A Better Bedside Manner

A shortage of trained professionals, an ever-enlarging patient pool, fixed (and in some cases, shrinking) budgets: the healthcare business faces some tough challenges right now. But amidst all the talk of a healthcare crisis, some innovative solutions are emerging to help healthcare providers streamline inefficient processes and improve the overall patient experience.

Take Orlando Health, for instance, one of Florida’s largest and most comprehensive private, not-for-profit healthcare networks. The system provides advanced medical treatments and procedures for nearly two million Central Florida residents and 4500 international visitors annually, and recently decided to automate certain repetitive functions at its MD Anderson Cancer Center Orlando in order to save time and focus more on delivering patient care. The convoluted system used to discharge patients from the hospital was one such process ripe for re-engineering.

“The inpatient discharge process is a challenge for many healthcare organizations – and, not unlike other leading healthcare delivery systems, Orlando Health has been challenged by delayed discharge times for certain patients,” admits Rick Schooler, CIO for the healthcare provider. His team’s analysis of the contributing factors uncovered a core problem of timely and synchronized communications among the nurses and physicians involved. “Typically, an attending physician orders the discharge of a patient if all other involved physicians agree. Unfortunately, this requirement results in nurses expending time throughout their workday contacting the other physicians for their approval. The duration of this process had become excessive, consuming valuable nursing time leading to delayed patient discharges.”

After trying various ways of simplifying this process and cutting down the discharge time, the hospital brought their ideas to Nortel and asked for help in creating an automated system that would help them achieve their goals.

“We realized the core challenge to address within our patient discharge workflow was one of obtaining physician consensus to discharge within the shortest time possible,” explains Schooler. “Our review of potential technology and process solutions were filtered by a requirement for nurses to be able to send instantaneous notification of a Discharge Request to the involved physicians, and then to subsequently obtain an immediate (or much more timely) response from all.

Schooler’s team ultimately resolved to initiate an order from its patient care information system to the physician’s cell phone via the Nortel IVR, and then to similarly process the response.“It was an idea that was initially presented to Orlando Health management by two physicians seeking a way to streamline the patient discharge process,” he says. After weeks of analysis and vetting of ideas and approaches, Orlando Health settled on the strategy of an integrated solution between its patient care information system, its physician credentialing information system (in order to obtain cell phone numbers), Nortel’s IVR and the various physician cell phones.

“Our previous experience with Nortel’s IVR enabled us to envision its solution potential, given our requirements of technology integration, instantaneous notification and immediate response processing,” says Schooler. “We did not conduct a technology search, as such, since we already understood the potential of our installed IVR capabilities.”

The main features of the Nortel solution offer significant benefits to Orlando Health. Once a clinician, case manager or physician determines a patient may be eligible for discharge in the next 24 hours, they enter a Discharge Request for Tomorrow into the patient care information system, just as they would any other order. Once this request is submitted, a standard HL7 message is sent to the Nortel IVR Hospital Discharge Application. At that point, the IVR application contacts the appropriate physicians with a discharge request, beginning with the admitting physician and working through all additional attending and consulting physicians. By using touchtone or voice recognition, the physician can accept or decline the discharge request – or can be connected (via phone) to the clinician who submitted the request. Once all physicians have accepted the discharge, the nurse begins to gather all the information, education and other discharge related items needed for a successful discharge the following day.

“Because this process initiates a request and not an order, the attending physician for that patient is presented with the information necessary to make an educated discharge decision,” explains Schooler. “Once all other involved physicians have responded, he or she can enter a discharge order into the patient care information system.” Throughout the entire Discharge Request information flow, any involved physician may decline, and their name and response will be logged into the patient care information system for review.

The new system has had a significant impact on the patient discharge process – both from a patient perspective, and from the point of view of hospital staff. “We are most encouraged by the results,” enthuses Schooler. “In the pilot areas, the discharge time was improved significantly, by a matter of hours. Patients have returned home earlier, bed turnover has improved and patient throughput has increased.” Most crucially, the nurse-doctor ‘phone tag’ scenario has been replaced by a simple order within the hospital’s patient care information system, a cell phone button push (or voice response) by the physician, and a response transaction back to the patient information system.

So does Schooler have any recommendations for organizations looking to undertake a similar rollout? “Seamless technology integration among the IVR, the patient care information system and the source for physician cell phone numbers is vital,” he says. “Physician acceptance of the process change and the use of cell phones is critical as well. Obviously, physician cell phone numbers must also remain up-to-date, which may be more of a challenge depending on an organization’s level of automation.”

These challenges notwithstanding, the ultimate result for Orlando Health has been a more streamlined and efficient process – which can only be a good thing. “As we look at where we invest in information technology across the health system, we’re always looking for opportunities that address financial concerns, quality concerns, patient safety and efficiency,” concludes Schooler. “And this particular endeavor touches on all four.”

System benefits

• The new Hospital Discharge Application allows a nurse to initiate a discharge by clicking on a patient’s name on the system screen, instead of making 15 to 25 calls per patient.

• This increase in efficiency has enabled patients to be discharged up to four hours earlier than usual.

• All the necessary calls are made to the physicians associated with the patient to obtain their consent and logged into a secured electronic system.

• If a doctor wishes to consult with the floor nurse before making a decision on a discharge, the HDA application will automatically connect to the patient’s floor nurse and allow the two to converse. Once the physician is satisfied he/she can register their decision.

Implementation challenges

Implementing a new IT system invariably throws up challenges of its own. So how did Schooler and his team tackle the implementation process to ensure a smooth rollout? “This endeavor essentially amounted to new product development,” he explains. “As such, both Nortel and Orlando Health provided capable project management and development resources. From its inception, a pilot and phased-rollout-over-time approach was planned as the only way to introduce this innovation to the organization. As with any project, there have been the normal starts, stops and bumps along the way. However, once both parties agreed we were in fact developing a product for the industry, our resolve became much more focused – leading to success.”