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.

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.

Mobile consultant: evaluation of additional services.

As the need for mobility in the medical world increases, newer systems and applications came to light; many of them based on wireless and mobile networks. PDA based systems were presented in the past, capable of videoconferencing and transmitting high quality images between a roaming consultant and a fixed point in the hospital. These systems not only had desirable characteristics but also incorporated additional services that were found of value: paging, Voice over IP calling, Internet, email, intranet, patient record update, etc This paper presents an engineering and clinical evaluation of those additional services based on both objective and subjective criteria. It concludes that such complementary services can be desirable as they increase personnel mobility, utilize the hospital resources more efficiently while at the same time increase productivity and decrease the cost of hardware and communications.

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.

Prepaid convenience.

Consider prepaid calling cards as a new tool in your marketing arsenal. Your hospitality facility may be considering the sale and distribution of prepaid phone cards to provide more convenience to patients or as a replacement to traditional calling cards for mobile employees. Prepaid phone cards represent a new twist and many advantages for long distance calling.

Networking via wireless bridge produces greater speed and flexibility, lowers cost.

Wireless computer networking. Computer connectivity is essential in today's high-tech health care industry. But telephone lines aren't fast enough, and high-speed connections like T-1 lines are costly. Read about an Ohio community hospital that installed a wireless network "bridge" to connect buildings that are miles apart, creating a reliable high-speed link that costs one-tenth of a T-1 line.

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.

Inova Fairfax Hospital goes wireless to improve services.

The advent of the wireless technology has brought new communications opportunities to healthcare facilities. A wireless phone system has allowed key employees to stay in touch at Inova Fairfax Hospital in Virginia, saving countless hours compared to traditional beeper systems, as well as saving money in reduced costs and improved efficiency.