The doctor is no longer the sole care provider. Teams of doctors, nurses, pharmacists and allied health professionals now look after patients. But archaic communication technologies like the pager are not effective in this new workflow yet are still being used by more than 90% of hospitals. This is a huge loss to our patients, causing delayed discharges, increased costs and in some cases fatal medical errors.
The science of medicine has seen rapid transformation but the art has remained much the same. From the discovery of Penicillin during the turn of the last century, healthcare has seen an exponential growth in innovation. Medicine has seen drastic advances in drug discovery, genomics, and devices. Recently, digital health has also been revolutionizing the practice of medicine, by replacing paper charts by easily searchable soft copy documentation. These technological advancements have made a huge difference for patients’ health outcomes. However, they have not kept abreast with the changing workflow in medicine.
Where did teamwork in healthcare come from?
Learning from aviation
The aviation industry in the 1980s went through an internal analysis exercise to understand the source of errors causing fatal crashes. It recognized the inability of humans to work in complex environments without making errors and redesigned its entire training program and organizational structure to bolster teamwork. This body of research then traversed into the healthcare industry where teamwork also became more important to reduce medical error.
Expanding teams post World War II
Additionally, the post World War II era has seen an explosion in increasingly sophisticated and complex medical procedures.1 Whereas then you had one doctor have primary responsibility over the patient and perhaps a nurse assisting him. Today, you can have multiple doctors all subspecializing in a small area of human organ system or diseases, nurses, pharmacists and a wide array of allied health professionals. The need for these allied health professionals was felt for three reasons; increasingly complex procedures requiring specialized assistance, aging populations requiring an expansion of medical services and increasing healthcare costs seeking cheaper labor cost models for care provision. It is estimated that 60% of healthcare workforce now consists of allied health professionals.
How complex are processes in healthcare and what technologies are supporting them?
Hospitals are saturated with complex workflows as teams dynamically form and disestablish around a given patient. This causes large coordination problems, and increases costs from inefficiencies. On average, a patient is seen by 5-10 different providers during their hospital stay. Each of these providers are caring for 10-20 patients at the same time. All of them come on and off shifts regularly and at different times. Hence, creating a knowledge gap on who else is looking after their patient. On average, a clinician knows only 30% of a patient’s care team. ‘When technology does not adequately support the goals of the care team, it often causes workflow workarounds. These alternate workflows are a cause for concern because these informal, evolutionary systems rely on the clinicians’ memories, and bypass decision-support safeguards that the system may provide.’
Archaic technologies in use
Despite the recognition for teamwork for improving quality of care for patients, and a rapidly expanding team, tools to help coordinate care have remained much the same. More than 90% of real-time communication in hospitals still occurs via pagers. Studies show pagers cause discharge time to be elongated by 100%. While the pager was a sufficient tool for communication in the 1980s when teams were smaller, today it has far out served its purpose.
Old technologies causing major medical errors
Hospitals and clinics are highly stressful environments. In such environments, it is often preferred to communicate face to face or else over the phone, termed synchronous communications. However, such interruptions lead to reduction in working memory, which increase the risk of medical errors. Hence, psychologists and communication experts believe asynchronous forms of communication in the hospital should be encouraged unless relaying highly urgent or complex information. Since the pager provides little to no context on whether the incoming communication is urgent or complex, it becomes synchronous. More than a hundred thousand people die in the USA due to medical errors. Poor communication leads to 50% of them. A recent study has shown, every interruption while delivering drugs causes a 4.6% higher risk of medical errors.
Next frontier in healthcare communications: smartphones
The need for care coordination has increased significantly due to larger care teams. Technology has not kept abreast with an ever more complex healthcare workflow. New innovations like smart phone messaging and team transparency solutions, increase efficiency while maintaining patient safety will have the greatest chance of widespread adoption. We are at the dawn of when the art of medicine finally catches up with the science.
By Divya Dhar
Patients Charting the Course: Citizen Engagement and the Learning Health System: Workshop Summary. Source: http://www.ncbi.nlm.nih.gov/books/NBK92080/
University of California San Francisco, Advancing the Allied Health Professions. Futurehealth.ucsf.edu. Retrieved 2012-03-06
Patient Safety and Quality: An Evidence-Based Handbook for Nurses. http://www.ncbi.nlm.nih.gov/books/NBK2638/
The economic and productivity impact of IT security on healthcare, Ponemon 2013 , AHA Trend Chartbook 2012. Bureau of Labor Statistics
Healthcare Risk Control. Communication. ECRI Institute. https://www.ecri.org/Forms/Documents/Communication.pdf
Westbrook J, Dunsmuir W. Association of Interruptions with an increased risk and serverity of medication administration. Arch Intern Med. 2010;170(8):683-690
Jan 23, 2014 @ 17:34
By Divya Dhar, M.D. and Co-Founder of Seratis