Implementation of smart phones to facilitate in-hospital telephone communication: Challenges, successes and lessons from a neonatal intensive care unit

Factors influencing the successful implementation of a novel digital health application to streamline multidisciplinary communication across multiple organisations for emergency care

RATIONALE

Delivering optimal patient health care requires interdisciplinary clinician communication. A single communication tool across multiple pre-hospital and hospital settings, and between hospital departments is a novel solution to current systems. Fit-for-purpose, secure smartphone applications allow clinical information to be shared quickly between health providers. Little is known as to what underpins their successful implementation in an emergency care context.

AIMS

To identify (a) whether implementing a single, digital health communication application across multiple health care organisations and hospital departments is feasible; (b) the barriers and facilitators to implementation; and (c) which factors are associated with clinicians' intentions to use the technology.

METHODS

We used a multimethod design, evaluating the implementation of a secure, digital communication application (Pulsara™). The technology was trialled in two Australian regional hospitals and 25 Ambulance Victoria branches (AV). Post-training, clinicians involved in treating patients with suspected stroke or cardiac events were administered surveys measuring perceived organisational readiness (Organisational Readiness for Implementing Change), clinicians' intentions (Unified Theory of Acceptance and Use of Technology) and internal motivations (Self-Determination Theory) to use Pulsara™, and the perceived benefits and barriers of use. Quantitative data were descriptively summarised with multivariable associations between factors and intentions to use Pulsara™ examined with linear regression. Qualitative data responses were subjected to directed content analysis (two coders).

RESULTS

Participants were paramedics (n = 82, median 44 years) or hospital-based clinicians (n = 90, median 37 years), with organisations perceived to be similarly ready. Regression results (F(11, 136) = 21.28, p = <0.001, Adj R2  = 0.60) indicated Habit, Effort Expectancy, Perceived Organisational Readiness, Performance Expectancy and Organisation membership (AV) as predictors of intending to use Pulsara™. Themes relating to benefits (95% coder agreement) included improved communication, procedural efficiencies and faster patient care. Barriers (92% coder agreement) included network accessibility and remembering passwords. PulsaraTM was initiated 562 times.

CONCLUSION

Implementing multiorganisational, digital health communication applications is feasible, and facilitated when organisations are change-ready for an easy-to-use, effective solution. Developing habitual use is key, supported through implementation strategies (e.g., hands-on training). Benefits should be emphasised (e.g., during education sessions), including streamlining communication and patient flow, and barriers addressed (e.g., identify champions and local technical support) at project commencement.

Virtual Visitation in a Neonatal Intensive Care Unit: Insights From 5 Years Using a PDSA Model to Improve Family-Centered Care

This 5-year study evaluated a virtual visitation implementation initiative in a neonatal intensive care unit. Our objectives were to (1) use the Plan-Do-Study-Act methodological framework to implement a virtual visitation program, (2) investigate whether implementation of virtual visitation could be done with no patient harm and minimal workflow disruption, (3) foster a top-down participatory structure for decision making, and (4) evaluate parent use and satisfaction. The study involved a qualitative and quantitative description of cycles and results. Routine collection of outcome data allowed problems that arose as a result of changing practices to be quickly and efficiently addressed. The study results suggested that the virtual visitation implementation initiative in a neonatal intensive care unit using Plan-Do-Study-Act cycles helped create an environment of trust and provided benefits. A steady increase in the use of virtual visitation by parents and their extended families indicated utilization. During the COVID-19 pandemic, virtual visitation helped families feel connected with each other and their neonate, despite being in separate locations.

Impact of Obstetric Communication on Decision-to-Delivery Time

OBJECTIVE

In obstetric emergencies, care coordination is critical in achieving a "decision-to-delivery" time of 30 minutes. Reliable communication is essential to optimize coordinated care of mother and baby. Clinical mobility (CM) platforms have been shown to improve communication during medical emergencies; however, their impact on improving decision-to-delivery times has not been shown. This study aimed to determine the impact of a new CM platform on decision-to-delivery time.

STUDY DESIGN

A multidisciplinary team designed a CM platform that employs a wall-mounted panel paired with mobile technology to alert all relevant clinical staff. This new platform uses in-room preprogrammed messages that alert predetermined responders matching the emergency. For example, the "STAT section" button summons doctors (obstetrics, anesthesiology, and neonatology), obstetric nurses, and newborn resuscitation staff via smartphones. Impact of this platform was assessed with process and outcome data: cord artery pH, 5-minute Apgar's score; and decision for cesarean section to time of: skin incision, uterine incision, and delivery. This pre- and postimplementation study (October-September 2018 vs. January-December 2019) centered on the opening of our new Obstetric Care Unit. Data were analyzed with Chi-square and Mann-Whitney U-test.

RESULTS

Emergent cesarean delivery was performed in 172 women pre- and 124 postimplementation of the new CM platform. In postimplementation, we observed a 7.4-minute reduction in time from decision-to-delivery (26 pre- vs. 18.6 minutes postimplementation, p = 0.001). Delivery within 30 minutes improved by 15.2% (p = 0.018). Times to skin and uterine incision were also significantly reduced. The two groups had similar neonatal outcomes: birth weight, Apgar's score at 5 minutes, and cord artery pH did not differ, but the study was underpowered to compare these outcomes.

CONCLUSION

This new CM platform significantly reduced decision-to-delivery time, in turn improving compliance with the "30-minute rule." All relevant personnel were contacted specifically, while avoiding overhead paging and other unnecessary messages.

KEY POINTS

· Obstetric communication via a clinical mobility platform shortens the delivery to delivery interval. · Obstetric communication systems via an information technology (IT)-system results in a higher frequency of deliveries within 30 minutes.. · Communication systems may be a useful tools to synchronously call multiple services to respond..