Nurse Call Systems: Opportunities for improving patient satisfaction scores and patient safety

I was in Boston recently, at the Medical Device Connectivity meeting, where I heard an excellent presentation by Kourtney Govro, CEO of www.sphere3consulting.com.  I was quite impressed.  She has a great concept and has translated it into a product that has already been adopted by 12 hospitals in 5 states.  They have been able to show significant improvements in patient satisfaction scores and decreased patient falls at these hospitals.

Their company’s concept is that every hospital has a nurse call system at every bedside and that there is a tremendous opportunity to “mine” the data generated by these systems in order to find real, actionable data.  Depending on the age of the existing system(s) in a given institution, the data can be mined directly, and in other instances it might need to go to a third party integrator (such as Capsule, Connexall, Emergin, iSorona, etc) before an organization can really get the full range of benefit.

She very correctly pointed out that the nurse call system is a very key driver of patient satisfaction.  When a patient or family member presses that button, they have an issue that they need resolved.  If that issue is not resolved in a timely manner, they will not be happy.  One of the most common reasons why patients press the button is because they are in pain.

HCAHPS survey questions #4, #9 and #13 are directly linked to the patient’s experience with their nurse call system.  (Note those of you not familiar with HCAHPS, better learn about them.  These scores directly affect Medicare and Medicaid reimbursement.  Scores are published and consumers are paying attention.)

4.      During this hospital stay, after you pressed the call button, how often did you get help as soon as you wanted it?

9.      During this hospital stay, how often was the area around your room quiet at night?

13. During your hospital stay, how often was your pain controlled well?

In many institutions that Kourtney has visited, the hospital has never systematically examined the processes, notifications, expectations and escalations after a patient presses that button.  Even without the data, a thorough review of the overall process will demonstrate that there are lots of “holes” for a given patient’s nurse call request to fall into.  In most organizations, this process is locally defined on each nursing unit and is usually unwritten.

In some hospitals the nurse call is decentralized, meaning that the call goes directly to the primary caregiver, either via a light and tone system or pager.  In some hospitals, the nurse call is centralized, meaning that the call goes to an intermediate person who triages the patient’s request and then forwards the request to the appropriate caregiver.  Both approaches have many variations and advantages/disadvantages.  In many hospitals, there is mix of approaches.  Many hospitals also have a mix of different vendors and/or generations of nurse call systems.

Regardless of whether a centralized or decentralized system is used, there are many legitimate reasons why the person who is “supposed” to respond to the call is not able to do so in a timely manner.  These reasons range from technical (the call never made it to them) to human (they were busy taking care of another patient) to physical (geography of the unit they are working on) to process (inadequate alarm escalation scheme built into the system).  Because there are so many legitimate reasons, the data needs to be analyzed to ascertain what is going on with all of these calls. 

Nurse calls are “alarms”, no different from alarms generated by other devices.  All alarms require attention of some kind.  In most hospitals, caregivers are inundated with alarms to the point of being overwhelmed.  In general, alarms are a huge patient safety problem in hospitals.  This general topic was covered in depth at the recent Medical Device Alarms Summit meeting.  I was on the program steering committee for the meeting and will be posting some comments shortly.

Many Clinical Engineering readers of this post may be saying to themselves that they do not have any direct responsibility for nurse call systems in their institution and don’t want any responsibility for these systems.  Regardless of whether you have service responsibilities for the nurse call systems, you should always be alert to new ways in which technology can improve matters at your institution.  When you come across technologies such as this one, you should proactively be pushing such information to those who need to know in the organization.  By doing so, you will gain a reputation as the one who is “thinking outside of the box” and looking at the big picture. 

This is my first “blog” entry in my new role as President of HealthCare Technology Consulting LLC.  If you have not already done so, please check out my web site.