Who’s on First?

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Improving hospital workflow through OnPage alerting

At many points in a hospital’s functioning, workflow touches the outcome. Good workflow leads to good outcomes. And, similar to IT, good workflows are indicative of a lean organization. One particular area of the hospital that needs to feel the hand of technology and workflow improvement is doctor and on-call scheduling. Traditional workflow has on-call scheduling committed to a whiteboard. However, in a field that is hungry for improvement, medicine can surely optimize this process and make it leaner.

What are ways for improving scheduling doctors? What are the potential impacts from improvement? Read on.

How poor scheduling makes for poor hospital workflow

Scheduling doctors is an important part of a hospital’s functioning. It’s how doctors know who’s on-call first and what’s on second, to paraphrase Abbott and Castello. Yet in traditional doctor scheduling  information is committed to a whiteboard or a few sheets of paper. Any change to the schedule is remedied with pen and paper or marker. This process though is inefficient at best because it leads to an extra step when trying to reach a doctor on their pager. Rather than immediately contacting the individual on call, the nurse either goes to the whiteboard or looks for the most recent printout of the schedule.

Furthermore, since pagers are often used to alert the doctors, doctors are at the mercy of what is becoming an increasingly unreliable technology.  We have written extensively on the problems with pagers in hospitals such as our recent post on Land of the Walking Dead Zone. Problems with pagers are focused around issues such as:

  • Pages can be blocked by the physical infrastructure in hospitals and the surrounding environment
  • Doctors receive alerts on pages and then need to bring the conversation to their cell phone
  • There is no way to confirm that a doctor has received a page

So, when you take a poor workflow like the one described above and marry it to a poor technology, you will inevitably introduce significant problems into the healthcare setting.

Overall, the conclusion is that using a whiteboard for care coordination simply leads to poor workflow. Clearly, a technology is needed to automate the process and eliminate processes which introduces the possibility of error.

Improve scheduling and improve hospital workflow

Our recent case study on SAGE Neurohospitalist Group highlights the benefits of improved workflow in a hospital setting. SAGE is a teleneurology group based in California that provides neurology services to rural and underserved communities. Formerly, when one of its client hospitals needed a neurologist, the client hospital would:

  1. Contact the office administrator at SAGE indicating they needed a neurologist
  2. The office admin at SAGE would look for the on-call neurologist’s number and page them
  3. If the neurologist received the page, they would answer. However, the office admin never knew if the page was received or not
  4. If the neurologist was busy with another patient, they would need to wait until they were free to answer the page

This whole process could cause up to a 20 minute delay in answering a rural hospital’s request for neurological care.

Realizing the inefficiencies of this process, SAGE introduced our product into their workflow. Now, when a patient arrives at a rural hospital in SAGE’s network, the hospital simply calls up the SAGE OnPage account associated with their hospital.  Now, in under one minute, a neurologist is contacted and able to return the rural hospital’s call.

There are no longer any administrators at SAGE that need to look up a doctor’s pager number. Instead, a rural clinic simply dial’s into SAGE’s OnPage account and whoever is the attending neurologist for the day will receive the call. The rural hospital only needs to keep track of one number and with that phone number they will immediately page the neurologist on-call. If the first neurologist is unable to answer their call then the page will be forwarded to the second neurologist on-call.

By using this improved workflow, SAGE has:

  1. Not experienced missed pages ever since implementing OnPage.
  2. Not lost pages due to connectivity and range issues are no longer a problem as OnPage works with Wifi.
  3. Enabled page escalation. Escalation is now an automated process. If the first SAGE neurologist is not able to respond to an alert, the page is automatically forwarded to the next neurologist on-call.
  4. Been able to guarantee their clients a response in under 5 minutes although 95% of responses occur in one minute or less.
  5. All Enabled tracking through OnPage’s Audit Trail. Increasing the accountability of SAGE’s service.
  6. Ensured that of the pages are attended to within the first two escalations which means patients receive care faster.
  7. Realized a business growth of 700%!

By improving the workflow, not only did SAGE reach patients faster, it also improved its business.


Clearly, lean workflow cannot be ignored. It’s too important a step to overlook since its impact, as seen with SAGE, can be transformative to both lives and the bottom line.

We’ll be at HIMSS17 next week and would look forward to the opportunity so schedule some time with you to talk about workflow. We’re at booth #343. Sign up!

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