ED communications: three ways to make seconds count

ED communications: three ways to make seconds count

December 29, 2016
Dr. Andrew Mellin
From the December 2016 issue of HealthCare Business News magazine

By Dr. Andrew Mellin

Every second of waiting time that goes by in the emergency department (ED) — waiting to receive a result, to move a person to a bed, to start a treatment — is not only costly, but can also have a major impact on patient care quality. EHRs, electronic white boards and process improvement initiatives can all play a role in reducing wasted time, but even with the most optimum use of those tools and approaches, there will still be many moments of waiting in every patient encounter.

Emergency department wait times average about 30 minutes, and treatment time about 90 minutes, according to a 2014 survey by the Centers for Disease Control and Prevention. This adds up to about two hours in the ER on average, although this time can be significantly longer for semi-urgent or non-urgent patients. Demand for emergency department services is expected to continue to rise as our population ages and as EDs continue to take the lead in responding to disasters, contagious illnesses and other situations that require the rapid organization of teams of individuals.

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As we rely more on EDs to deliver health care, making sure this department operates as efficiently as possible becomes an imperative. Novel communication technologies, supported by the right processes, can help in a number of ways to streamline operations, reduce waste and enhance the coordination of ED and support staff. Let’s look at the complex communication needs of hypothetical ED patient “Anna Smith,” as we follow her journey.

Automated diagnostic test results communication
Ms. Smith presents with chest pain, and the ED physician orders an emergency chest CT to rule out a pulmonary embolism. Today, the radiologist would read the film, figure out how to contact and notify the ED physician of the result and then wait for the ED physician to return a call after a page. Through technologies that augment an existing radiology information system (RIS) many of these steps can be eliminated by automatically sending a secure message created from the transcribed report (that was immediately generated using a speech recognition tool) directly to the ED physician, with rules to escalate the message if it is not acknowledged by the ED physician in a specific amount of time. The automatically generated message can also contain a link to the image in a mobile PACS viewer so the ED physician can quickly review the report and the image.

Secure communication and conversations
The pulmonary embolism has been quickly ruled out, and the ED physician requests a stat cardiology consult to further evaluate Ms. Smith. To identify the on-call cardiologist, the ED physician and staff need to know who is on call and what is that physician’s preferred method of communication. Next, the ED physician must securely convey the reason for the consult and background information, and ideally, the entire interaction would be logged for quality purposes. While this is often a cumbersome, phone-based process, secure messaging tools can automate this entire process, from identifying the on-call cardiologist to enabling a secure conversation delivered on preferred devices, to complete auditing of the interaction. In this scenario, the ED physician and cardiologist rapidly carry out a secure conversation on mobile devices, and the cardiologist heads to the ED.

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