Workflow efficiency is of utmost importance in the operating room at UW Medicine’s Valley Medical Center, a 321-bed acute care community hospital and clinic network in the suburbs of Seattle.

THE PROBLEM

The operating room unit includes 18 surgery rooms on two floors, and delays in any activities necessary to expedite pre-op preparation, the speed of the procedure and post-op care – for example, room set-up, instrument sterile processing or transport help – are expensive.

Until 2015, the clinicians, nurses and support staff who had to coordinate these activities communicated with each other using a complex mix of pagers, legacy phones and whiteboards. In this environment, it was difficult to even track the location of valuable operating room equipment.

“We needed a faster, easier way for everyone to connect with each other and share patient and workflow information,” said Jeremy Wyatt, manager of perioperative services and manager of sterile processing at the UW Medicine Valley Medical Center. “In 2015, we consolidated operating room perioperative communications and alarm/alert notifications on the HIPAA-compliant Voalte smartphone system.”

This was part of a hospital-wide rollout of Voalte communications technology with goals aligned with the medical center’s four “Patients Are First” strategic pillars – provide the highest quality care, improve patient experiences, lower costs, and become an employer of choice by improving clinician and staff experiences.

PROPOSAL

The Valley Medical Center multidisciplinary team selected the Voalte platform, a comprehensive communications platform for secure text messaging, alarm and alert notifications, and voice calls.

The platform connected care teams by replacing outdated communication devices such as pagers with smartphones that feature a unified, patient-centric directory and integration with existing information systems.

“By expediting communication and collaboration between caregivers and staff, this solution was intended to improve workflow efficiency, reduce operating room turnaround times, and help alleviate stress for physicians and nurses caused by communication delays or errors,” Wyatt explained.

MARKETPLACE

There is a variety of vendors of clinical communications technology platforms on the health IT market today. Some of the vendors of this technology include DocbookMD, Halo, Imprivata, Klara, Lua, QliqSOFT, Spok, Telmediq, TigerConnect and Vocera.

MEETING THE CHALLENGE

To best address the communication issues, Valley Medical Center integrated the communications platform with its Epic Rover EHR, Connexall middleware and Rauland nurse call system.

“We put shared Apple iPhones in the hands of everyone – operating room and circulating nurses, anesthesia providers and technicians, patient care assistants, transport staff, surgical services technicians, admitting staff, and the post-anesthesia care unit staff,” Wyatt noted. “The easy-to-use directory includes a status bar that provides information on the availability of nurses, technicians and other staff, patient room assignments and back-up coverage.”

"The use of smartphones had a direct impact on significant improvements we’ve made in measures directly related to clinical communication, including the quietness of the hospital, communications with nurses and the response of hospital staff."

Jeremy Wyatt, UW Medicine Valley Medical Center

Since staff use the Voalte and Connexall technologies throughout the medical center, messages and alert notifications are sent efficiently to the relevant staff, he added.

“For example, all code notifications with the location of the patient’s room are now sent to the entire code team,” he explained. “If a patient who is not supposed to leave the bed without help gets out of bed, our bed exiting system sends an alert to the nurse assigned to the room. By integrating Voalte with our nurse call system, nurses directly receive patient calls and can immediately talk to the patient when appropriate.”

The ability to assign roles in the communications platform directory has been particularly helpful to Valley Medical Center staff.

“For example,” Wyatt said, “we’ve added operating room charge nurse as an ‘assignment,’ which enables that person to send notifications to all the relevant staff when cases are added on or room assignments change. The first icon on every Connexall screen is a big red dot called ‘Anesthesia Stat,’ which can be initiated when an event is not going as planned and is programmed to go to every employee in the perioperative department.”

In addition to time-saving benefits, the communications platform has enabled Valley Medical Center to drastically reduce the need for overhead paging, he added.

“Having a surgical procedure can be an extremely stressful experience, and constantly hearing announcements on a pager does not ease that anxiety,” he stated. “It’s not surprising that numerous studies have shown that noisy hospital environments correlate with poorer outcomes. Noise is also detrimental to the staff, since working in a loud environment is not going to have a calming effect needed to give the best care to the patient.”

RESULTS

Time is one of the most precious assets in the operating room, a determinative factor not only in patient care but also in economic terms.

“An average operating room minute is $130, which means that if we reduce the time per case by just one minute, we save Valley Medical Center $1.56 million in staffing efficiency on the 12,000 surgeries the operating room does each year,” Wyatt explained. “Since integrating the Voalte platform with Connexall and Epic, the improved efficiency in the operating room has saved Valley Medical Center tens of millions of dollars. By being able to do more in less time, we are increasing the number of surgeries we perform by an average of 200 cases per year.”

The integrated communications system is used throughout most of the medical center, and since staff made communication technology upgrades in 2015, Valley Medical Center’s Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores have improved in every measure except for one – cleanliness of hospital environment.

“The use of smartphones had a direct impact on significant improvements we’ve made in measures directly related to clinical communication, including the quietness of the hospital, communications with nurses and the response of hospital staff,” Wyatt said. “Interestingly, environmental services is the only department that currently does not use Connexall and Voalte smartphones. The phased rollout of the smartphone system began in renal respiratory, which became the hospital’s first unit to receive a 99% rating on a patient satisfaction survey.”

ADVICE FOR OTHERS

“It’s critically important to understand how new communications technology will be used in daily practice,” Wyatt advised. “During the planning phase, solicit input from all smartphone users to fully understand clinical and communication workflows and their specific challenges and information needs.”

Informaticists need to involve clinicians early in the process to understand how workflows intersect with and affect the use of technology, he added. Educating clinicians on what the technologies can do and how they will be used helps earn their trust that these changes will lead to better patient care and outcomes, he said.

“Another key consideration is setting up the directory to facilitate appropriate pathways for communication handoffs and alarm and alert filtering to smartphones, particularly for time-sensitive messages,” he concluded. “Informaticists, IT personnel and nurses need to work collaboratively before, during and after implementing the new technology. It’s important to recognize that clinical communication is a fluid, ever-changing process that requires constant attention and refinements.”

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