Wednesday, December 9, 2009

Hospital Noise

Ring, Buzz, Tone, all sounded as Caregivers bustled and hustled past my seat with IV bags, food, charts, and doctors. My heart rate increased. It seems no matter how long I have worked with hospitals those noises still make me nervous. It’s kind of like taking your first airplane ride – you are not quite sure what the noises mean but you know the plane could fall from the sky at any moment. I began thinking about noise, as I waited to speak to the Nursing Director, why is it so noisy? When you are sick all you want to do is rest, yet how do you rest when an IV pump - that sounds like the worst alarm clock in the world - is going off randomly down the hallway.

Noise is measured in decibels(db) - I learned that from my early days of designing sound systems. The average bedside monitor is approximately 79db (Hospitals & Health Networks Dagmara Scalise Mayo Clinic May 2004) but what does that mean? Compare it to a heavy truck driving by – a diesel mind you – which is 80 decibels. At Mayo clinic they documented the loudest point of the day to be at a pre-intervention shift change which was at 113db – to compare a gunshot is 140db.

Is a “decibel” really the right method or measure? Do we really expect the Clinicians to be concerned with actual decibel readings? Is it practical to think that they are going to carry around a little decibel meter in their pocket and then say ohhh we are 15 decibels too loud? Impractical, Difficult, and Inefficient….

Since assessing all noise on a unit is a huge undertaking (footsteps, conversations, cell phones, chatter, beds running into walls) - What if we took the section of noise that has to do with alarms and began to create a method to quickly and efficiently assess it? Total quantity of alarms multiplied by total devices in the rooms = the Noise Issue. (that’s way too simplistic but it helps establish the initial concept)

The initial solution by hospitals (and manufactures trying to sell a product) is “send it to a wireless phone or device”. While I am onboard with the mobility revolution – I think that it’s an overused medium that manufactures and vendors use to pull at the overworked heart strings of the caregivers. The mantra “We can make your life easier – just send it to a wireless phone” conceptually is wonderful but realistically how many alarms can we actually take on our hip? (See earlier post) Don’t jump on the band wagon that mobility is always best - jump on the band wagon that efficiency – ease of use – reduced redundancy is always best.

At Sphere3 we utilize a sophisticated equation in our workflow analysis and link it back to proper categorization of alarms which decreases alarm fatigue. One of the items we look at is noise and utilizing a scoring system we help establish the most effective area to automate.

I think that it would be interesting to create a calculator that the caregivers could easily use to establish their noise level – efficiently and effectively. Anyone interested?

Check out the article posted by @BhawkesRN (Beth Hawkes) on Noise.

Friday, December 4, 2009

Single Source of Truth

The Clinical Transformation blog is about workflow – how do we positively impact the caregiver’s day by providing technology that is purposefully chosen based on process. Remember if you pick the product without knowing the workflow you want to achieve up front – then you are shopping for a book based on the picture on the cover not the content of the material.

That being said - I am totally enamored with what is occurring with device connectivity platforms and the flexibilities they offer. I am equally enamored by the marketplace shift that is occurring. Companies large and small move into a space as a disruptive technology, and it begins a ripple effect. This starts to shift our view of status quo and wonder – is there a better way?

One of the best parts of our growing start up is all of the interesting people I get to meet. Wednesday, I had the opportunity to sit down with Tom Herzog, VP of IT and Medical Device Technology – head of the MDBUS. Tom is a fascinating individual who is very intelligent and a visionary in the marketplace - I was blown away by our conversation and truly appreciated the interaction. He is someone to watch. MDBUS is Cerner’s connectivity platform that connects medical devices to the EMR. While MDBUS has several similarities to CapsuleTech (blogged about earlier) they have built tight relationships in the marketplace with companies such as Hill-Rom that allow them to garner additional information on an interactive touchscreen, and interactive integration software piece that allows a user to query systems using a handheld device.

The one items that stands out to me as their biggest challenge (this might be the elephant in the room) in the market place is the blessing and curse of the Cerner brand. Cerner is well known for innovative thinking and product development – if you have been to a smart room you would agree. The blessing of the brand is it’s trusted stability in the marketplace with a growing enterprise EMR market share documented at 13%(2006 HIMMS) which I have read other sites to be closer to 20%. This is a great base of clients who are prime candidates for “the bus”. As a relatively unknown startup – I am envious of having such a well known brand. What Mr. Patterson has done is amazing.

The curse of the Cerner brand is it’s tight tie to a specific EMR. While the product is designed to be EMR vendor agnostic - it would only be logical to utilize the product to position themselves in competitive accounts. Why would Epic invite a Cerner product into the mix? I could be way off base here but this seems counter intuitive. While it may occur – GE still utilizes Emergin (aka Phillips) Emergin as a standalone brand had the ability to be Vendor Agnostic but now linked to Phillips it is a leverage point to bring Phillips into an account.

All of that aside – the thought process used in developing MDBUS is correct – the product is really impressive. Open Source – Open Data – Single Source of Truth (as Tom would say) is important in healthcare. It offers significant abilities to decrease caregivers workload and increase safety.

I think that every hospital should be evaluating these types of systems and DOCUMENTING their validity.
What method are you using to see if this is garnering you results?
Is it going to positively affect safety, accountability, redundancy, and noise?
Is it affecting their caregiver satisfaction, patient satisfaction, and safety?

I think that Capsuletech (Brian McAlpine) and Cerner MDBUS (Tom Herzog) are fellas that you should watch – I know I am. I appreciate this interaction.

Who would’ve thought – a little gal from Kansas would be talking to such powerful industry changing people. All it took was Twitter and a choice to join the conversation – are you ready to join?

Thanks Tom – look forward to learning more.

Stay tuned – I am working on a thought provoking post about Cerner’s vision of allowing people to write apps to their Iphone and utilize the EcoSystem to share (possibly sell) that work. Probably one of the most innovative ideas I have heard in a long time – not sure I am on board with the ide, but I can’t wait to experience it myself.

Tuesday, December 1, 2009

The 5 I's of Fall Mitigation

Our Goal is to reduce falls in the patient rooms – whether or not you hire Sphere3. I believe in the power of the conversation for the overall improvement of healthcare. I encourage you to read what is written and add to it. We have had a great team working to develop this framework but I believe in the power of collaboration.

Collaboration outside of healthcare can also be powerful. As many hospitals have discovered, manufacturing may have some ideas that could answer some of the questions. What are other industries that may compliment process improvement for healthcare?

The First "I": Introduce

The basic premise of the first “I” is to describe how the patient is introduced to the unit. This is not a, “hello my name is Joe, what’s yours?” It is how do they get there and once they are there how do people know? Not that we are recommending a camp like cheering section to greet them in a tunnel but how are the caregivers on the unit provided with information that a new patient has arrived. What’s the “on-boarding” process? One consideration for this process will be, is it important for everyone to know a new patient has arrived?

There is considerable time savings opportunities (and cost savings as well) prior to arrival on the unit. There are several areas to consider including how are you tracking the time from entry to bed and all the steps in between? How is the transporter contacted and how are they tracked? How does the hand-off work?

What are your thoughts on Introduce – Transport – Notification?

Our team works with your hospital to customize a strategy to respond to the above questions. Our Fall Mitigation Analysis software program allows us to document, analyze, and provide innovative recommendations for improvement. Your information is assessed against best practices for optimal results.