Study: Wireless on-call systems welcomed, boost efficiency
 |
Published in the March 29 issue of BMJ Open, John D. Blakey, PhD, from the respiratory biomedical research unit at the University of Nottingham in Nottingham, England, and colleagues investigated if a wireless system of call handling and task management for out of hours care could replace a standard pager-based system and improve markers of efficiency, patient safety and staff satisfaction.
The authors noted that in Nottingham, admissions have risen almost 15 percent between 1999-2000 and 2010-2011 while individual junior doctor’s hours have fallen by more than 35 percent. “As a consequence of this … it became apparent that changes to the traditional on-call system were required to maintain patient safety,” the authors wrote.
Hospital at Night (H@N) was developed and adopted nationally, according to the authors. Confined to the U.K., the authors remarked the issue of maximizing limited clinical resources is a common theme industry-wise. H@N projects intend to achieve safe clinical care using teams comprising junior doctors, nurses and clinical support workers to provide out-of-hours cover.
“All requests for patient-related tasks from ward nurses are directed through a coordinator, usually a senior nurse, who provides a triage function and allocates tasks to team members,” the report noted. “This national initiative is intended to deploy a coordinated team that improves efficiency in resource management, particularly allowing medical staff more time to engage in clinical activity.”
At Nottingham Care Hospital, a prospective assessment was designed using quantitative and qualitative methods, including interviews with staff, a standard satisfaction questionnaire, independent observation, data extraction from work logs and incident reporting systems and analysis of hospital committee reports.
Length of hospital stay, incidents reported, coordinator call logging activity, user satisfaction questionnaire and staff interviews were assessed. Users were more satisfied with the new system (satisfaction score 62/90 vs. 82/90), the results found. “With the new system over 70 hours a week of coordinator time was released, and there were fewer untoward incidents related to handover and medical response.”
In both two-month periods, there were 552 electronically reported incidents, the results found. Of these, the majority related to patient falls. “On systematic review of all 1,104 incidents, we found 17 to be related to inadequate or absent handover or to a slow response of H@N, which resulted in actual patient harm or required remedial action to prevent this,” the authors noted. “Thirteen of these occurred prior to wireless working and four after its introduction. Exposure to wireless working was therefore associated with a reduction in the proportion of incidents that were attributable to the H@N system.”
Broad clinical measures (cardiac arrest calls for peri-arrest situations and length of hospital stay) improved significantly in the areas covered by the new system, the study authors wrote.
However, the authors acknowledged that wireless systems similar to H@N are not yet commonplace in secondary care in Europe and noted implementation barriers such as cost. ‘Wireless technology and securely held electronic data have become a central part of daily life outside the NHS,” they concluded. “[We] present an acceptable way of introducing such technology to address some of the issues common to H@N systems: we found it to be welcomed by users, efficient and be correlated with improved broad clinical outcomes.”