 68 MINUTES

THE RESULTS

• Reduced average door-to-balloon time from 129 to 68 minutes• Improved response time and patient care• ER operator or house supervisor sends code STEMI notification

to 30 staff members• Staff members respond with status• Escalations and follow-ups as necessary• Process review after each event to improve wherever possible

IN REVIEW

Better workflows improve patient care and satisfaction

Right information, right person, right device, right time

Technology can significantly improve communication efficiency

Efficient communications increase patient safety and satisfaction, improve provider satisfaction, and support the delivery of excellent care

LET’S GET IN TOUCH!

Learn more:

CASE STUDIES VIDEOS

We’d love to hear from you!

[email protected]