A recently published study on contributing factors to delays in communications between clinicians claimed to find that outdated communications technology – specifically, pagers – is the primary cause of loss in productivity, costing hospitals billions of dollars per year. While I saw several flaws in the study – including how questions were phrased to generate respondents’ opinions – my major concern was that by focusing on technology alone, the study actually does a disservice to the industry.
As a veteran in secure clinical communications technologies who works with hundreds of hospitals and health systems across the country, I can vouch for the fact that the specific technology or communications modality is not the primary source of communications breakdowns between – it’s poor processes and workflow.
I know this because of independent research studies that we commissioned, aimed at measuring communication cycle times between nurses and physicians using a variety of different contact modalities – pagers, texting, real-time calls, etc. One study conducted by the University of Colorado in 2005 compared nurse-to-physician contact cycles between four hospitals. In the facility where a single, standardized process was established and workflow issues were addressed and improved, we saw:
- 10 times more contact cycles completed within two minutes;
- 81% fewer subsequent calls (rework); and a
- 71% reduction in nurse-to-physician contact cycle times in the ICU – from 7 to 2 minutes.
This study was replicated at Orange Coast Memorial Medical Center in California just last year, where we again found that by establishing a single, standardized process and addressing workflow issues, we documented a:
- 70% reduction in the average nurse-to-physician contact cycle time – from 46 to 14 minutes;
- 40% reduction in the median nurse-to‐physician contact cycle time – from 10 to 6 minutes; and
- 60% reduction in the number of contact cycles greater than 30 minutes.
The first study was done at a time when there was very little text messaging and more paging among clinicians. And despite a difference of eight years between the studies, the end result is the same – poor processes create breakdowns that cause delays, regardless of the technologies or contact modalities employed.
Many factors play into the reliability of various wireless technologies. I have seen many cases where old paging technology can be more reliable than SMS texting that relies on the cellular networks or secure texting via a mobile app that relies on Wi-Fi availability. The problem is not whether clinicians are using pagers or smart phones, but rather poor processes that result in them texting, paging or calling the wrong person at the wrong time.
Gaining an understanding of the complexity inherent in clinical communication processes will be more productive than putting the blame on any one form of technology. Swapping out pagers for the latest new secure messaging app and smartphone isn’t going to solve this for any of the hospitals and health systems I’ve talked to. When talking about critical, life-saving communications, designing and enabling accurate and reliable processes must be at the forefront of the conversation.