Have you ever been a patient or visitor in a hospital? I’m sure you have. And, if you’ve ever spent time near a Nursing station or in a patient room, you have no doubt heard a menagerie of beeps, bells and alarms. In fact, I’m sure you have asked yourself at least once – is anyone paying attention to the noise?
In today’s world of Healthcare IT there is more and more focus on integration between medical devices, patient communication devices and the EMR. Additionally, device related caregiver to caregiver secure communication is rapidly becoming the norm across many organizations with the introduction of smart phones as a commonplace tool. As this integration develops, healthcare providers are faced with a growing number of alerts, alarms, notifications and communications to manage on a variety of devices. The question becomes – What defines the right alert at the right time to the right person?
On a recent client engagement, Impact Advisors delved into that question. While building a brand-new patient care facility, a myriad of opportunities for device integration with the EMR became available. With each new integration point came additional questions such as:
- How do we manage this data?
- How does the EMR receive this information and how do the third party vendors send it?
- Who should receive this particular alert?
- What’s the escalation path and timeframe?
- What are the policies and procedures for managing the information at the clinician level?
I am sure you can imagine from the short list above, each question begets more questions. Before us was an opportunity to be on the bleeding edge of integration, patient satisfaction and safety improvement, workflow efficiency and regulatory compliance. Yes, even regulatory compliance. With all the new alerts comes a critical importance – we cannot wear out the care givers. The need to be thoughtful about the necessity and effectiveness of such “noise” so as not to create “alert fatigue” was paramount. This point is so critical that the Joint Commission even made it a Patient Safety Goal requiring hospitals to establish policies, procedures and education for managing specified alarms and the purpose and operation of alarm systems. It makes sense, right? Why alert someone to something if they become so desensitized by them that they don’t even hear it?
As important as valuing the alerts themselves, the team also needed to map out how the devices route information to the EMR. EMR’s typically come with a number of robust tools that receive alerting information from devices and, through a set of rules, determine if those alerts should make it to the end user. If so, they know which end user to send them to and on which device (smart phones for example). These rules also contain escalation paths. So, if Nurse One does not respond to an alert, within “x” amount of time the alert escalates to Nurse Two and so on until the alert is managed. These rules allow for a variety of routing and escalation paths to bridge the gap to the right alert, at the right time, to the right person.
During the device integration and alarm management project, the client, Impact Advisors, the EMR vendor and third party vendors went through a painstaking process of assessing each alert that could be provided by the device. For some devices, such as physiological monitoring, there were over a thousand potential alerts. As each alert was evaluated, the team took great measure to ensure the notifications were of value to the caregiver. Many potential alerts were turned off and the focus was placed on alerts that were patient critical and provided significant importance to clinicians. The team constantly asked themselves – “is this one too many?”
When the doors to the new facility opened, the client was well prepared to manage the new devices, integration and alerts that were part of the expansion. Pilots had been completed, training was detailed and mock simulations had been executed. In each case, the team again reviewed the alerts – are they effective? Are they necessary? Do they provide value? Do they improve efficiency and increase safety and patient satisfaction?
In the end, the answer was yes. And patient safety, communication and EMR documentation was improved through the integration of devices such as smart beds, nurse call, physiological monitoring and other solutions. Through the collaboration of Impact Advisors, the EMR vendor and device vendors, the clinical landscape became more effective and efficient. But alert management is not a “one and done” project. It requires diligence and continual monitoring and review to ensure that alarm fatigue has not become commonplace and clinicians are still finding value in the process.
So, the next time you wonder – “is anyone paying attention to that incessant beeping?” The answer is yes. More people than you know!