Overview

The University of Maryland school of medicine aimed to improve inefficiencies of clinical workflows through implementation of a mobile telephone communication system in a NICU.

In collaboration with Healthcare: The Journal of Delivery Science and Innovation

Organization Name

University of Maryland School of Medicine

Organization Type

• Academic Medical Center

Local/Organizational Context

• Prior to this intervention, the NICU transitioned from open-bay rooms to 52 individual patient rooms, which significantly increased the size of the clinical care area and spread out nursing staff from a centralized working station to multiple workstations.
• Prior to this transition, physicians relied on overhead page notification to signal a need to respond to incoming telephone calls. The overhead paging system created significant amounts of noise and was not working efficiently in this particular clinical setting.
• When the NICU built the individual patient rooms, they decided to forgo an overhead paging system and implement a cellular phone-based paging system. They initiall implemented Cisco Jabber 4.8, but the implementation staff reported that phone the calls were not being successfully transferred from the front desk to the staff members. They decided to explore other options.

Leadership

• Neonatal ICU physicians and nurse leadership determined the communication objectives.
• Clinical engineers determined the technology to support communication and were responsible for providing ongoing support for the chosen technology.
• The information technology (IT) department supported WiFi integration.

Funding

• This project received institutional funding.

Research + Planning

• Multiple technical factors were considered prior to implementation of this project: WiFi and cellular infrastructure, data security, integration with patient monitoring systems and electronic health records, support of personal devices, equipment durability, infection control, battery life, asset management, customer support capabilities, and interoperability of devices and applications.
  • The project team suggests that clinician teams looking to implement mobile communication would benefit from partnerships with professional technical experts to assist with decision-making for hardware and software, prior to and following implementation.

Tools or Products Developed

• Calls to a device were screened by the unit secretaries and answered on desk phones. Unit secretaries transfer phone call from within and outside the hospital to individual devices, as appropriate to facilitate communication between parties. If phone calls were unanswered after a pre-determined number of rings, they were automatically forwarded back to the unit secretaries.

Tech Involved

• Telephone

Team Members Involved

• Administrative Assistant
• NPs
• Physicians
• RNs
• Support Staff

Workflow Steps

• When NICU staff begin their shift, they receive one of the Motorola MC40 smartphones for use during the shift.
• When someone calls the NICU unit desk either internally or from outside the hospital, the unit secretary answers calls on Cisco desk phones and provide call screening.
  • If the unit secretary feels the caller needs to be put through to a specific staff member, then he or she transfers the phone call to the smartphone carried by staff member.
  • If the staff member does not answer the call after a specific number of rings, the call is rerouted back to the unit desk for unit secretaries to answer.

Budget Details

• Cost of purchase of Motorola MC40 smartphones
• Cost of annual licence fees for telephony system
• Cost of any upgrades to the supporting infrastructure
• Cost of technical support for users and for system integration

Outcomes

• Number of calls per hour: Median number of calls per hour to a unit secretary desk phone significantly decreased during the study period.
• Number of successfully transferred calls: The number of calls that were successfully forwarded to their intended recipient significant increased during the study period.
• Number of successful calls: The percentage of successful calls was unchanged between the pre- and post-intervention periods.

 

• The intervention led to >70% successful call transfers without the negative effects of overhead systems.
• The implementation of compatible software resulted in a reduction in the number of calls to the unit secretary per hour, an increase in successful call transfer on first attempt, and a reduction in time time to reach a bedside nurse by phone.

Unique Challenges

• The voIP application was non-native (not specifically designed for the operating system) to the devices. Unfortunately this lead to an error when staff member’s phones went into sleep mode that also caused the vo-IP application to unexpectedly log off.

Sources

Hughes Driscoll CA, Gurmu S, Azeem A, El Metwally D. Implementation of smartphones to facilitate in-hospital telephone communication: Challenges, successes and lessons from a neonatal intensive care unit. Healthc (Amst). 2018 Aug 14. pii: S2213-0764(18)30012-5. doi: 10.1016/j.hjdsi.2018.07.001. [Epub ahead of print] PubMed PMID: 30120051.