Parkview Medical Center is a 350-bed, nonpro­fit hospital in Pueblo, Colorado. Its aim is, in part, to be the healthcare provider of choice for patients, physicians and employees.

THE PROBLEM

More than 10 years ago, Parkview embarked on an initiative to improve the patient experience through enhanced patient safety, better patient communication and a reduction in medication errors.

Patient experience is crucial to hospitals because, under a key federal value-based purchasing program, as much as 30% of a hospital's incentive payment is based on patients' evaluations of its performance in the Hospital Consumer Assessment of Healthcare Providers and Systems measure.

Parkview also looked to improve the clinician experience, in part by equipping providers with the tools that enable them to communicate more effectively with patients in order to enhance patient education and generate better health outcomes.

Previously, clinicians often were frustrated by the inefficiencies of carrying multiple devices, such as a pager, a barcode scanner and a VoIP phone for voice calls.

PROPOSAL

To help accomplish these objectives, the hospital decided to equip its clinicians with Vocera Edge, a smart mobile point-of-care solution that can orchestrate people, data and processes in real time. Among the safety benefi­ts the technology delivers is the automation of bar-coded medication administration to reduce medication errors.

"Most notably, gains were achieved in the category 'communication about medicines.' It was the second-lowest scoring domain on the survey – raising satisfaction scores from about 20% to 70%."

Steve Shirley, Parkview Medical Center

Additionally, a core component is First Dose Education, a workflow support module that automatically detects when the ­first dose of a medication is being administered and notifi­es the clinician before the BCMA to educate the patient and inquire about questions or concerns. From the mobile technology, the clinician then can fully document this engagement-driving interaction in the electronic health record.

MEETING THE CHALLENGE

Ensuring a positive patient experience starts with safety on all levels, said Steve Shirley, vice president of information technology and CIO at Parkview Medical Center. Medication errors, such as omission, mistaken dosages and incorrect infusion rates, are among the most common mistakes that lead to longer hospital stays, increased treatment costs and negatively impacted patient and family experience, he added.

"To reduce these errors, Parkview automated its BCMA process with Vocera Edge," he explained. "Operating on an intuitive, Apple iOS or Android platform, the solution automatically guides clinicians through safety checks at the point of care to administer and document medications through positive patient identification.

"The handheld device scans and links barcodes on patient wristbands and medications to ensure that the right person is receiving the right medication or service at the right time," he continued. "The solution also scans the barcode on the clinician's ID card to log in and record their identity, provide care team members with access to real-time patient data, and enable clinicians to upload information from the bedside into the hospital's information systems."

Further, to improve patient communication and education, Parkview implemented First Dose Education to help ensure patients' questions and concerns were immediately addressed, he added. 

With true point-of-care access to data from the EHR, the solution enables clinicians to customize new medication reminders, while reference tools are available at their ­fingertips, he said.

"Automated data analysis and reporting detects if clinicians have been delivering education as well as documenting patient questions or concerns," Shirley noted. "Prior to implementation, clinicians charted after the administration without notes, which led to an increased risk for incomplete or inaccurate documentation. The new solution streamlines the process, so every relevant detail is captured at the bedside."

RESULTS

Since implementation, Parkview's HCAHPS scores have increased, including the particularly challenging medication communication metric, which rose by 50 percentage points, Shirley reported. Such improvement is crucial because the Centers for Medicare and Medicaid Services' value-based purchasing program reimbursement evaluates both a hospital's HCAHPS internal improvement and its performance against other hospitals, he explained.

"Following the rollout of First Dose Education, ratings from HCAHPS evaluations showed signi­ficant improvement," he said. "Most notably, gains were achieved in the category 'communication about medicines.' It was the second-lowest-scoring domain on the survey – raising satisfaction scores from about 20% to 70%.

"Additionally, Parkview significantly reduced medication errors from 20% to 8%," he continued. "Similarly, the number of serious errors – for example, the wrong patient, drug or dose – was reduced from fi­ve to zero."

Apart from the patient experience improvement, Parkview clinicians report that the solution helps them deliver safer, higher-quality care that improves their patient communication and engagement and strengthens collaboration with the care team, he added.

"In an internal survey, more than 80% of Parkview's clinicians agreed Vocera Edge and First Dose Education improved their ability to communicate patient information, while nearly as many agreed they feel more connected to their care teams," he said.

ADVICE FOR OTHERS

Patient-clinician communication is key to HCAHPS success, Shirley said.

"Although it is often called a satisfaction survey, many of the 22 HCAHPS evaluation questions do not ask if patients were satisfi­ed, but rather if and how often they experienced effective clinician communication and adequate information sharing," he noted.

"To cost-effectively improve these metrics, hospitals should equip clinicians with mobile, easy-to-use communication tools to help them efficiently and completely address patient questions and concerns," he advised. "These interactions need to be conducted at the bedside, not with the clinician standing at a computer terminal or leaving the patient room where they will likely be interrupted."

Further, providing a smart mobile overlay to the EHR allows clinicians to access clinical data in context, educate and engage patients at bedside, capture richer data, and securely communicate with the trans-disciplinary care team, he concluded.

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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