Mayo Regional Hospital implements a state-of-the art
wireless communications system.
Although typically considered a safe place, emergency departments (EDs) have seen a startling increase in aggressive behavior toward medical and nursing staff over the past several years. Data from a 2009 study in the Journal of Nursing Administration indicated a large number of nurses are victims of physical violence or verbal abuse every year. In a 2008 study in the Journal of Academic Emergency Medicine, caregivers reported a yearly average of 11 attacks per ED. In addition, the study found ED nurses feel less safe at work than do other healthcare employees, indicating an urgent need for management to create more secure ED environments across the country.
Mayo Regional Hospital is a critical access hospital located in the Piscataquis county seat of Dover-Foxcroft, Maine. In the past year and a half, its ED has gained regional recognition for its response to a number of aggressive patient situations and its impressive ability to de-escalate aggression and violence directed at ED staff.
Mayo credits its high number of aggressive behavior incidents to the prevalence of mental health issues in the community. When mental health patients destabilize, they are often taken to the Mayo ED by law enforcement. Prior to October 2008, ED nurses had been both physically assaulted and threatened by emotionally unstable patients.
Much of the danger emergency department caregivers faced was due to delays in call and response time from local law enforcement (the hospital, with only 12,000 ED visits a year, does not have the resources for a full-time security presence in the department). In the case of an aggressive patient or visitor, caregivers needed to quickly notify the rest of the staff of safety risks posed by an upset patient or visitor. If a caregiver felt threatened without a phone nearby, they had few options for accessing immediate assistance.
By late 2008, the ED saw an increase in the frequency of patient outbursts and was repeatedly experiencing a delay in the arrival of law enforcement. The time was right for Mayo to implement a state-of-the art wireless communications system. Vocera, a Silicon-Valley based company, provides wireless communication badges designed to help staff communicate instantly at the point of care. As the first hospital in Maine to adopt the Vocera communications system, staff based its decision on hospital case studies and references that showed Vocera had streamlined communication and enhanced patient and staff safety.
Planning the intervention
In October 2008, the Vocera system went live with the ED and supervisors, and training began immediately. The badges are worn around the neck and provide the ability to communicate, hands free, from anywhere at any time. Most importantly, intelligent software allows communication with critical resources with just a simple spoken command. The badges can connect staff with one another or local law enforcement.
Mayo partnered with Vocera Professional Services to train staff on how to operate the badge through classes and scenario experience training. Classes focused on functionality, voice commands and speech recognition optimization. The department practiced best practice workflow for a number of scenarios involving aggressive patients in different parts of the ED.
Since the Vocera implementation, Mayo has conducted qualitative sampling to measure its impact in the ED through staff feedback. Staff members share that the implementation of the Vocera badge has improved communications between members of the ED team, and it has enhanced patient safety by improving communications.
HIT dimensions utilized
The Vocera communications system can operate in any 802.11b/g networked building or campus. The system software platform runs on a standard Windows server and contains system intelligence — including call management, call connections and user profiles — as well as Nuance speech recognition and voiceprint verification software.
De-escalating violent and aggressive patients is a challenge in almost every ED in the state. Mayo was the first hospital in Maine to implement Vocera specifically for ensuring security and safety. Vocera was tested initially with a select group of staff members, but now is used by all on-duty nurses in the hospital, as well as the ED physician, cardiopulmonary technician, radiology technician and lab personnel.
Mayo staff has experienced a streamlining of communication between caregivers, especially in situations involving violent or aggressive patients. The hospital has already used Vocera badges to mitigate a potentially dangerous patient situation in which a suicidal patient, believed to be stable by doctors, unexpectedly escalated into anger. The doctor on call immediately used his badge to contact law enforcement, who arrived within four minutes after the call.
The Vocera communications system requires a robust voice-grade wireless system be in place before the system can be used effectively. Mayo Regional Hospital coordinated a wireless system upgrade in conjunction with the implementation of the Vocera communications system. For challenges with deployment and adoption of the Vocera badge technology, Mayo staff utilizes Vocera's 24-hour online support.
The most influential changes in care delivery came through staff's increased feeling of personal safety, allowing them to focus on patients and portray a sense of safety to all in the ED. As with any new technology, making the Vocera badge the first medium for communication was different, but was quickly adopted.
For Mayo Regional Hospital, a wireless communications system was a practical tool for increasing the safety of staff and patients. Wireless communication systems can serve a wide variety of purposes, as the Vocera badge is used in more than 600 hospitals around the world. In addition to its role as a safety mechanism, a wireless communication system can be an effective tool for institutions looking to improve workflow or streamline internal
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