Large organizations with mobile workers, such as hospitals, face diminished productivity when communication is inefficient and its employees are unable to locate their coworkers in a timely manner.
Large organizations with mobile workers, such as hospitals, face diminished productivity when communication is inefficient and its employees are unable to locate their coworkers in a timely manner. We faced this problem at Memorial Sloan-Kettering Cancer Center (MSKCC) just a few years ago. MSKCC is a 500-bed, free-standing, comprehensive cancer center in New York City. In addition to the inpatient hospital, there are several ambulatory locations in Manhattan and five regional network sites in the surrounding counties and New Jersey. Across all locations, we receive approximately 500,000 outpatient visits and administer 78,000 chemotherapy and 57,000 radiation oncology treatments annually. With multiple locations and such a high volume of patients, efficient communication is essential. We selected Vocera® (www.vocera.com), a wireless communications system, to improve communication and increase productivity at MSKCC.
Several years ago, staff and inpatients at MSKCC were unhappy about the noise levels, disruptions, miscommunication, and inefficiencies associated with our traditional nurse call system, which used multiple modes to locate and communicate with staff. The system included a main switchboard, overhead paging for multidisciplinary staff, and an intercom for staff-to-staff communication and to notify staff of telephone calls at the nurses’ station. Although these systems functioned, they were not suited to meet the needs of a multidisciplinary mobile staff, and a major drawback was that the staff often had to wait for long periods at the nurses’ station for return pages. Overall, it was thought that these systems resulted in reduced time at the bedside, slower response time to patient and provider requests, high noise levels, and delayed transfer of information.
The need for a better system became apparent, and to see what alternatives were available, a team consisting of representatives from nursing, telecommunications, information technology (IT), and biomedical engineering was assembled. The team determined that the replacement system must be hands-free, lightweight, wireless, and have voice recognition, which would allow healthcare workers to exchange information as they moved around the unit. After conducting some research, the group decided to use the Vocera communications system in a pilot program in a 42-bed medical-surgical oncology unit. The program assessed the effect of Vocera on workflow, communication, and delivery of care over the course of several months.
Vocera is a lightweight, battery-powered, wireless device that allows for hands-free communication and is designed to blend with current technologies. The system runs on a wireless network and has two components: intelligent database software that runs on a Windows server and a communications badge. Each user has a unique profile in the system and wears the badge on a lanyard or clipped to their clothing. The system enables calls to and from the badge using voice recognition and has the broadcast functions of a walkie-talkie and a hands-free speakerphone. It can be used via internal or external phones, has the instant connection feature of push-to-talk phones, and allows voice messaging. Each device is assigned a virtual extension for return calls when pages are sent to providers, and no one has to remember a single phone number or extension. The system, which has been endorsed by the American Hospital Association, is especially well-suited for use in a healthcare environment because it includes several security features, including encryption (data scrambling), authentication (voice printing), and data integrity (it does not record or store conversations).
Our Pilot Program
In 2005, the nursing and IT departments collaborated to implement a pilot of the Vocera system, which was intended to assess noise reduction, efficiency, and patient and staff satisfaction. A timeline and training curriculum was established and the components of the system were procured. The IT department ensured the infrastructure was in place to support Vocera, and they configured and validated the templates, imported them to the Vocera system, and coordinated the distribution of the product. The staff then went into the technical training phase, which was rolled out for unit Vocera administrators and both clinical and nonclinical staff.
Pilot Program Findings
Four months after the Vocera pilot program was implemented, a survey was distributed to 64 nursing staff, which yielded an 88% response rate. Of the respondents, 91% agreed or strongly agreed that there was a reduction in the disruption of overhead paging, 84% felt that the system improved communication among unit staff, and 82% said there was increased accessibility to other staff for bedside assistance. The staff also agreed that there was increased accessibility to coworkers during an emergency.
Vocera System Features
• Highly accurate, user independent speech recognition
• Call by name, function, or group
• Broadcast calling
• Push-to-talk mode
• Panic call groups
• Call blocking and call screening
• Conference calling and group messaging
• Call transfer and call forwarding
• Voice and text messaging with audio playback
• Biometric voiceprint verification
• Support of multiple geographic sites from a single centralized server
• Site-to-site calling
• Tiered administration
• Group-based user permission structure
DEVICE MANAGEMENT (optional)
• Patient monitoring systems
• Telemetry monitoring systems
• Staff assignment
• Supply management systems
B2000 COMMUNICATIONS BADGE
• Voice controlled
• Weighs less than 2 oz (53.9 g)
• Rechargeable lithium ion battery
• Do Not Disturb button
• OLED high-contrast display
• BioCote® antimicrobial coating
Based on the success of the Vocera pilot, a rollout of the system was planned in 2006 for all inpatient units. The nursing department developed policies and procedures for use of the system, including compliance for wearing the badge, signing badges in and out at the start and end of each shift, and compliance with HIPAA regulations. All staff had to attend a training session—no training meant no Vocera—and the staff were relieved of their clinical responsibilities during the training sessions.
Once Vocera was fully rolled out for the inpatient units, we reviewed its potential in the outpatient setting. The outpatient nursing leadership and staff decided that the best use of this system would be in the chemotherapy units. In our multiple outpatient settings, the pharmacies are not contiguous to the chemotherapy units and there are runners who deliver chemotherapy and other drugs from the pharmacy to the units. We felt that Vocera would allow for improved communication among the treating nurses, the verification nurses, the pharmacists, and the runners. Further, use of the system would allow the eight ambulatory nurse leaders, who are located at various sites within a 13-block area of Manhattan, to communicate with staff and each other without having to leave their offices.
Where We are Today
Four years after our first pilot program, we are still using the Vocera communications system. We have found this system to reduce noise and disruptions, improve workflow by reducing step in the communications process, and, most importantly, to allow nurses to spend more time taking care of patients. Vocera has also been useful during emergency drills because it allows information sharing and updates among leadership and the nursing units. We are currently examining the optional device management feature for the system (see Vocera system features below), which would allow Vocera to receive alarms from ventilators, nurse call systems, and telemetry systems, all of which would lead to increased patient safety.
Gay F. Bailey, RN, MBA, OCN, director of nursing ambulatory services, Memorial Sloan-Kettering Cancer Center, New York City