How clinical communication tools help improve one ER's 'left without being seen' rate

This case study shows how Hardin Memorial Hospital lowered that rate from 5.6 to 2.2 percent – and improved its HCAHPS scores thanks to better communication between doctors and patients.
By Bill Siwicki
10:29 AM
Vocera Minute hanging on neck of a doctor

Hardin Memorial Hospital, in Elizabethtown, Kentucky, had a clinical communication system in the emergency department that just wasn't cutting it for caregivers. It needed a better way for emergency clinicians and others to communicate in the frenzy of the emergency room and with colleagues elsewhere in the hospital.


The ED at Hardin Memorial had been using the Voalte app on a smartphone for clinical communication. Clinicians had said this was a cumbersome task, as the emergency department is an extremely fast-paced environment. Most of the nurses and physicians would carry their phones in their pockets, which meant they may or may not immediately see a call or a text come through.

Additionally, even if they heard the phone, stopping what they're doing to read the message and reply back was disruptive. This caused delays in communication, which was frustrating to the staff. Due to that frustration, many of the nurses and physicians stopped using the smartphone – which also caused delays. This impacted flow in the department, emergency department wait times, patient satisfaction and staff satisfaction.

That's when Hardin Memorial found technology Vocera Communications that armed clinicians with instant, wireless voice communication badges that could be controlled with verbal commands. Medical staff now are equipped with the Vocera Badge, which is worn around the neck and allows for hands-free voice communication from anywhere in the department.


In addition to Vocera, there are many clinical communications technology systems on the market today. Vendors include Cisco, Critical Alert Systems, DrFirst, Everbridge, OnPage, QliqSOFT, Telmediq and TigerText.


Implementing the hands-free communication system has made a tremendous difference in the emergency department, which subsequently has positively impacted patients, their families and staff – said Deanna Parker, assistant vice president of emergency services at Hardin.

"Anyone in healthcare knows how challenging communication is due to the high stress and ever-changing environment," she explained. "Inadequate communication is frustrating for staff because it takes time away from caring for the patient. All clinicians go into healthcare wanting to provide excellent care, so not being able to communicate effectively impacts the health of your work environment."

"Clinicians have the ability to communicate needs in the moment, which ultimately impacts the care provided at the bedside."

Deanna Parker, RN, Hardin Memorial Hospital

Being able to communicate in an effortless manner has drastically reduced the frustrations of the staff, improving the morale of the department, she added. When staff are more satisfied and engaged, research shows that translates to the bedside, and Hardin Memorial has seen just that, she said.

"The device also offers additional support from a safety aspect, which is a huge vulnerability and concern for anyone working in an emergency department," Parker said. "There is a security feature on the badge that allows communication to be heard by staff but not by the patient. We also have provided the security officer stationed at the emergency department entrance a badge, which again allows direct connection in the case there is a security threat."

This makes staff feel safer, and therefore more valued, she added.


Speed of care has made a noticeable difference: The "left without being seen" rate improved from 5.6 percent to 2.2 percent. And the badges eliminate overhead noise, creating an environment of quiet appropriate for healing.

The hospital also helped boost patient satisfaction, with a three-point increase in Hardin's overall Hospital Consumer Assessment of Healthcare Providers and Systems score. Scores for the emergency department related to "staff caring for patients as a person" improved from 56.6 to 63.4. Perhaps the most impressive improvement was HCAHPS scores related to "doctors informing patients about treatment" in the emergency department: This metric jumped from 53.3 to 77.1.

"Our overall efficiencies improved," Parker said. "Clinicians have the ability to communicate needs in the moment, which ultimately impacts the care provided at the bedside. Since all ancillary departments that support the emergency department are required to wear a badge, it provides a direct link to those services, such as radiology."

The physician, for example, now has the ability with the press of a button to call the radiology tech to communicate any specific patient needs and determine a timeframe to communicate with the patient.

"Unfortunately, when being seen in an emergency department, there are wait times associated with completing diagnostic testing like labs, X-rays, CT scans, and the badges have provided us the ability to communicate more frequently with our patients because we are all connected," she said.

"The providers know they have a direct line of communication with the nurse or anyone who impacts patient care, so there is less time searching for someone in the more than 32,000 square feet space."

Less unproductive time has allowed for more productive and meaningful time with patients, which is what translates into higher HCAHPS scores, she added.


"It is important to have every team member who will be impacted by a new technology or process be engaged early," Parker advised.

"It is so important to listen to the voice of clinicians and frontline staff throughout the decision-making process, during deployment, and even after implementing a new technology," she explained. "Actively listening and providing a culture of empowerment for nurses, physicians and other members of the care team is key."

Maintaining an open dialogue with staff also helps improve adoption of the technology, she said. Be flexible and continue to monitor and adjust workflows, she added.

"It also is important to identify clinician champions and super-users when implementing new technologies," she said. "Select a clinician champion who is well-respected by peers, passionate about the new technology, understands its benefits, and is knowledgeable about how to use it effectively."

Twitter: @SiwickiHealthIT
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