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Do you want to reach the triage nurse immediately, but can’t remember who is assigned to that role today? Do you wish you could ask a patient’s doctor a specific question, but are left on hold? Many EDs point to portable phones as the solution to these and other communication problems. Here are some of the benefits of portable phones:
• You can reach ED staff directly. At Tallahassee (FL) Memorial Hospital, ED nurses give the number of their personal phone if they need a return call, instead of the nurses’ station number, so they can be called directly, says Cindy Bruns, RN, BSN, CEN, quality management coordinator for the emergency center. "This decreases the frustration and time spent of being put on hold," she reports.
• You can reach someone with a particular job title around the clock. Portable phones allow you to always reach a designated person, such as the triage nurse, at the same number every day, regardless of who is working that day or where they happen to be — for example, at the triage desk or assisting a patient to a bed, says Christine Clare, RN, MS, CEN, CNA, director of critical care at Kaiser Permanente Harbor City (CA) and former nurse manager for express care at Loma Linda (CA) University Medical Center, where portable phones were used.
"As we don’t assign the same nurse to the same assignment every day, someone may assume that Nurse Judy is performing triage because she did so yesterday," says Clare. When that individual contacts the department, they might ask for the person by name, instead of the triage nurse, Clare adds. "This will cause delays, as the wrong person will receive the phone call. That results in either a hang up and re-call, or waiting while the proper individual is connected," she says.
• The ED physician can consult the patient’s primary care physician during the exam. A patient might have chest pain with an abnormal electrocardiogram (ECG), but with no previous ECG at the ED, says Glenn Birnbaum, MD, FACEP, an ED physician with Emergency Medical Associates, an ED physician group based in Livingston, NJ. "By immediately talking to their primary care physician, I can determine if this an old [problem] or a new change that needs immediate treatment," he says.
For instance, a patient with a new left bundle branch block and chest pain is a candidate for emergent angioplasty or thrombolysis, notes Birnbaum. "Knowing what the old ECG showed enables me to make that decision right at the bedside," he says. It is also reassuring to patients to hear you speaking to their primary physician early on, says Birnbaum. "I can then tell them, Your doctor agrees with our plans.’"
• Communication with other departments is facilitated. At Tallahassee Memorial’s ED, nurses use the phone to call other departments, to give reports, obtain results, or contact physicians. If they need a call back, they provide their individual phone number rather than their ED number, says Bruns. For example, a floor nurse can call an ED nurse directly if a report about the patient can be taken, and the floor nurse avoids being put on hold, she explains. On weekends, a phone is also given to the X-ray coordinator so the charge nurse can be in direct contact at all times, she notes.
• Fewer calls go through the secretary. Phone calls go directly to the appropriate person rather than the secretary, says Clare. She estimates that the number of calls going through the secretary decreased by at least 25%.
At Tallahassee Memorial, all calls previously were channeled through the nurse’s station, says Bruns. The person calling often was left waiting on hold until the individual was located via the ED intercom, she explains. Although generic calls such as physician orders still come through the main ED number, Bruns estimates that the number of incoming calls has decreased by 50%.
• Overhead paging is decreased. Direct-call phones can significantly decrease the number of overhead pages in the department, says Clare. "The ED has lot of inherent noise with ambulances arriving, ill children who are crying, etc.," she notes. "Anything that can be done to decrease the noise in the department is greatly needed." In addition, direct calling results in immediate answering of the call or need, says Clare. "This further decreases noise as multiple calls and/or pages are avoided, due to missed pages or extensive delays in answering," she notes.
• Patients also can use the phones. Although patients in treatment rooms use the wall phones that are part of the regular ED phone system, the portable phones might come in handy, says Bruns. "Patients in a hall bed are given one of the radio phones if they need to make a call, for example, to obtain a ride home," she says.
For more information about use of portable phones to improve communication, contact:
• Glenn Birnbaum, MD, FACEP, Emergency Medical Associates, 651 W. Mount Pleasant Ave., Livingston, NJ 07039. Telephone: (973) 740-0607. Fax: (973) 740-9895. E-mail: firstname.lastname@example.org.
• Cindy Bruns, RN, BSN, CEN, Emergency Center, Tallahassee Memorial Hospital, 1300 Miccosukee Road, Tallahassee, FL 32308. Telephone: (850) 431-5079. Fax: (850) 431-6537. E-mail: BRUNS-C@mail.tmh.org.
• Christine Clare, RN, MN, Kaiser Permanente Harbor City, 25825 S. Vermont Ave., Harbor City, CA 90710-3599. Telephone: (310) 517-4370. Fax: (310) 517-4374. E-mail: Christine.X.Clare@kp.org.