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Closing the Loop on Communication in the Care Environment

· Tim Needham, Chief Commercial Officer

Tim Needham, Chief Commercial OfficerI am naturally drawn to pattern recognition. It’s my thing. It’s what I leaned on while independently consulting in clinical communications from 2014-2018. That was an exciting time in the category, as vendors and health systems alike were in a rapid learning curve often fed by project failures or stumbles.

During 2017 and 2018, I interviewed approximately 40 health systems with two primary goals:

  1. Identify best practices for clinical communication technology and process implementation
  2. Validate the strengths and weaknesses of category vendors

Two patterns emerged: First, health system personnel willingly provided feedback about category vendors, but had little to say about the overall value or impact of implementations. Secondly, very few could remember why the project started in the first place. I heard a lot of “I think we had some phones that needed to be replaced,” and “We needed HIPAA secure texting for physicians,” but not much more.

Given the time and expense associated with these deployments, I began to ask myself what communication vendors should be focused on in order to bring real value to health systems. To address this question, I rejoined PatientSafe in late 2018 and we began work on the answer:

“Our mission is to make the experience of care simple and effective by delivering vastly improved closed-loop communication and collaboration workflows to our clinical end users.”

What do we mean by this, exactly?

  • A clinician’s day is driven by a series of care delivery interventions that are interconnected, require collaboration from others, and are almost always specific to a patient.
  • Each of these tasks can be traced to an origin point, or trigger, that sets the required actions in motion.
  • In the past, point-of-care technology deployments have largely focused on fixing a single-point problem and end up impacting clinician workflow negatively – making an already complex job even harder and creating end user adoption challenges.

Clinicians do “close the loop” on communication and collaboration workflows today in service of their patients. However, too often this involves heroic efforts: managing significant complexity, holding a mental “to do” list, dealing with constant interruptions, and expending significant time and energy in the process. In order to follow through on our team’s mission to make the experience of care simple and effective, we recognize that technology is just a piece of the equation. Significant effort should be expended understanding current state challenges, identifying opportunities for improved outcomes, and collaborating on workflow optimization.

Our methodology does just that. Our model identifies four distinct types of communication triggers. In order to achieve improved workflow, we need to help clinicians prioritize their task list with as much automation as possible based on trigger source and the severity of the response needed, while providing visibility and access to other team members involved in closing the loop on care.

The four types of triggers we map with our clients when building a long-term strategy include:

  1. Communications: Peer-to-peer text messages, voice calls or SMS pages
  2. Alerts: Nurse call, stat orders, critical results
  3. Alarms: Code Blue, patient monitoring, bathroom pull cord
  4. Interventions: Assessments and documentation, rounding notifications

Once we identify and consider the workflow implications across the four types of triggers, we then develop new workflows to help more efficiently and effectively achieve a closed-loop state. As a result, our approach has evolved to include true ownership of workflow design across all related systems to help ensure that our customers find value in our consulting work. We expect to be well-versed in industry best practices for workflow design across nurse call, patient monitoring alarms, critical notifications from the EMR, and clinical documentation.

To illustrate, below is an example of a future-state workflow I saw documented by a vendor for a project back in 2018. While it addresses the origination of a technology workflow (nurse call alert to smartphone), it does not address the follow-on steps that are required to actually achieve a closed-loop workflow for both the clinician and the patient.

Future State – Pain Request (inadequate):

Diagram of an inadequate workflow triggered by a nurse call

This approach left the following notable gaps:

  • What actions are required to complete satisfaction of the original trigger – the patient request for pain support?
  • What are best practices for managing the RN-to-physician communication that will result from the initial request trigger?
  • What documentation is required as part of the workflow, and where is this documentation performed?

In contrast, here is one summary example of output from a recent project in which the PatientTouch application supports Epic’s implementation of Rover and Haiku, including documenting across the two systems the actions required to truly close the loop on the patient need:

Future State Closed-Loop Workflow – Pain Request:

Diagram of a closed-loop workflow triggered by a nurse call

While the effort required design and document the complete set of initial and response triggers and the subsequent actions required is significant, when completed correctly, it gives our clinicians much more clarity on workflow modifications and expected benefit.

In the case outlined above, we were able to work with our client’s informatics team to identify:

  • The most time-efficient means of satisfying the patient need by leveraging each application’s strengths
  • An understanding of how the clinical user interacts with each application and how they link to support overall workflow
  • The role of clinical documentation as a response to a communication workflow trigger
  • Alignment between care roles to reduce unnecessary, forced interruptions relating to voice calls

Our team’s experience indicates that taking a workflow redesign approach that accounts for all types of triggers, carries them to their true closed-loop state, and defines and measures outcomes we can achieve repeatable, adoptable processes.

If you also have an interest in understanding the impact of Closed-Loop Communication and Collaboration Workflow and how it can positively impact your organization and care teams, contact us today!

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