Wired Hospitals: From Science Fiction to the Bedside
How local hospitals are using technology to reshape the way nurses work
A patient reports some weakness on their left side, a common warning sign of stroke. They need an expert opinion — and fast. At Martin Luther King, Jr. Community Hospital (MLKCH) in Los Angeles, the staff knows just what to do: fetch the robot!
The Virtual Consultation
No, robots aren't yet attending medical school (we have at least a few more years before that happens). However, a growing number of hospitals like MLKCH are now using telepresence devices: robots that allow a remote clinician to examine and interact with a patient. “It sits in ICU and we can call to bring it up,” explains Michelle Querubin, RN, BSN, a telemetry staff nurse. “It is the fastest way to obtain a neurologic consult. We explain to the patient so they are not taken aback when they see the robot.”
Some telepresence devices are little more than videophones, but the one MLKCH uses is more sophisticated, even including a built-in stethoscope. “The robot can be manipulated by the neurologist,” explains Eric Thorsen, RN, an ED nurse. “There is a screen with a camera and the screen shows the neurologist’s face.” With this technology, the consultant can be there for the patient when needed even if they’re many miles apart.
“You can’t tell where the consultant is, but that doesn’t matter,” says Querubin. Innovations like this have made MLKCH one of 27 hospitals across the country selected by Hospitals & Health Networks and the American Hospital Association as 2017’s “Most Wired” facilities.
Another of MLKCH’s advanced telecommunication tools is a Martti video translator system, which connects clinicians and patients to remote interpreters who provide real-time translation. The service uses a secure wireless network and is available 24/7 to translate hundreds of languages.
MLKCH has portable Martti devices with video monitors that allow deaf patients to view sign language interpreters, but there’s also an app for the hospital’s iPads, making the technology readily available to any of the units. “It has really improved patient rapport,” Querubin says. “Even if the nurse doesn’t speak the patient’s language, quality care can be provided in a language they can understand. This is a great resource. It’s very easy and takes no time to connect.”
Aside from the broad range of languages supported, an advantage of Martti is that its translators are certified medical interpreters who can accurately communicate the nuances of treatment plans. “It makes it more comfortable for the patients,” says Querubin. “We had a patient who spoke a different language and whose family didn’t speak English either. We brought out the translator. It answered their questions about the plan of care and addressed concerns they had.”
Of course, hospitals usually have staff neurologists and some have on-staff translators, at least for certain languages. However, even if the facility has the appropriate specialist or interpreter, there’s no guarantee they’ll be on duty or nearby when they’re needed most. Telepresence systems like these help hospitals fill the gaps.
Above left: MLKCH telemetry nurse Michelle Querubin has to warn patients so they aren’t startled by the robot. Center: Pomona Valley Hospital Medical Center’s Karen Blessing and Kim Ranney take digital photos for a newborn’s ID. Right: Barbara Gross, director of the Heart Institute at Children’s Hospital Los Angeles, says hospitals need to think about interoperability before rolling out new technologies.
Digital Mother’s Milk
Other areas ripe for technological revolution are all the things we do on a day-to-day basis that are tedious, repetitive and/or prone to errors. The right technology can save time while avoiding dangerous mistakes.For example, Pomona Valley Hospital Medical Center (PVHMC) has developed a system to ensure that babies in the NICU receive only the correct milk. “We were able to institute a program called Mother’s Milk,” says NICU nurse Kim Ranney, RN. “It’s an electronic check.”
How does it work? “Mothers are provided with barcodes and label the breast milk at home,” Ranney explains. “You can scan the baby’s armband. If the milk doesn’t match, it says ‘wrong baby.’ It alleviates the chance of making an error. … With double-checking, we have had no incidents.” Ranney also uses a handheld device to take state-mandated photos of newborns and scan their IDs. She can use the same device to take photos of wounds and send the images right into the medical record.Another error-avoiding innovation is the computerized IV pump.
With the latest infusion pump technology, the medication order is scanned and goes right in, with no menus to click through. The computer programs the pump for the proper rate and the volume of medication infused is recorded in the patient’s EHR.“The newest model has an integrated way to scan and program medications,” Querubin says. “Now, it will automatically do this once the right patient is identified. It is really amazing.”
Another “Most Wired” honoree in the “advanced” category, Cedars-Sinai Medical Center was an early adopter of infusion pump integration. “Prior to this technology, nurses manually programmed infusion pumps and transcribed data into the EMR,” explains Candice Ney, RN-BC, MSN, lead inpatient operational workflow specialist. “The use of this technology is live in our acute care settings and is now considered standard of care at Cedars-Sinai.”
Blood by Wire
What works for infusion pumps can also work for other nursing tasks that involve a lot of data entry or include critical information, such as blood administration. “Blood administration is an extremely high-risk procedure, so Cedars-Sinai implemented the ability for the nurse toscan the blood product prior to administering to ensure that the product matches the patient, their blood type and the order placed by the physician,” Ney explains. “If there is a mismatch, the nurse is alerted and the product is returned to the blood bank.”
MLKCH employs a similar system, which is also programmed to remind the nurse how often to check different vital signs. For example, a popup will notify the nurse to take vital signs every five minutes, every 30 minutes and so on. The system prompts the nurse to review the recorded information to ensure it is accurate and then updates the patient’s record.
“This blood administration is a lengthy process with a lot of data entry,” says Thorsen. “The program functions as a way to record and double-check it, and it references the hospital policy. Also, conscious sedation takes a lot of vital signs. It is a hassle to do it by hand.” Where else can time be saved? MLKCH equips their transfer techs with mobile phones so they can remotely request a transfer. “You let them know what the patient’s needs are: IV pole and monitor,” Thorsen explains.“You can technically call for a patient transfer without leaving your chair.”
Cedars-Sinai Medical Center’s Candice Ney demonstrates the training version of the hospital’s automated infusion pump technology, which uses a barcode scanner to ensure that each patient gets only the correct IV medication.
Planning the Future
Since MLKCH IS a relatively young hospital, many advanced technologies have been incorporated into the hospital’s procedures from the start. For most hospitals, though, implementing a new technology involves changing existing processes, which requires effective planning strategies. With potentially risky tasks, any changes, even process improvements, have to be approached with care.
“To be honest, we were very cautious in implementing this [blood administration] solution given the seriousness of the procedure itself,” Ney says, “but we were so thrilled when we saw it in action. It was intuitive and reliable, and our nurses picked up the workflow change quickly.” When rolling out a new tool or system, it is crucial to hear and embrace the opinions of those who will actually be using the tool in the care of patients.
At PVHMC, nurses have a formal role in the development and testing of new technology. After all, nobody can deny that when nurses aren’t involved in design, there are likely to be flaws. PVHMC recognized that nobody knows the work of bedside nurses better than the nurses themselves.
The Human Factor
When interviewing applicants for these roles, explains PVHMC Director of Clinical Informatics Karen Blessing, RN-BC, MBA, “We weren’t looking for computer gurus. New hires can learn the computer skills. We needed clinical experts who understood their clinical workflow and could work with their peers. … We have one from each clinical area, including ancillary staff. They help us with our design decisions.” “It really makes it a smoother process,” says Ranney, who is one of the nurses helping to test new technology.
“We know what we need. For example, I document the new system to see how it will go and critique it before we go live.” Barbara Gross, RN, MSN, NEA-BC, director of the Heart Institute at Children’s Hospital Los Angeles (CHLA) — another “Most Wired” honoree — says that when developing or rolling out new systems or tools, it’s also important to consider other existing technologies. “Our heart center has so many pieces of equipment and works with so many vendors,” she says. “The systems didn’t always speak to one another. Platforms didn’t talk to each other. There are multiple systems in a hospital. That is a challenge.”
Gross says the key to interoperability is to have biomedical engineering work alongside information technology and clinicians from different disciplines so they can all be the same page. This pays dividends down the road. Thanks to these efforts, she explains, “Information from perfusion for a patient on cardiopulmonary bypass goes into the same database as in extracorporeal membrane oxygenation (ECMO). You have all that information in one spot instead of multiple spots.”
Tomorrow’s Tech Today
CHLA has also had considerable success with finding new uses for existing technology — leveraging what they already have rather than adding something completely new. “Our staffing system is also being used as an acuity system,” Gross explains. “It interfaces with multiple systems. It shows hours per patient-day or cost per patient day. Otherwise, we would be buying multiple, multiple, multiple systems and not achieving economies of scale. Look at the big picture to ensure maximum utility.”
Gross, who has worked with CHLA for 41 years, has personally witnessed modern healthcare technology’s emergence and evolution. “It’s an exciting time,” she says. “It has been for many years, but it’s taken us time to get up to speed with the potential. For the nurses, it saves them time: ‘How can we get that data into the EHR?’ We all need to be working together asking these questions.”
Daria Waszak, RN, DNP, CEN, COHN-S, is a Long Beach native and SDSU and UCLA alumna. She has over 20 years of clinical and leadership experience and is currently a RN/BSN faculty member.
Photo at top of webpage: Eric Thorsen, a Martin Luther King, Jr. Community Hospital ED nurse, uses a telepresence robot for remote consultation.
This article is from workingnurse.com.