Application of a smartphone nurse call system for nursing care.

BACKGROUND: Traditionally, a patient presses the nurse call button and alerts the central nursing station. This system cannot reach the primary care nurse directly. The aim of this study was to apply a new smartphone system through the cloud system and information technology that linked a smartphone and a mobile nursing station for nursing care service. MATERIALS AND METHODS: A smartphone and mobile nursing station were integrated into a smartphone nurse call system through the cloud and information technology for better nursing care. RESULTS: Waiting time for a patient to contact the most responsible nurse was reduced from 3.8 min to 6 s. The average time for pharmacists to locate the nurse for medication problem was reduced from 4.2 min to 1.8 min by the new system. CONCLUSIONS: After implementation of the smartphone nurse call system, patients received a more rapid response. This improved patients' satisfaction and reduced the number of complaints about longer waiting time due to the shortage of nurses.

Structured physician order entry for trauma CT: value in improving clinical information transfer and billing efficiency.

OBJECTIVE: The purpose of this study was to measure the effects of use of a structured physician order entry system for trauma CT on the communication of clinical information and on coding practices and reimbursement efficiency. MATERIALS AND METHODS: This study was conducted between April 1, 2011, and January 14, 2013, at a level I trauma center with 59,000 annual emergency department visits. On March 29, 2012, a structured order entry system was implemented for head through pelvis trauma CT, so-called pan-scan CT. This study compared the following factors before and after implementation: communication of clinical signs and symptoms and mechanism of injury, primary International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) code category, success of reimbursement, and time required for successful reimbursement for the examination. Chi-square statistics were used to compare all categoric variables before and after the intervention, and the Wilcoxon rank sum test was used to compare billing cycle times. RESULTS: A total of 457 patients underwent pan-scan CT in 2734 distinct examinations. After the intervention, there was a 62% absolute increase in requisitions containing clinical signs or symptoms (from 0.4% to 63%, p<0.0001) and a 99% absolute increase in requisitions providing mechanism of injury (from 0.4% to 99%, p<0.0001). There was a 19% absolute increase in primary ICD-9-CM codes representing clinical signs or symptoms (from 2.9% to 21.8%, p<0.0001), and a 7% absolute increase in reimbursement success for examinations submitted to insurance carriers (from 83.0% to 89.7%, p<0.0001). For reimbursed studies, there was a 14.7-day reduction in mean billing cycle time (from 68.4 days to 53.7 days, p=0.008). CONCLUSION: Implementation of structured physician order entry for trauma CT was associated with significant improvement in the communication of clinical history to radiologists. The improvement was also associated with changes in coding practices, greater billing efficiency, and an increase in reimbursement success.

Transferred and delayed care of patients with colorectal cancer in a safety-net hospital system--manifestations of a distressed healthcare system.

BACKGROUND: Safety-net hospital systems provide care to a large proportion of United States' under- and uninsured population. We have witnessed delayed colorectal cancer (CRC) care in this population and sought to identify demographic and systemic differences in these patients compared to those in an insured health-care system. DESIGN, PATIENTS, AND APPROACH/MEASUREMENTS: We collected demographic, socioeconomic, and clinical data from 2005-2007 on all patients with CRC seen at Parkland Health and Hospital System (PHHS), a safety-net health system and at Presbyterian Hospital Dallas System (Presbyterian), a community health system, and compared characteristics among the two health-care systems. Variables associated with advanced stage were identified with multivariate logistic regression analysis and odds ratios were calculated. RESULTS: Three hundred and eighteen patients at PHHS and 397 patients at Presbyterian with CRC were identified. An overwhelming majority (75 %) of patients seen at the safety-net were diagnosed after being seen in the emergency department or at an outside facility. These patients had a higher percentage of stage 4 disease compared to the community. Patients within the safety-net with Medicare/private insurance had lower rates of advanced disease than uninsured patients (25 % vs. 68 %, p < 0.001). Insurance status and physician encounter resulting in diagnosis were independent predictors of disease stage at diagnosis. CONCLUSIONS: A large proportion of patients seen in the safety-net health system were transferred from outside systems after diagnosis, thus leading to delayed care. This delay in care drove advanced stage at diagnosis. The data point to a pervasive and systematic issue in patients with CRC and have fundamental health policy implications for population-based CRC screening.

Use of communication technologies to cost-effectively increase the availability of interpretation services in healthcare settings.

Poor patient-provider communication due to limited English proficiency (LEP) costs healthcare providers and payers through lower patient use of preventive care, misdiagnosis, increased testing, poor patient compliance, and increased hospital and emergency room admissions. Scarcity of bilingual healthcare professionals and prohibitive interpretation costs hinder full implementation of language service despite federal and state laws requiring their provision. We review recent published literature and unpublished data documenting the use of telephonic and video interpretation methodologies to improve healthcare communication with LEP persons. For example, a cooperative of nine California public hospitals and their associated community clinics, psychiatric facilities, skilled nursing facilities, and public health departments have implemented shared video interpretation services with video/voice-over Internet Protocol call center technology that automatically routes requests for interpretation in 15 languages to a pool of 30 full-time interpreters and 4 trained bilingual staff. For organizations seeking to initiate or expand their language services, the Internet provides access to translated documents, promising practices, step-by-step guides, planning tools, and research briefs. Such recent technological advances make provision of language services-to respond to federal and state mandates and improve access and quality of care to LEP persons-more feasible than is widely believed. Increased government and foundation support, and collaboration among provider organizations themselves can catalyze these efforts.

Changing from paper to paperless hospitals in busy academic centers.

To decide to change from paper to a paperless hospital, one decides to go on a journey. This chapter will outline the destination, the reasons to make the journey and describe the best route to the destination. Becoming paperless is the route taken to the destination.

Are physician pagers an outmoded technology?

BACKGROUND: Pagers are the most commonly used method of communications in American hospitals. However, its financial cost and efficiency is unknown. OBJECTIVE: To evaluate the efficiency of conventional hospital pagers and to estimate the financial cost of time wasted by the use of these pagers. METHODS: We conducted a survey among 100 clinicians, nurses and pharmacists in our community teaching hospital, estimating the time spent in the process of sending and responding to pages and the financial equivalent of this time, and evaluating the potential advantages of hospital-based wireless telephones compared with traditional pagers. RESULTS: A total of 70 clinicians completed the survey for a response rate of 70%. The average time spent per daytime shift in using the paging system was between 48 and 66 minutes for physicians, 120 minutes for nurses and 165 minutes for pharmacists. The financial cost of time lost for a single medical ward for one month was estimated to be $2,732-$17,250, depending on the case scenario. CONCLUSIONS: Our study suggests that the traditional paging system is an inefficient means of communication between clinicians and hospital staff and that a switch to direct phone calls might be far more cost-effective. Similar considerations probably apply to most hospitals that still use traditional pagers.

Operator service access and pay telephone compensation rules--FCC. Final rule.

In its Memorandum Opinion and Order on Reconsideration, the Commission affirms certain aspects of the Second Report and Order and makes a number of modifications. First, the Commission affirms its holding that interexchange carriers (IXCs) must pay competitive payphone owners (PPOs) compensation in the amount of $6 per month per payphone. Second, the Commission modifies the Second Report and Order to allow IXCs to avoid the obligation to pay compensation if they do not receive access code calls from payphones to which they are not presubscribed. Third, the Commission affirms its decision to use to toll revenue standard for apportioning compensation among those IXCs required to pay. Fourth, the Commission clarifies in a number of respects its requirements pertaining to the customer-owned coin-operated telephone (COCOT) lists provided by local exchange carriers (LECs) to IXCs. In addition, the Commission denies Allnet's Application for Review of a decision by the Common Carrier Bureau relating to the list of IXCs required to pay compensation. The Commission's Memorandum Report and Order on Reconsideration ensures that PPOs receive fair compensation for the service they provide in originating interstate access code calls from their payphones.

Enhanced nurse call systems.

This Evaluation focuses on high-end computerized nurse call systems--what we call enhanced systems. These are highly flexible systems that incorporate microprocessor and communications technologies to expand the capabilities of the nurse call function. Enhanced systems, which vary in configuration from one installation to the next, typically consist of a basic system that provides standard nurse call functionality and a combination of additional enhancements that provide the added functionality the facility desires. In this study, we examine the features that distinguish enhanced nurse call systems from nonenhanced systems, focusing on their application and benefit to healthcare facilities. We evaluated seven systems to determine how well they help (1) improve patient care, as well as increase satisfaction with the care provided, and (2) improve caregiver efficiency, as well as increase satisfaction with the work environment. We found that all systems meet these objectives, but not all systems perform equally well for all implementations. Our ratings will help facilities identify those systems that offer the most effective features for their intended use. The study also includes a Technology Management Guide to help readers (1) determine whether they'll benefit from the capabilities offered by enhanced systems and (2) target a system for purchase and equip the system for optimum performance and cost-effective operation.

Standardizing medical device communications: the Medical Information Bus.

Data collection from different types of medical devices is currently a time-consuming process that is done manually. The Medical Information Bus (MIB) defines standardized methods for interfacing medical devices and computer systems. The potential impact on current electromedical products and future product developments is huge. This article describes MIB and identifies some of the issues that must be resolved for its successful implementation.

Voice message processing: cost effective communication.

Healthcare organizations are constantly under pressure to reduce operating costs. One target area for cost reduction and improvements can be the telephone system. A relatively new communication tool is now available to help offset the costs and inefficiencies of the telephone--voice message processing. The voice message processing system allows messages to be processed, delivered, and received more efficiently. This system can be used to increase an organization's productivity while decreasing their operating costs.

Hackers ring up big phone bills for hospitals.

A big telephone bill--possibly in six figures--can be a painful way for a hospital to find out its phone system isn't secure. When unusually large long-distance bills start to show up, chances are a professional telephone hacker has broken in. According to experts, one in 15 businesses has been victimized by long-distance toll fraud, and loss estimates range from $900 million to $4 billion a year.

Reduce costs and generate revenue with telecommunications.

Financial managers are constantly faced with the pressures of running a cost efficient organization, and must look for new and innovative ways to reduce costs and generate revenue. Telecommunications can provide the financial manager with opportunities to save money and produce income. Ideas such as disposable or dispensible telephones, call tracking systems, and pay telephones can all become important steps to improving the financial health of an organization.

Talk is not cheap: improving patient telephone profitability.

Because of the recent deregulation of the telecommunications industry, healthcare institutions are facing rising telephone costs and the sensitive issue of charging patients for phone services. Flat fee and call resale programs are two options that can help ease the financial strain while preserving the relationship between hospitals and patients. While both programs have their benefits and drawbacks, if properly implemented, the cost of telephones and services can be equally divided while enhancing the quality of service.

Flexible telecommunications. An enhanced system can cut costs and generate revenues.

Hospitals can cut costs and even generate new revenues by updating their telecommunications systems. Hospitals with sophisticated systems can cut costs in a number of ways. They can bypass local telephone service, use common carrier services, integrate internal transmission systems, establish private networks, and avail themselves of other specialized, cost-reducing services. A sophisticated system can also enable a hospital to generate revenue by reselling excess long-distance and local service, becoming a common carrier, installing pay telephones, and providing other services. Facilities or systems choosing to develop a large, complex system must, however, address certain legal and managerial issues. Not-for-profit organizations must, for example, determine whether selling services will endanger their tax-exempt status. A number of other legal issues will also arise. In addition, facilities or systems planning a large telecommunications upgrade should assemble a knowledgeable, experienced telecommunications project team early.