Improving Clinical Communication for Care Coordination
Truly collaborative care requires efficient and effective clinical communication during patient handoffs — from the emergency department to radiology to surgery and even to the patient’s primary care physician. With most physicians and other clinicians using disparate communications platforms, however, handoffs can be uncoordinated and incomplete, leading to wasted time, unnecessary costs and unplanned outcomes.
Mobile clinical communication with secure messaging and open application programming interface capabilities can streamline workflows and collaboration among care teams. To illustrate how essential this more efficient clinical communication workflow is to the patient journey and to ensure safe and well-organized handoffs, we will follow fictional patient Joe Smith who, after breaking his leg in a motorcycle accident one evening, arrives at the ED in an ambulance.
Once Smith arrives in the ED, the triage nurse sends a text message to the ED physician. With a fully integrated communication platform, the nurse is able to see in real time that the message is delivered and read. The physician instantly views the message, even though she uses a different mobile device and operating system. Her immediate response eliminates care delays and improves Smith’s speed of care, because his caregivers are communicating in real time.
To begin preparing other clinicians for handoffs across the enterprise, the physician orders a multitude of tests and requests an X-ray. Her actions affect several departments and care team members, including the radiologist, surgeons, specialists and hospitalists.
Handoff №1: ED to imaging
The nurse creates a group text around Smith to ensure the entire care team is involved and updated on his status and results at the same time. New members of the care team are added to the group at the appropriate time, which eliminates phone tag and unnecessary delays. The clinical communication platform also confirms who in the group has read the messages, which eliminates uncertainty and reduces the need to repeat communication.
Constant shift changes in the ED can make it difficult to identify and reach on-call specialists in a timely manner. A clinical communication platform integrated into the scheduling system allows the nurse to connect with the correct on-call physicians simply by finding their role on her mobile device — instead of needing to know their names or mobile numbers or searching for an updated call sheet.
An open API also allows for integration with multiple systems — including electronic health record data, laboratory information management systems, nurse call systems, scheduling services and answering services — so that all relevant patient information is available in one location. Less searching for contact or relevant information can mean faster responses and less time spent waiting by providers and patients.
Handoff №2: Imaging to surgery
The radiologist orders X-rays of Smith’s leg after receiving the text message from the ED physician. Meanwhile, the ED physician locates the on-call orthopedic surgeon on his mobile device, and the surgeon is then added to the group.
After performing the study, the radiologist can send key images directly from the PACS to the group members, who can communicate about the injury with more efficiency.
The orthopedic surgeon and other members of the care team can ask questions in real time through the group text. Such asynchronous communication eliminates phone tag and wasted time from leaving and listening to voicemail — or lining up a live phone to call to get the relevant information.
Based on the combined data from the group communication, Smith is scheduled for emergency surgery through the mobile, integrated clinical communication platform.
Handoff №3: Surgery to inpatient
Thanks to this early communication, all equipment and surgical staff are prepared in the operating suite. While Smith is in surgery, the hospital prepares his inpatient recovery room and begins setting the stage for his discharge by contacting his primary care physician. This preparation keeps the community physician informed, helps avoid readmission and enables better continuity of care.
Even though the primary care physician is not part of the same hospital communication network as the other caregivers, she is able to view messages and communicate with the care team via a text message. This message is launched from a temporary encrypted browser on her mobile phone. She has not needed to download any software or apps to stay in the loop and be informed about Smith’s condition, further enabling his effective care coordination.
Consult: On-call physician to consulting specialist
During his recovery at the hospital, Smith experiences swelling in his calf consistent with a blood clot. Because the clinical communication platform is integrated to the EHR, the on-call orthopedic surgeon can request a consult with a vascular surgeon in the EHR, which generates an instant notification with clinical context to the relevant vascular surgeon’s mobile device.
The orthopedic surgeon’s request avoids outdated workflows and requirements for ordering consults, including email notifications and phone calls, which can sometimes go unchecked for hours. With automated results delivered through secure messaging, the vascular surgeon receives a message with Smith’s information from the EHR and can make a faster and more informed decision at the point of care. This approach helps improve overall patient outcomes and satisfaction, and leads to shorter lengths of stay, for Smith and other patients like him.
Handoff №4: Discharge and transition to the community
No blood clot was found by the vascular surgeon, and Smith is showing steady improvement in physical therapy. He is ready to return home. The discharge coordinator uses the group messaging tool to notify the physical therapist, orthopedic surgeon, hospitalist and hospital pharmacy to prepare for the final handoff and discharge checklist.
Medications are ordered, along with the medical equipment that Smith will need at home. The primary care physician receives a copy of Smith’s discharge instructions via the group messaging tool. The discharge nurse is notified to transport Smith to his wife’s vehicle outside the hospital.
Connecting care teams for improved continuity
Although this case study is fictional, the issues it addresses are very real for hospitals across the country. It shows how a more efficient clinical communication workflow can eliminate care delays, inefficiencies and confusion associated with busy, around-the-clock EDs, as well as care transitions inside and outside hospitals and health systems.
Secure messaging and integrated systems accessed through a mobile platform can improve patient safety, care quality and patient satisfaction through shorter lengths of stay. Such technology can enhance continuity of care between handoffs, decrease wait times and consult times and reduce readmission rates for improved overall financial and clinical performance.
Brad Brooks is co-founder and CEO of TigerText in Santa Monica, Calif.
The opinions expressed by the author do not necessarily reflect the policy of the American Hospital Association.
Originally published at www.hhnmag.com.
