smartpage: North Shore Pilot Trial


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Presented by Aidan Gill

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smartpage: North Shore Pilot Trial

  1. 1. from North Shore Pilot Trial Staff Feedback: ‘This is one of the best things they’ve done in this hospital’ – Ward Nurse ‘They trial all sorts of things in the wards, but this one should stay’ – Ward Nurse ‘It makes us more efficient. Nurses know we’re around and we’re able to respond back. It’s so good, saves so much time.’ - Doctor
  2. 2. Hospital Paging Systems  Used in every hospital in NZ and Australia  Contact Number Paging     Contact number only, no indication of urgency Doctors stop what they’re doing to find a phone and ring back Nurses wait for ~10 minutes, pages often not returned Text Message Paging    100 character limit, 2-3 min delay No acknowledgement of delivery No easy way to reply ‘mrs lee- shin has fall, alert, 0bs n/s 1hr 100, bruise on lt hip. denied pain, pls r/v tka ann 3372’ – Ward Page, 99 chars
  3. 3. Task Management Systems  Task Manager, SPADE, Clinical Task List      An intranet based list of non-urgent tasks Must be checked regularly every hour, even at night Message delivery can be an hour or more later Only used for 20% of tasks, everything else is via text page iBleep    SMS based, accessed via Britain on PDAs Trialled at WDHB with limited success Not seen as an improvement on pagers
  4. 4. (Note: Fictional pages, for demonstration only)
  5. 5. Waitemata Smartpage Trial – January 2013  22 Doctors, 180 Nurses over four weeks     Preconfigured Smartphones   Kept in the telephonists office Ward interfaces   6 medical wards – CCU, CVU, SSU, Ward 3, 6 and 10 1 medical house officer – the Med C H/O 1,380 pages Each ward given login details and a shortcut on the desktop Anonymous online post trial survey  With the help of Brian Cusack and Dave Parry from AUT
  6. 6. Communication Patterns  More information being sent with each page    Rapid page acknowledgments and return phone calls   Median response time of 15 seconds from sending Patient care questions are often answered straight away   Average of 166 characters (max 532), opposed to 77 with text paging Full set of patient and nurse details, plus vital signs and NEWS in 20% Previously these would wait until a doctor arrived on the ward Zero repeat paging by week 4 of the trial  No stress over whether a page has been delivered ‘They get back to us a lot quicker now. We used to get very annoyed when they didn't get back to us.’ ‘When they ring back they ring back straight away. It’s almost instantaneous.’
  7. 7. Communication Before and After ‘mr smith wd6, bp 79/40 manual, p now 104, sats 98, asympt, pl r/v news 3’ (72 characters) (850+ characters) Note: Names and patient identifiers changed
  8. 8. Post Trial Survey  Anonymous online feedback – 74 nurses, 17 doctors    Communication     100% of nurses found it easier to portray how unwell a patient was 94% of doctors found that nurses were easier to understand 100% of doctors found Smartpage to make handover more accurate Response times and workflow    100% found Smartpage improved communication 100% wanted to continue with the system 98% of nurses felt doctors were responding faster 76% of doctors felt they could complete tasks faster than before Time Saved  Doctors – reported time savings – 10-15 minutes per hour
  9. 9. Paging Systems Comparison Very Good Good Series1 Series5 Neutral Series2 Series3 Bad Series4 Very Bad 1 2 3 4
  10. 10. Staff Feedback  5 pages of written and verbal feedback  ‘It’s so good. Sometimes doctors change teams and you don’t know. The other day I paged 3 times and didn’t hear from the doctor for hours only to find out it was the wrong person. You just don’t know that messages are sent, you have to page again. That wouldn’t happen with Smartpage.’ – Nurse  ‘This is an excellent device, it makes on calls smoother and less stressful, and lets you focus more on tasks at hand. It makes your job easier, and improves communication with nursing staff.’ – House Officer  ‘This is one of the best things they’ve ever done in this hospital.’ - CCU Nurse
  11. 11. Extended Trial at Waitemata DHB  From December 2013      Now running on 13 wards North Shore and Waitakere Hospitals 2 → 12 oncall house-officers Every medical and surgical service Independent DHB evaluation    Analysis of 2,000+ page logs Surveys repeated by the DHB Independent focus groups
  12. 12. Additions since the Waitemata Trial  Weekend Handover Lists     Replaces paper lists cellotaped to whiteboards Tasks on the phone when doctors log in Record of tasks completed Analytics and Workflow Reporting     What tasks are sent and where they come from Automated reporting and comparison of workloads Tools for audit and service improvement Extensive record of after-hours activity – not before available
  13. 13. Hospital Analytics and Reporting    Workforce planning and the efficient use of doctors Recharting and Warfarin extremely common Quantify time spent on tasks such as IV lines and blood tests  ? Hospital Phlebotomists Workload average over weekend - (min/average/max) Day Doctor Night Doctor
  14. 14. Questions  ‘It makes us more efficient. Nurses know we’re around and we’re able to respond back. It’s so good, saves so much time.’ – North Shore Hospital, Doctor  ‘Everyone on this ward really loves it. Doctors get back to us quicker, and when they ring back they ring back straight away. It’s almost instantaneous.’ – North Shore Hospital, Nurse  ‘Now we know what's going on - at the moment we keep paging and paging the doctors as we don't know what's happening.’ – North Shore Hospital, Nurse