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Analytics help improve physician response
Analytics help hospital defend malpractice cases
Most hospitals have no documented information about communication events phone calls, pages, texts, voicemails between their nurses, physicians and other clinicians that occur hundreds of times each day. One hospital in Ohio not only is capturing detailed data on these incidents, but also is using it in creative ways to manage risk, safeguard patients, and improve the responsiveness of its medical staff.
St. Rita's Medical Center in Lima, OH, serves a 10-county area in northwestern Ohio and is the largest hospital in a 70-mile radius. Since 2005, the hospital has been using a sophisticated clinical communications system to ensure that calls and messages route to the right clinicians at the right time, based on their workflow, call schedules contact preferences, and the clinical situation.
In addition, the hospital has found ways to benefit from the data analytics that are possible with the service, says Herbert Schumm, MD, St. Rita's vice president of medical affairs.
The system processes about 180,000 clinical communication events annually among St. Rita's clinicians and provides analytics, which enable detailed reporting about each contact event, Schumm says. This information gives St. Rita's invaluable insights into its clinical communication processes and the outliers that increase risks.
St. Rita's uses the PerfectServe system from the company based in Knoxville, TN. Other vendors of communications and analytics systems include Vocera, based in San Jose, CA. Check with your communications vendor for similar options.
a.system like the one in place at St. Rita's eliminates the need for subjective interpretations when the hospital must establish the steps and timeline of a communication process preceding an adverse event, Schumm explains. Using the system's analytics, the hospital can quickly identify and drill into data that shows the specific time each communication event was initiated; the originating department and number; the intended recipient; the actual recipient; the contact modality (cell phone, voicemail, text message); the length of the call; and, for calls that employ failsafe contact processes, whether and when a specific call was answered by a clinician and the elapsed time to retrieve a voice message.
'Black box' for adverse events
The hospital uses this data whenever it is investigating cases relating to quality or risk management. In fact, St. Rita's decided to implement PerfectServe after it was unable to prove that one of its nurses had contacted a physician three times, Schumm says.
"This is our 'black box' for communications that lets us piece together exactly what happened and when," Schumm says. "Also, our physicians have become conscientious about being responsive, in part because they are aware that we automatically document the communications process."
Using the system's analytics, the hospital can quickly identify and drill into data whenever it is investigating cases relating to quality or risk management, Schumm says. After an adverse event, the hospital can quickly determine what calls were made between the physician and the unit, with exact time frames.
Documentation can be pivotal
"It really helps us start to put together a timeline," he says. "From a risk management standpoint, it's a huge help with the root-cause analysis. Normally you would have the charts and people's recollections, but with the analytics system you have the exact time of every phone call. That becomes powerful."
Some of that information can be found in a hospital's normal phone system, but St. Rita's found in the past that like most such phone systems, the memory only stored a fairly small amount of information before erasing it. Once they were aware of a problem or lawsuit months later, the data often was unavailable. Going through the phone company was slow and laborious, and the hospital had to pay for the research.
For those reasons, St. Rita's rarely relied on phone records to investigate problems or defend lawsuits. Now Schumm can pull up the phone records for any incident on his own computer within a couple of minutes. He notes that avoiding just one malpractice settlement can pay for several years of subscribing to a communications system.
"We've had two cases recently where the documentation was pivotal in the defense, because we were able to show that calls did go out and exactly when," he says. "I just had a physician come and ask for the calls he made to St. Rita's a couple of years ago, because he was being sued. I got them up and printed them off while he waited just a few minutes."
Data can defend physicians
The system can come to the physician's defense as often as it catches their failures. Schumm recalls a case in which a patient's care was compromised because the physician supposedly did not respond to several calls from an in-house clinician. The staffer claimed to have called the physician several times and provided the exact times of her calls.
"It didn't match up at all with our call logs," Schumm says. "Those calls just weren't there. That is very persuasive when I can sit down with a manager and say, 'Here's what your staff person says happened, and here's what our objective data shows us.'"
Schumm notes that such discrepancies are not always the result of deception. They can result from poor communication and simple mistakes, he says. For instance, a nurse may stop by the unit desk and say to another nurse, "Give Dr. Jones a call about the heparin for Mrs. Smith." She leaves and assumes the call is made, even notes in the chart that the doctor was called. If the second nurse is distracted and does not make the call, the first nurse may assume the doctor never called back.
"We made another change so that on our units every nurse carries a modular phone and can place the call directly, going right into our system, and the doctor is paged to call straight back to that handset," he says. "We've streamlined the communications system, and that has helped tremendously."
Data help avoid arguments
a.cording to the Joint Commission, communications breakdown is the single greatest contributing factor to sentinel events and delays in care in U.S. hospitals. St. Rita's uses its analytics system to track a key source for such breakdowns, such as physicians who do not respond to calls.
Of the hospital's approximately 15,000 monthly communication events processed by the system, about 15 to 25 are directed to the PerfectServe Help Center to report a problem with a physician not responding. Schumm and the patient safety team use monthly reports from the Help Center as a way to open a constructive dialogue with physicians whose names repeatedly appear on this list.
"It really helps to have such clear, objective evidence for the physicians," Schumm says. "Most of the time, showing them the reports is enough to prevent future incidents. We also avoid the 'he said, she said' situations because the data shows us the process of what actually happened, helping us look past the emotions and get to the root cause of the problem."
Not only does the system log when calls were placed to the physician, but it also records how long before the physician responded. This can be important information when the physician insists that he or she always responds promptly, Schumm says.
"We now have the verifiable data to say they are responding promptly or they aren't," Schumm says. "From the medical staff standpoint, that becomes what the Joint Commission calls focused performance practice evaluation, a way to monitor the performance of the physician who is not responding to calls. We've now had two physicians who just admitted they weren't getting calls returned, and they left our staff."
Since the system collects communications process information automatically, nurses do not have to "tattle" on doctors who do not always respond in a timely manner, Schumm notes. This not only relieves nurses of an uncomfortable task, but also enables St. Rita's to avoid adversarial situations that can undermine physician-nurse relationships.
The hospital also works with physicians to manage their call volume.
"We keep an eye on how many calls physicians are getting and when they are getting them, so we can sit down and find ways to manage and prioritize them, which really helps the high-volume physicians," Schumm says. "One of our nephrologists showed me his log for the day, and he'd taken 150 calls in one day. He couldn't manage that, so we worked with his group to prioritize the calls and also to encourage more text messaging so he wouldn't have to return so many calls."
Herbert Schumm, MD, Vice President of Medical Affairs, St. Rita's Medical Center, Lima, OH. Telephone: (419) 226-9734. E-mail: email@example.com.