The doctor is no longer the sole care provider. Teams of doctors, nurses, pharmacists and allied health professionals now look after patients. But archaic communication technologies like the pager are not effective in this new workflow, yet are still being used by more than 90% of hospitals. This is a huge loss to our patients, causing delayed discharges, increasing costs and fatal medical errors.
The science of medicine has seen rapid transformation, but the art has remained much the same. From the discovery of Penicillin during the turn of the last century, healthcare has seen an exponential growth in innovation. Medicine has seen drastic advances in drug discovery, genomics, and technology. Recently, digital health has also been revolutionizing the practice of medicine, by replacing paper charts with easily searchable soft copy documentation. These technological advancements have made a huge difference for patients’ health outcomes. However, they have not kept abreast with the changing workflow in medicine.
From where did teamwork in healthcare come?
Learning from aviation
The aviation industry in the 1980s went through an internal analysis exercise to understand the source of errors causing fatal crashes. It recognized the inability of humans to work in complex environments without making errors and redesigned its entire training program and organizational structure to bolster teamwork. This research then entered into the healthcare industry where teamwork also became more important to reduce medical error. [i]
Expanding teams post World War II
Additionally, the post World War II era has seen an explosion in increasingly sophisticated and complex medical procedures. [i] Whereas before one doctor had primary responsibility over the patient, today doctors, specializing in a small area, i.e. the human organ system or diseases, nurses, pharmacists and a wide array of allied health professionals all attend the patient. The need for these allied health professionals was felt for three reasons: increasingly complex procedures requiring specialized assistance, aging populations requiring an expansion of medical services and increasing healthcare costs seeking cheaper labor cost models for care provision. It is estimated that 60% of healthcare workforce now consists of allied health professionals.[ii]
Why are current technologies not able to support hospital workflows?
Hospitals are saturated with complex workflows as teams dynamically form and disestablish around a given patient. This causes large coordination problems and increases costs from inefficiencies. On average, a patient is seen by 5-10 different providers during their hospital stay. Each of these providers are caring for 10-20 patients at the same time. All of them come on and off shifts regularly and at different times. Hence, there exists a knowledge gap of whom else is looking after their patient. On average, a clinician knows only 30% of a patient’s care team. ‘When technology does not adequately support the goals of the care team, it often causes workflow workarounds. These alternate workflows are a cause for concern because these informal, evolutionary systems rely on the clinicians’ memories, and bypass decision-support safeguards that the system may provide.’[iii]
Archaic technologies in use
Despite the recognition of teamwork for improving quality of care for patients, and a rapidly expanding team, tools to help coordinate care have not advanced. More than 90% of real-time communication in hospitals still occurs via pagers. Studies show pagers cause discharge time to be elongated by 100%. [iv] While the pager was a sufficient tool for communication in the 1980s when teams were smaller, today it lacks the requirements of a fast-paced hospital workflow.
Old technologies causing major medical errors
Hospitals and clinics are highly stressful environments. In such environments it is often preferred to communicate face to face or over the phone; these are termed synchronous communications. However, interruptions lead to reduction in working memory, which increase the risk of medical errors. Hence, psychologists and communication experts believe asynchronous forms of communication in the hospital should be encouraged unless relaying highly urgent or complex information. Since the pager provides little to no context on whether the incoming communication is urgent or complex, it becomes synchronous. More than a hundred thousand people die in the USA due to medical errors. Poor communication leads to 50% of them.[v] A recent study has shown that every interruption while delivering drugs causes a 4.6% higher risk of medical errors. [vi]
Next frontier in healthcare communications: smartphones
The need for care coordination has increased significantly due to larger care teams. Technology has not kept abreast with an ever more complex healthcare workflow. New innovations that put the focus on the patient have the ability to increase efficiency while maintaining patient safety. We are at the dawn of a new age in medical technology, when the art of medicine finally catches up with the science.
[i] Patients Charting the Course: Citizen Engagement and the Learning Health System: Workshop Summary. Source: http://www.ncbi.nlm.nih.gov/books/NBK92080/
[ii] University of California San Francisco, Advancing the Allied Health Professions. Futurehealth.ucsf.edu. Retrieved 2012-03-06
[iii] Patient Safety and Quality: An Evidence-Based Handbook for Nurses. http://www.ncbi.nlm.nih.gov/books/NBK2638/
[iv] The economic and productivity impact of IT security on healthcare, Ponemon 2013 , AHA Trend Chartbook 2012. Bureau of Labor Statistics
[v] Healthcare Risk Control. Communication. ECRI Institute. https://www.ecri.org/Forms/Documents/Communication.pdf
[vi] Westbrook J, Dunsmuir W. Association of Interruptions with an increased risk and severity of medication administration. Arch Intern Med. 2010;170(8):683-690
