Who’s on First? What’s on Second?
How to improve your hospitals’ on call scheduling and critical messaging through workflow redesign
At many points in a hospital’s functioning, workflow touches the outcome. The problem facing much of healthcare though is that the established workflow for alerting and messaging physicians is broken. What are ways for improving scheduling doctors? What are the potential impacts from improvement? Read on.
How poor on call scheduling makes for poor hospital workflow
Scheduling doctors is essential for a hospital’s efficient functioning. It’s how doctors know who’s on first and what’s on second, to paraphrase Abbott and Costello. Yet many hospitals we see have their schedules committed to a whiteboard or a few sheets of paper. When so much technology exists to facilitate scheduling, committing important information to a white board or a piece of paper leaves the hospital open to many unintended errors.
These problems are highlighted by the facts laid out in one study which noted:
Efficient communications and collaboration between physicians, specialists, nurses and care team members is critical to enhance patient safety, and support the coordination and delivery of patient care across health settings. … Inefficient communications during critical clinical workflows costs the average U.S. hospital approximately $1.75 million annually.
Inefficiency has a price tag and a big one at that.
How poor alerting practices hurt hospital workflow
Further impacting efficient workflow is the use of pager technology. Doctors are at the mercy of what is becoming an increasingly unreliable technology. These issues include:
- Pages can be blocked by the physical infrastructure in hospitals. This sometimes requires the front desk to page the physician multiple times to ensure they received the message
- Pagers are not attached to a workflow. As such, if a physician is unable to answer a page, there is no escalation to another doctor
- Pagers are typically not part of a HIPAA compliant process so the information that can be put on the device is limited.
- Pagers require the physician to copy the information from the pager to a cellphone to enable further communication
- Pages themselves provide limited information and don’t enable image or voice attachments to enhance the conversation
The troubles with pagers are further encapsulated by the malpractice suits that result from poor communication. According to one source
[In] 23,000 medical malpractice claims and suits [brought in 2015] in which patients suffered some degree of harm, three out of every 10 cases include at least one specific breakdown in communication. … errors often occur because information is unrecorded, misdirected, never received, never retrieved, or ignored.
Pagers are unfortunately susceptible to this very sort of miscommunication and communication breakdown. For the very reason that they are not persistent and do not provide a way for further communication, pagers can bring an unnecessary degree of harm into healthcare.
What do improved scheduling and hospital workflow look like?
Research demonstrates that efficient communications and collaborations between physicians and nursing teams are critical to improved patient outcomes. This improvement is based on understanding the imperfect workflow – described above – and recognizing the attributes of an improved scenario.
This improved workflow should:
- Adhere to HIPAA-compliant standards
- Have an electronic on-call schedule which includes escalation. The entire rotation for the month could be included and updated as needed. This would forgo the need to forward updates to the schedule to numerous hospitals.
- Ensure alerts are persistent and continue until answered. If a specific doctor needs to be reached then alerting should continue until the doctor responds.
- Include messaging. In obstetrics, for example, 63% of communication failures are in physician to physician communications. If secure messaging were provided to physicians in a way that grabbed their attention and ensured the physician reviewed potentially life-impacting data, the possibility for improved patient outcomes would be significant.
- Provide an audit trail so that administrators can determine if alerts have been read
- Enable physicians and their colleagues to communicate via smartphone as it is the preferred mode of communication and information exchange by physicians
- Enable physicians to attach images and voice messages to electronic messages. If they are unable to type a message, they can provide a voice message to explain relevant details and send the message in a HIPAA-secure manner to their colleagues.
These steps highlight the necessary components of a critical alerting platform that is required to improve doctor to doctor and doctor to hospital communication. By improving communication, hospitals will improve workflow and reduce mistakes. Hospitals and clinics can attempt to develop the technology which underlies this sort of improved workflow or they can try the OnPage solution which encompasses all these components.
Statistics show that 70% of treatment delays and sentinel events in a hospital are caused by a communications breakdown. To me, that seems like a sufficient reason for hospital staff and doctors to find a way to improve workflow and the ways they communicate. Otherwise, we risk inviting chaos into the hospital.
How confident are you that your workflow couldn’t use an improvement? Call us for a consultation and demo.