Avera Health is a health system based in Sioux Falls, South Dakota, that serves a population of nearly 1 million people across five states through 36 hospitals, more than 200 primary and specialty care clinics, and more than 30 senior living facilities.

THE PROBLEM

Until 2014, Avera's providers and caregivers relied on a complex mix of pagers and legacy phones for communication. It needed a faster and easier way to enable its caregivers to connect with each other and share patient information.

Some providers and other licensed caregivers were carrying two or three devices at a time, which proved burdensome. In addition, alarm fatigue was a concern for those caregivers, so an integrated alarm system with a secure communication device was requested by many throughout the Avera Health system.

PROPOSAL

A multidisciplinary team, including bedside providers and licensed caregivers, selected the platform from vendor Voalte, a comprehensive communication platform for secure text messaging, alarm and alert notifications, and voice calls.

Voalte Platform connected care teams using a unified, patient-centric directory, replaced outdated communication devices such as pagers, streamlined multiple devices with one system across all facilities, and integrated with existing systems.

MARKETPLACE

There are a variety of healthcare communications platform offerings on the market. Vendors of these technologies include LiveProcess, PatientSafe, Spok, TigerConnect and Vocera.

MEETING THE CHALLENGE

Avera uses three Voalte Platform systems. The staff for e-services (Avera's telemedicine system), ambulatory care clinics, long-term care and hospital nursing stations use the Voalte Messenger desktop client.

Nursing staff, pharmacists, licensed professional staff and others in Avera hospitals use Voalte One on shared Voalte smartphones. Almost 1,000 providers in more than 50 physician and advanced practice provider groups use the Voalte Me app on their personal smartphones.

"Because Avera covers such a large geographic area, physician specialists including cardiologists, nephrologists, psychiatrists and other physicians may need to visit as many as 55 unique sites," explained Candice Friestad, RN, director of clinical informatics at Avera Health.

"Before we began using Voalte Me, it was not unheard of for physicians to use their smartphones to text as well as perhaps take a photograph of an onscreen radiology image using a personal phone and send the image to colleagues for consultation. With Voalte Platform, we now have a secure way to exchange images."

"Because physicians can assign themselves to patients, or roles or teams, anyone on the care team can quickly and efficiently reach the proper physician."

Candice Friestad, RN, Avera Health

The ability to assign roles in the Voalte Directory has been particularly important in smaller facilities in the health system, where caregivers typically rotate among multiple functions. This functionality ensures that all roles are covered and makes it clear who is filling a given role on the current shift.

"Similarly, when nurses and support staff are assigned to rooms, physicians can immediately identify and communicate directly with the bedside care team," Friestad said. "And because physicians can assign themselves to patients, or roles or teams, anyone on the care team can quickly and efficiently reach the proper physician."

Voalte Platform integrates with the Meditech electronic health record, Connexall middleware, Rauland Responder nurse call system, and Drager and Phillips monitors at Avera Health.

"Four of the ECRI Institute's top 10 safety concerns for 2018 are answered by Voalte Platform integration capabilities in use at Avera," she added. "These features include accessing patients' EHR information, transmitting alarms from patient monitoring equipment to caregivers' Voalte smartphones, and sending critical labs directly to the care team."

RESULTS

Time to discharge at one hospital has dropped from three hours, 22 minutes in May-June 2014 to two hours, 57 minutes in FY18. And for improved patient care, the number of times respiratory therapy reported late or missed medications dropped by a factor of 10.

"Before Voalte, printed orders or searching the EHR were the only way for respiratory therapists to know when a new order had been issued," Friestad said.

"They needed to check the printer or a PC for orders every few minutes, but often found it difficult to allocate the time to do this," she explained. "A pre-Voalte implementation survey revealed that 100 percent of Avera's respiratory therapists missed at least one therapy or medication order per day by at least 30 minutes, a number that includes patient refusals."

As part of the Voalte Platform implementation, order notifications were immediately sent to the responsible therapist's smartphone. The result: Since the platform rollout in 2015, only 11 percent of respiratory therapists per day now miss an order by 30 minutes – nearly 10 times fewer than before, and this metric includes those patients that refuse a treatment.

"Another example of how we're using this technology to improve efficiency and reduce wait times for patients involves our discharge process," she said. "Once a discharge order is entered into the EHR, Voalte Platform leverages Connexall middleware to simultaneously send it to the unit, charge and bedside nurses, pharmacist and pharmacy tech, respiratory therapy, case management, and social workers."

ADVICE FOR OTHERS

"One key piece of installing this technology is the teamwork required with clinicians and information technology to assure a robust wireless and security infrastructure that the system can rely on," said Friestad.

"In addition, to involve your bedside caregivers and other users in the setup for improving their workflow. It's especially important to make sure the directory is easy to use, supports clinical workflows and helps standardize communication across disciplines, and in Avera's case, across hospitals and other healthcare facilities that are in multiple states."

Another key consideration is setting up appropriate pathways for communication handoffs and alarm and alert filtering to smartphones to avoid miscommunication and expedite responses to time-sensitive messages, she added.

With the platform, Avera Health nurses, other healthcare professionals and physicians spend less time trying to communicate with each other and more time caring for their patients, she concluded.

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com