Anyone who has experienced a family member or friend going to the hospital for surgery knows how hard it is to wait for that loved one to return from the operating room.

THE PROBLEM

Waiting and wondering can cause high levels of stress. All too often, there are few or no updates from nurses and doctors on the status of the procedure until it's over – which can be hours. The lack of communication can cause worry and anxiety, which can negatively impact the patient and family experience.

"Because patients and families have a choice of healthcare providers and where they elect to have surgery, it is important to provide high-level service as well as high-quality care," said Hope Johnson, RN, administrator of perioperative services at Pennsylvania's Lehigh Valley Health Network. "With a focus on improving the healthcare experience, we wanted to improve communication and engagement with patients and families."

It was the hope that connecting with them in a more timely and personal way would help provide more comfort and care to them, while providing market differentiation for the eight-hospital network, she added.

PROPOSAL

The perioperative leadership team at Lehigh Valley Health Network wanted to enhance patient and family communication and deliver a unique healthcare experience. It wanted a secure way to update families before, during and after a surgical procedure in real time so they would not be left wondering and worrying about loved ones.

"We also wanted to give families the freedom to leave the waiting room for a bathroom break or go get a bite to eat without fear of missing the nurse or doctor who may have an update," Johnson explained. "There also are family members who live out of town or who cannot take time off work all day to be at the hospital, but still need and want information about their loved one."

In an effort to provide needed communication and engagement to families and friends, Lehigh Valley implemented the Vocera Ease app, which enables team members to send secure texts, photos and video updates to loved ones that patients select from their contact list. The app also lets family and friends respond to updates with emojis, giving immediate feedback and support to caregivers.

"With a focus on improving the healthcare experience, we wanted to improve communication and engagement with patients and families."

Hope Johnson, RN, Lehigh Valley Health Network

"Before selecting Ease, a multidisciplinary team of perioperative leadership, information services and operating room staff researched potential solutions, and narrowed it down to two," Johnson recalled. "The other solution was more passive, with canned messages sent from the EHR. The challenge with this approach is that the timing of a milestone entered into an EHR is not always accurate or in real time."

It also made patients feel more like procedures rather than people, she opined. 

Ease is more personal and customizable, which fits Lehigh Valley's culture and mission better, she said. While the organization implemented the app before COVID-19 hit, its capability became even more important during the pandemic when visitors were not allowed to accompany patients into the hospital, she added.

MARKETPLACE

On the healthcare communications technology front, vendors include Avaya, Halo, HipLink Software, Mobile Heartbeat, PatientSafe Solutions, PerfectServe, Spok, Telmediq and Vocera.

MEETING THE CHALLENGE

Vocera Ease is being used by Lehigh Valley's care team members to send secure, personalized text messages, photos and video updates in real time to family members and friends who are awaiting the outcome of a surgery. The HIPAA-compliant messages, pictures and videos disappear 60 seconds after being viewed, and nothing is saved on the mobile device. These features provide an additional layer of security and privacy.

"The app is available on iOS and Android devices," Johnson said. "After downloading the free app on their personal device and completing a quick registration process to ensure HIPAA compliance, the patient can create a secure network of loved ones from their contact list to receive all updates clinicians send. Prior to a procedure, our pre-admissions team educates the patient and family about the app, letting them know it is available and helping them download it if they want to use it."

A significant benefit of the application, Johnson said, is that it enables staff to send messages in nine different languages. As a result, nurses can send messages to the families using their first language, further enhancing the patient and family experience.

"It also is important to note that use of the app does not replace face-to-face meetings our surgeons typically have with families, post-surgery," Johnson noted. "Those human connections are still an important part of our process. This program is designed to fill in the gaps between the time patients go in for surgery and this post-operative conversation."

Clinicians also can use the app to notify family members that they need to come back to the waiting area if they stepped away and a face-to-face is needed, she added.

RESULTS

Before implementing the mobile solution, physicians sometimes missed family members who might leave the waiting area to get a drink or go to the washroom, which left some family members upset and still wondering about the status of their loved ones. By receiving real-time, personalized secure messages and photos directly on their mobile devices, loved ones no longer need to worry about missing an update from the care team.

"Since implementing the Ease app, communication and engagement with family members across the country have increased," Johnson noted. "In 2018, we sent 44,195 secure messages and photo updates to patients' loved ones across 47 states. In turn, these families and friends responded to care teams with more than 26,270 emojis, including thumbs-ups, hearts and prayer hands. In 2019, the numbers nearly doubled, with 72,131 messages sent to 49 states and 42,206 emojis received."

During the first three quarters of 2020, nearly 56,000 messages were sent to family members in all 50 states, and 68,479 emojis were sent back in response.

"The app, which has a customizable survey, also gives us insight into patient and family experience in real time," she added. "Based on survey results between January and September 2020, 96% of respondents indicated the hospital demonstrated compassion and caring by offering the app to patients and families. Additionally, 95% said they would recommend the hospital to others based on their experience with the application."

Perhaps the best evidence of success, however, has been some of the free-text comments returned in the surveys, she said. One read: "I think it is great and everyone was amazing with keeping me updated during one of the most nerve-racking points of that day for me. Without this app I would have been a complete wreck." Another said, "The hospital is phenomenal, amazing, great. So are the doctors and nurses. Thank you for all you do!"

"We also heard a story about a woman who was having surgery in one of our hospitals," Johnson remembered. "When she was asked who was receiving the messages about her, she said one of the people was her son, who was a deployed soldier in Afghanistan. To be able to keep him apprised of her progress in real time and ease that burden for both of them, was just incredible."

ADVICE FOR OTHERS

"It is important to evaluate and compare solutions to ensure the one you select will meet your objectives, is easy to implement, and will not complicate clinical workflows," Johnson advised. "That is why it is so important to engage members of the care team early in the evaluation and selection process of a new technology."

If they are the ones who will be using it, they should have a say, she added. Clinical adoption of a new solution can be challenging, so making nurses, doctors and other clinical team members part of the process early helps build buy-in and advocacy, she said.

"Successful deployment of a new technology may need to start in one department with one care team to ensure a smooth implementation process enterprise-wide," she suggested. "We started the robotics team, initially using generic images of technology rather than people. This approach was critical to getting many physicians comfortable with the concept as well as the app. Eventually, the images and messages became more human-centered, once clinical team members became more comfortable with the content and security of the messages."

After creating success in robotic surgeries, word quickly traveled to other surgical departments.

"The competitive nature of cardiologists, neurologists and orthopedic surgeons helped accelerate deployment and adoption," she concluded. "Yet the technology was not deployed in a cookie-cutter approach. Instead, the implementation team worked closely with each clinical team to understand the messages and photos they wanted to share to get them engaged and on board, accelerating the adoption process."

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