Image of research team
(From left) Jesse Hansen, Philip Hagedorn and Margot Lazow are working to improve communications between nurses and residents.

Jesse Hansen, MD, now a clinical cardiology fellow in the Heart Institute at Cincinnati Children’s Hospital Medical Center, participated last year in the first-ever clinical informatics research rotation for residents offered by the Division of Biomedical Informatics. Hansen just published the first research paper from that experience focused on improving interdisciplinary communication in the hospital environment with secure text messaging. Here, he talks about the paper, where his research is heading next, and his future goals as a clinician and researcher.

 

Can you tell us more about your project?

My coauthors Philip Hagedorn, MD, Margot Lazow, MD and I undertook a quality improvement project to use secure text messaging capabilities to improve interdisciplinary communications. Our Pediatric Quality & Safety  paper outlines the work. 

We were looking to improve communication channels between medical residents and nurses. The two groups  previously relied on unidirectional pager systems, but those pagers could be a source of frequent interruptions, constant handoff of messages, and avoidable confusion between team members.

We used quality improvement methodology to both implement a secure text messaging system (Voalte) and to evaluate its impact on communication patterns. The goal was to create a unified communication platform for nurses and residents. 

The Voalte system minimizes communication failures by facilitating secure text messaging and voice calls between residents and nurses. It introduces a bidirectional communication method that gives team members the ability to respond in the same medium—no more switching from pager to phone. Secure text messaging also allows closed-loop communication, allowing team members to see when their messages have been delivered and read.  

 

Where did you get the idea for this project?

I came of age in the era of text messaging and instant and accurate communication methods. Text messaging, email, and social media had taught me how important rapid, effective, and reliable communication is to the functionality of our modern society. When I entered the hospital as a first-year resident, I saw the opportunity to improve communication patterns.

 

Why did the Voalte technology seem like a good solution?

The nurses were already using the Voalte technology, so the hospital had the infrastructure in place. Since we had no budget, being able to anchor our project to an existing hospital service was critical to its success.

Any communication or technology platform is going to have strengths and weaknesses, and we were aware that Voalte was not a perfect answer to our problems going into this project. That awareness at the outset helped us to design a workflow that mitigated some of these problems.

Our supportive IT staff were amazing at helping us identify and fix problems outside the control of our workflow process. The strengths of the Voalte system include the ability to communicate directly with individual providers, rapid bidirectional communication, high reliability, and modern communication characteristics like status indicators, delivery and read receipts, and group communication capabilities.

 

What did you learn by developing this project?

First, technology is never the limiting factor in introducing a new workflow. We struggled most with behavioral change stemming from the preexisting communication culture and expectations that have developed over many years at our institution.

I also learned about persistence. There were several points where our project seemed to be at a dead end. But I had a mentor in Dr. Hagedorn who had been through this before and recognized the difficult spots. He was able to use his knowledge of the institution to help push the project over each one of these obstacles, whether it was through recruitment of extra help or ongoing encouragement that resident engagement actually can solve hospital-wide problems. 

 

What’s ahead in development and use of the Voalte technology?

Voalte is now widely used by providers throughout the hospital and clinics. There have been important upgrades in infrastructure that have extended the capabilities of the system and resolved some of the quirks we had to work around during our project.

Looking forward, there are many interesting questions to be answered around using Voalte as a way to implement just-in-time clinical decision support that is targeted at individual providers based on specific patient triggers. Studying how to best implement this in a way that is salient and unobtrusive in the daily workflow of nurses and doctors will be critical to its future success.

 

How are you integrating this experience into your ongoing work as a physician and researcher?

I now have a better understanding of how seemingly simple changes in the tools we use to care for our patients can have huge impacts. If these changes are not done in a thoughtful and eloquent manner, it can result in unsatisfactory medical care.

Teams looking to implement changes in clinical workflows need to have a deep understanding of both the technical and clinical obstacles to effective use of the tools they are trying to build. Advances in biomedical informatics will only be realized if researchers, analysts, clinicians and vendors can work together in a wholistic manner that respects the complexity of the information environment in the modern hospital setting.

 

For more information, contact Jesse Hansen, MD at jesse.hansen@cchmc.org.

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