Background: Joint Commission has identified “communication” as the third most frequent root cause of sentinel events.1 Alpha-numeric pagers are common for communication among healthcare professionals. Pagers are not HIPAA compliant and communication through pagers often lacks sufficient information for effective communication.2 Because pager communication is one-way, closed loop communication requires a return telephone call, disrupting workflows. In 2015, to improve our communication practices, our hospital adopted a secure, mobile text messaging platform, Vocera Engage®. Adoption was negligible.
Purpose: We sought to improve safe and efficient communication by resuscitating a HIPAA compliant, two-way, mobile text messaging application.
Description: In January 2018, we formed a multidisciplinary workgroup including physicians, nurses, therapists, care management, social work, pharmacy and clinical informatics to enhance adoption of Engage®. In April 2018, a pre-pilot survey was administered to the staff. 242 responses were analyzed. In May 2018, a 4-day pilot was conducted on one floor where all staff were encouraged to utilize Engage® for communication that would otherwise have been conducted by text paging.
Based on pilot feedback and initial survey responses, we worked with the vendor to improve the Engage app as follows:
• Read-receipt functionality
o Cues visually when message is “read”
• Patient-contextual text messages
o Avoids typing in patient information
• Upgraded software application version on hospital phones
o Guarantees up to date functionality
• Fixed a bug that prevented display of the treatment team
o Allows for easy identification of staff caring for each patient
In September 2018, after these enhancements, we conducted a second pilot on two floors for 2 weeks. We re-surveyed participating staff to assess their perception of the new functionality and their outlook towards the messaging platform. 137 responses were analyzed.
Providers perceived improvement in provider and group communication. Providers also felt Engage® helps discharge patients faster, allows for faster notification of critical results and improves coordination of plans of care. Adoption rates for Engage® are currently 97% for nursing, 90% for first-call providers, 87% for patient care assistants, 96% for respiratory therapist and 76.5 % for pharmacists on the piloted medicine units.
Conclusions: By creating a multidisciplinary workgroup, iterative piloting, feedback and enhancements to our secure text messaging application, we have increased adoption of the application, decreasing reliance on pagers – an outdated, one-way communication vehicle wrought with HIPAA violations, delayed responses to critical information and workflow interruptions. We plan to expand this project with a goal of eliminating pagers in our hospital.