Application of a Smartphone Nurse Call System for Nursing Care
Shu-Ting Chuang, MS, RN,1,2 Yi-Fang Liu, MS, RN,1 Zi-Xuan Fu, PhD,3 Kuang-Chung Liu, MS,4 Sou-Hsin Chien, MD,2 Chin-Lon Lin, MD,5 and Pi-Yu Lin6 1
Nursing Department, 2Office of Superintendent, and Information Management Office, Taichung Tzuchi Hospital, Taichung, Taiwan. 4 Information Management Office and 5Medical Mission, Buddhist Compassion Relief Tzu-Chi Foundation, Hua-Lien, Taiwan. 6 Buddhist Compassion Relief Tzu-Chi Foundation, Hua-Lien, Taiwan. 3
Abstract Background: Traditionally, a patient presses the nurse call button and alerts the central nursing station. This system cannot reach the primary care nurse directly. The aim of this study was to apply a new smartphone system through the cloud system and information technology that linked a smartphone and a mobile nursing station for nursing care service. Materials and Methods: A smartphone and mobile nursing station were integrated into a smartphone nurse call system through the cloud and information technology for better nursing care. Results: Waiting time for a patient to contact the most responsible nurse was reduced from 3.8 min to 6 s. The average time for pharmacists to locate the nurse for medication problem was reduced from 4.2 min to 1.8 min by the new system. Conclusions: After implementation of the smartphone nurse call system, patients received a more rapid response. This improved patients’ satisfaction and reduced the number of complaints about longer waiting time due to the shortage of nurses. Key words: nursing care, smartphone nurse call system, patient satisfaction, team communication
Introduction
T
he nurse call system is an essential part of nurse care for patients. The traditional nurse call system is a static, placeoriented system in which a patient can only press the nurse call button and alert the central nursing station with the bed number but cannot communicate with the primary care nurse directly. If the most responsible nurse is not available at the nursing station, other workers would take the message and looking for him or her to answer or respond the call. This would cause a lot of effort running between the ward and the station for the most responsible nurse. To improve the nursing care under the circumstance of a nurse shortage, immobile communication has been replaced by mobile communication with a smartphone and mobile nursing station or a
DOI: 10.1089/tmj.2014.0071
new nurse call system in many hospitals in the world.1,2 In addition, hospital implementation of health information technology has been positively associated with the improvement of patient care quality.3 Health information technology such as electronic medical records, computerized provider order entry systems, medication management systems, and picture archival and communications systems are designed to improve the accuracy, accessibility, and timeliness of storage and transmission of patients’ medical information. Currently a nurse must care for several patients and do a lot of paperwork in Taiwan, as in elsewhere, and the quitting rate is high. The annual vacancy rate for nurses is 5.8% according to the 2012 Statistics of National Bureau of Health, Taiwan. In order to improve patient care, we tried to improve the management by designing a nurse call system that incorporated the nurse call system, a smartphone, information technology, and the cloud system. The new nurse call system would be expected to achieve the following goals: (1) reduce the response time for a patient’s nurse call; (2) reduce the notice time for prescription medication mistakes; (3) reduce the notice time for blood sample withdrawal; (4) improve both patient and medical personnel satisfactions; and (5) improve nursing management for personnel assignment and evaluation.
Materials and Methods In order to reduce the time for a nurse call and to locate the most responsible nurse from among the team members, the smartphone nurse call system was developed. Prior to the study, the hospital ward was designed to be built with a wireless environment to meet the future need for communication. The study was performed by a team of 15 members consisting of nurses, pharmacists, medical technologists, hospital specialists, and information engineers. The problems of the traditional nurse call system and communication between the medical team members were identified, and the solutions were proposed and developed by integration of the smartphone, nurse call system, nurse management program, and cloud system. In order to store the message in the cloud system, the voice message was converted to an Internet protocol (IP) package and transmitted through the Internet. Then it was converted to voice by voice over IP, and the message was sent to the smartphone of the most responsible nurse, the central nurse station, and the mobile nurse station by IP-Private Branch Exchange through the host server, communication controller, and master and slave call-linked system. This cloud-based smartphone nurse call system would enable the most responsible nurse to communicate with the patient and deliver timely service. The operation of a nurse call from a patient connecting to the smartphone nurse call system is shown in Figures 1 and 2. In order for other team members such as pharmacists or medical technologists to communicate with the most responsible nurse, the
ª M A R Y A N N LI E B E R T , I N C . VOL. 21
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Fig. 1. The operation of a nurse call from a patient connecting to the smartphone nurse call system. smartphone nurse call system linked with the nursing schedule by the cloud system with information technology. Similarly, this system automatically linked the patient’s bed number to the most responsible nurse for any medical team member when identifying the patient’s number through a smartphone or telephone.
EVALUATION To test the advantages of the new nurse call system, we studied the response to a nurse call before and after the implementation of the new system. The ward consisted of 48 beds and 19 bathrooms,
and the traditional nurse call system connected the call button on the bedhead wall or bathrooms and the mainframe server in the central nurse station (Fig. 3). Two nursing students and three nurses were trained and participated the testing. They recorded the response time of a nurse call from the day shift, 8h night shift, and 12-h night shift for 7 days (128 h in total). After the new nurse call system was implemented, the test continued for 7 days with the same day and night shifts. The new system could show the patients’ list with different wards. The bed number would automatically link to the most responsible nurse and the nursing station to any team member by the system. Student’s t test was used to analyze the data. In order to eliminate the bias, we excluded any outlier that was far outside the norm (i.e., 5% of the extreme data). A value of p < 0.05 was considered statistically significantly different.
Results REDUCING THE WAITING TIME FOR A NURSE CALL The smartphone nurse call system reduced the waiting time for a patient’s call. The response time to a nurse call was 4 s and 9 s, respectively, for the day shift and the night shift, which was reduced, respectively, 24 s and 64 s from the traditional nurse call system ( p < 0.001). Because of the quick message to the nurse, the patient received timely care, which relieved the discomfort of the patients and the anxiety of family members (Table 1).
COMMUNICATION BETWEEN THE TEAM MEMBERS AND THE MOST RESPONSIBLE NURSE In case of prescription medication mistakes or blood sample problem, the pharmacist or the medical technologist could talk to the most responsible nurse and solved the problem. For instance, for blood sample problem, there were 35 cases in which the nurse needed to be found per month in average. After the smartphone nurse call system was implemented, the average interval of searching for the nurse was reduced from 3.8 min to 6 s (saved 3.7 min) ( p < 0.001). Similarly, in about 30 cases per month it was necessary for pharmacists to communicate with the nurse for medication mistakes. The average interval for locating the nurse was reduced from 4.2 to 1.8 min (saved 2.4 min) when the new system was implemented.
PATIENT SATISFACTION AND MEDICAL PERSONNEL SATISFACTION
Fig. 2. The connection of components that operate the smartphone nurse call system from the bedside call button to the most responsible nurse, central nursing station, and mobile nursing station.
106 TELEMEDICINE and e-HEALTH F E B R U A R Y 2 0 1 5
Questionnaires were collected for investigation of the outcome of the smartphone nurse call system 1 month after implementation. The overall patient satisfaction with the new smartphone nurse care system was 96% 1 month after the implementation
SMARTPHONE SYSTEM FOR NURSING CARE
Fig. 3. Floor plan of Ward A. The traditional nurse call system connects bedside and bathroom call buttons to an analog telephone (dot) in the central nursing station.
of the new system (Table 2). Similarly, medical personnel satisfaction reached 88% with the new system.
the new project was carried out, the lost message rate to the most responsible nurse was 0%.
Discussion
PERFORMANCE MANAGEMENT The head nurse could monitor the nurse on duty in real time and the overall nursing schedule with this smartphone nurse call system. In addition, it provides a management platform for evaluation of personnel performance.
COST FOR THE SMARTPHONE NURSE CALL SYSTEM The traditional analog nurse call system had a high cost of NT $480,000 per ward, so that the average fee for the system was about NT $10,000 (US $3,300) per bed. In contrast, the cost of the smartphone nurse call system was reasonable, at NT $150,000 per ward, which could save NT $6,875 (US $2,291) per bed. In addition, after
Effective communication between the medical staff members and the patient is critical for patient care. We observed that the waiting time for a patient to contact the primary care nurse was reduced to seconds after the implementation of the smartphone nurse call system. The most responsible nurse was able to track the location of the patient and which patient pressed the nurse call button. With the traditional nurse call system in rooms with multiple patients, it is impossible to know accurately who made the call. However, with the smartphone nurse call system, the most responsible nurse knows specifically which patient made the call. In addition, the nurse can use this direct information from the patient to determine whether medication or equipment will be needed from the nearby mobile
Table 1. Reduction of Waiting Time on a Nurse Call After Applying the Smartphone Nurse Call System AVERAGE WAITING TIME (S) ON A NURSE CALL (A) BEFORE
(B) AFTER
DIFFERENCE = (A – B)
P
Day shift
28.1 – 8.3
4.2 – 1.9
24.0
< 0.001
8-h night shift
67.1 – 21.7
9.2 – 3.6
58.0
< 0.001
12-h night shift
79.4 – 22.7
9.2 – 4.2
70.2
< 0.001
NURSE SHIFT
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Table 2. Patient Satisfaction with the Smartphone Nurse Call System (n = 155) ITEM
PERCENTAGE (%)
Easy to reach the primary care nurse
96.0 – 13.1
Shorter waiting time for the nurse
94.3 – 15.5
Less complaining
95.9 – 11.7
Improvement of nursing service
96.1 – 11.8
Convenience of communication with the nurse
90.3 – 15.3
Overall satisfaction
96.1 – 9.9
nursing station. In addition, the new system provides staff members who can easily to reach the most responsible nurse when needed. The most responsible nurse can also identify the patient in need and obtain critical pieces of patient information for timely care. The performance of the smartphone nurse call system was very satisfactory. The most responsible nurse responded to the nurse call in 4 s and 9 s for the day shift and the night shift, respectively. This would meet the guidelines in many hospitals in the world that one of the staff members should arrive at the location of the patient within 3 min for an urgency call and within 5 min for normal, sanitary, and assistance calls.4 With the in-building wireless smartphone system, our patient satisfaction with the smartphone nurse call system was very high (96%). However, it has been pointed out that the smartphone system not only sends alerts, but also enables voice communication between mobile staff members and patients. Today’s nurse call market is proposed for the integration of additional information from the location and admit, discharge, transfer systems into what have traditionally been nurse call applications.5 Communication between the medical team members is also very important for patient care. The average time for pharmacists to locate the most responsible nurse for a medication problem was reduced from 4.2 min to 1.8 min by the smartphone nurse call system. Similarly, the average time for a medical technologist to locate the nurse for a blood sample problem was reduced from 3.8 min to 6 s. In addition, after the new project was carried out, the lost message rate to the most responsible nurse was 0%. This would critically improve patient care. In a study of clinical communication on internal medicine wards, residents were provided with smartphones.6 To reach the most responsible resident for a patient, a smartphone designated as ‘‘Team BlackBerry’’ was also carried by each senior resident and then passed to the resident covering the team at night and on weekends. Nurses were able to send e-mail messages or call smartphones directly. The result showed that residents strongly preferred the smartphones over conventional paging and felt that it improved efficiency and communication. Although nurses perceived a reduction in the time required to contact a physician (27.6 versus
108 TELEMEDICINE and e-HEALTH F E B R U A R Y 2 0 1 5
11 min), their overall satisfaction with the physician’s response time for urgent issues did not improve significantly. Residents strongly preferred e-mails as opposed to telephone calls as the prime method of communication. Another recent study encouraged nurses to communicate with residents by email with smartphones.7 The result showed that of the e-mails from nurses, 39.1% were requests for a call back, 18.9% were requests for a response by e-mail, and the remaining 42.0% indicated no response was required from physicians. For the messages requesting a response by e-mail, only 50% received an e-mail response. E-mail responses had a median response time of 2.3 min. Content analysis revealed that messages were predominantly nonurgent. This is the current picture of the communication among physicians, nurses, and other healthcare professionals7 and may affect the development of information and communications technology for improving clinical communication. A verbal interaction lacks documentation of communication, but it is the most effective way for health service, although most people, including residents, prefer e-mails as opposed to telephone calls as the primary method of communication.6 Nevertheless, our findings provide an effective communication among the patient, the most responsible nurse, and other healthcare professionals with the smartphone nurse call system. The cost of the nurse call system is another important issue. The cost for a traditional analog nurse call system was NT $480,000 (US $16,000) per ward (50 beds) and NT $10,000 (US $3,300) per bed. In contrast, the cost of the smartphone nurse call system was reasonable, at NT $150,000 (US $5,000) per ward, and it could save NT $6,875 (US $2,291) per bed.
Conclusions and Implications With the trend of technologized society, the focus of medical care systems has turned to efficiency for patient care. Integration of the cloud and information technology into nursing care service would facilitate the communication and efficiency of the nursing care. After implementation of the smartphone nurse call system, patients received a more rapid response from the most responsible nurse. This improved patients’ satisfaction and reduced the number of complaints about a longer waiting time due to the shortage of nurses. Therefore, the quality of medical care is improved, which benefits the patient, family, and medical staff members as well.
Disclosure Statement No competing financial interests exist.
REFERENCES 1. Bahlman DT, Johnson FC. Using technology to improve and support communication and workflow processes. AORN J 2005;82:65–73. 2. Guarascio-Howard L. Examination of wireless technology to improve nurse communication, response time to bed alarms, and patient safety. HERD 2011;4:109–120.
SMARTPHONE SYSTEM FOR NURSING CARE
Address correspondence to: Shu-Ting Chuang, MS, RN Nursing Department Taichung Tzuchi Hospital 88 Feng Hsing Road, Section 1 Tanzi, Taichung 42743 Taiwan
3. Restuccia JD, Cohen AB, Horwitt JN, Shwartz M. Hospital implementation of health information technology and quality of care: Are they related? BMC Med Inform Decis Mak 2012;12:109. 4. Ongenae F, Myny D, Dhaene T, et al. An ontology-based nurse call management system (oNCS) with probabilistic priority assessment. BMC Health Serv Res 2011;11:26. 5. Unluturk MS. Advanced nurse-patient communication system. J Med Syst 2012;36:2529–2536. 6. Wu RC, Morra D, Quan S, Lai S, Zanjani S, Abrams H, Rossos PG. The use of smartphones for clinical communication on internal medicine wards. J Hosp Med 2010;5:553–559.
E-mail: [email protected] Received: April 14, 2014 Revised: May 4, 2014 Accepted: May 8, 2014
7. Smith CN, Quan SD, Morra D, et al. Understanding interprofessional communication: A content analysis of email communications between doctors and nurses. Appl Clin Inform 2012;3:38–51.
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Shu-Ting Chuang, MS, RN,1,2 Yi-Fang Liu, MS, RN,1 Zi-Xuan Fu, PhD,3 Kuang-Chung Liu, MS,4 Sou-Hsin Chien, MD,2 Chin-Lon Lin, MD,5 and Pi-Yu Lin6 1
Nursing Department, 2Office of Superintendent, and Information Management Office, Taichung Tzuchi Hospital, Taichung, Taiwan. 4 Information Management Office and 5Medical Mission, Buddhist Compassion Relief Tzu-Chi Foundation, Hua-Lien, Taiwan. 6 Buddhist Compassion Relief Tzu-Chi Foundation, Hua-Lien, Taiwan. 3
Abstract Background: Traditionally, a patient presses the nurse call button and alerts the central nursing station. This system cannot reach the primary care nurse directly. The aim of this study was to apply a new smartphone system through the cloud system and information technology that linked a smartphone and a mobile nursing station for nursing care service. Materials and Methods: A smartphone and mobile nursing station were integrated into a smartphone nurse call system through the cloud and information technology for better nursing care. Results: Waiting time for a patient to contact the most responsible nurse was reduced from 3.8 min to 6 s. The average time for pharmacists to locate the nurse for medication problem was reduced from 4.2 min to 1.8 min by the new system. Conclusions: After implementation of the smartphone nurse call system, patients received a more rapid response. This improved patients’ satisfaction and reduced the number of complaints about longer waiting time due to the shortage of nurses. Key words: nursing care, smartphone nurse call system, patient satisfaction, team communication
Introduction
T
he nurse call system is an essential part of nurse care for patients. The traditional nurse call system is a static, placeoriented system in which a patient can only press the nurse call button and alert the central nursing station with the bed number but cannot communicate with the primary care nurse directly. If the most responsible nurse is not available at the nursing station, other workers would take the message and looking for him or her to answer or respond the call. This would cause a lot of effort running between the ward and the station for the most responsible nurse. To improve the nursing care under the circumstance of a nurse shortage, immobile communication has been replaced by mobile communication with a smartphone and mobile nursing station or a
DOI: 10.1089/tmj.2014.0071
new nurse call system in many hospitals in the world.1,2 In addition, hospital implementation of health information technology has been positively associated with the improvement of patient care quality.3 Health information technology such as electronic medical records, computerized provider order entry systems, medication management systems, and picture archival and communications systems are designed to improve the accuracy, accessibility, and timeliness of storage and transmission of patients’ medical information. Currently a nurse must care for several patients and do a lot of paperwork in Taiwan, as in elsewhere, and the quitting rate is high. The annual vacancy rate for nurses is 5.8% according to the 2012 Statistics of National Bureau of Health, Taiwan. In order to improve patient care, we tried to improve the management by designing a nurse call system that incorporated the nurse call system, a smartphone, information technology, and the cloud system. The new nurse call system would be expected to achieve the following goals: (1) reduce the response time for a patient’s nurse call; (2) reduce the notice time for prescription medication mistakes; (3) reduce the notice time for blood sample withdrawal; (4) improve both patient and medical personnel satisfactions; and (5) improve nursing management for personnel assignment and evaluation.
Materials and Methods In order to reduce the time for a nurse call and to locate the most responsible nurse from among the team members, the smartphone nurse call system was developed. Prior to the study, the hospital ward was designed to be built with a wireless environment to meet the future need for communication. The study was performed by a team of 15 members consisting of nurses, pharmacists, medical technologists, hospital specialists, and information engineers. The problems of the traditional nurse call system and communication between the medical team members were identified, and the solutions were proposed and developed by integration of the smartphone, nurse call system, nurse management program, and cloud system. In order to store the message in the cloud system, the voice message was converted to an Internet protocol (IP) package and transmitted through the Internet. Then it was converted to voice by voice over IP, and the message was sent to the smartphone of the most responsible nurse, the central nurse station, and the mobile nurse station by IP-Private Branch Exchange through the host server, communication controller, and master and slave call-linked system. This cloud-based smartphone nurse call system would enable the most responsible nurse to communicate with the patient and deliver timely service. The operation of a nurse call from a patient connecting to the smartphone nurse call system is shown in Figures 1 and 2. In order for other team members such as pharmacists or medical technologists to communicate with the most responsible nurse, the
ª M A R Y A N N LI E B E R T , I N C . VOL. 21
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CHUANG ET AL.
Fig. 1. The operation of a nurse call from a patient connecting to the smartphone nurse call system. smartphone nurse call system linked with the nursing schedule by the cloud system with information technology. Similarly, this system automatically linked the patient’s bed number to the most responsible nurse for any medical team member when identifying the patient’s number through a smartphone or telephone.
EVALUATION To test the advantages of the new nurse call system, we studied the response to a nurse call before and after the implementation of the new system. The ward consisted of 48 beds and 19 bathrooms,
and the traditional nurse call system connected the call button on the bedhead wall or bathrooms and the mainframe server in the central nurse station (Fig. 3). Two nursing students and three nurses were trained and participated the testing. They recorded the response time of a nurse call from the day shift, 8h night shift, and 12-h night shift for 7 days (128 h in total). After the new nurse call system was implemented, the test continued for 7 days with the same day and night shifts. The new system could show the patients’ list with different wards. The bed number would automatically link to the most responsible nurse and the nursing station to any team member by the system. Student’s t test was used to analyze the data. In order to eliminate the bias, we excluded any outlier that was far outside the norm (i.e., 5% of the extreme data). A value of p < 0.05 was considered statistically significantly different.
Results REDUCING THE WAITING TIME FOR A NURSE CALL The smartphone nurse call system reduced the waiting time for a patient’s call. The response time to a nurse call was 4 s and 9 s, respectively, for the day shift and the night shift, which was reduced, respectively, 24 s and 64 s from the traditional nurse call system ( p < 0.001). Because of the quick message to the nurse, the patient received timely care, which relieved the discomfort of the patients and the anxiety of family members (Table 1).
COMMUNICATION BETWEEN THE TEAM MEMBERS AND THE MOST RESPONSIBLE NURSE In case of prescription medication mistakes or blood sample problem, the pharmacist or the medical technologist could talk to the most responsible nurse and solved the problem. For instance, for blood sample problem, there were 35 cases in which the nurse needed to be found per month in average. After the smartphone nurse call system was implemented, the average interval of searching for the nurse was reduced from 3.8 min to 6 s (saved 3.7 min) ( p < 0.001). Similarly, in about 30 cases per month it was necessary for pharmacists to communicate with the nurse for medication mistakes. The average interval for locating the nurse was reduced from 4.2 to 1.8 min (saved 2.4 min) when the new system was implemented.
PATIENT SATISFACTION AND MEDICAL PERSONNEL SATISFACTION
Fig. 2. The connection of components that operate the smartphone nurse call system from the bedside call button to the most responsible nurse, central nursing station, and mobile nursing station.
106 TELEMEDICINE and e-HEALTH F E B R U A R Y 2 0 1 5
Questionnaires were collected for investigation of the outcome of the smartphone nurse call system 1 month after implementation. The overall patient satisfaction with the new smartphone nurse care system was 96% 1 month after the implementation
SMARTPHONE SYSTEM FOR NURSING CARE
Fig. 3. Floor plan of Ward A. The traditional nurse call system connects bedside and bathroom call buttons to an analog telephone (dot) in the central nursing station.
of the new system (Table 2). Similarly, medical personnel satisfaction reached 88% with the new system.
the new project was carried out, the lost message rate to the most responsible nurse was 0%.
Discussion
PERFORMANCE MANAGEMENT The head nurse could monitor the nurse on duty in real time and the overall nursing schedule with this smartphone nurse call system. In addition, it provides a management platform for evaluation of personnel performance.
COST FOR THE SMARTPHONE NURSE CALL SYSTEM The traditional analog nurse call system had a high cost of NT $480,000 per ward, so that the average fee for the system was about NT $10,000 (US $3,300) per bed. In contrast, the cost of the smartphone nurse call system was reasonable, at NT $150,000 per ward, which could save NT $6,875 (US $2,291) per bed. In addition, after
Effective communication between the medical staff members and the patient is critical for patient care. We observed that the waiting time for a patient to contact the primary care nurse was reduced to seconds after the implementation of the smartphone nurse call system. The most responsible nurse was able to track the location of the patient and which patient pressed the nurse call button. With the traditional nurse call system in rooms with multiple patients, it is impossible to know accurately who made the call. However, with the smartphone nurse call system, the most responsible nurse knows specifically which patient made the call. In addition, the nurse can use this direct information from the patient to determine whether medication or equipment will be needed from the nearby mobile
Table 1. Reduction of Waiting Time on a Nurse Call After Applying the Smartphone Nurse Call System AVERAGE WAITING TIME (S) ON A NURSE CALL (A) BEFORE
(B) AFTER
DIFFERENCE = (A – B)
P
Day shift
28.1 – 8.3
4.2 – 1.9
24.0
< 0.001
8-h night shift
67.1 – 21.7
9.2 – 3.6
58.0
< 0.001
12-h night shift
79.4 – 22.7
9.2 – 4.2
70.2
< 0.001
NURSE SHIFT
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Table 2. Patient Satisfaction with the Smartphone Nurse Call System (n = 155) ITEM
PERCENTAGE (%)
Easy to reach the primary care nurse
96.0 – 13.1
Shorter waiting time for the nurse
94.3 – 15.5
Less complaining
95.9 – 11.7
Improvement of nursing service
96.1 – 11.8
Convenience of communication with the nurse
90.3 – 15.3
Overall satisfaction
96.1 – 9.9
nursing station. In addition, the new system provides staff members who can easily to reach the most responsible nurse when needed. The most responsible nurse can also identify the patient in need and obtain critical pieces of patient information for timely care. The performance of the smartphone nurse call system was very satisfactory. The most responsible nurse responded to the nurse call in 4 s and 9 s for the day shift and the night shift, respectively. This would meet the guidelines in many hospitals in the world that one of the staff members should arrive at the location of the patient within 3 min for an urgency call and within 5 min for normal, sanitary, and assistance calls.4 With the in-building wireless smartphone system, our patient satisfaction with the smartphone nurse call system was very high (96%). However, it has been pointed out that the smartphone system not only sends alerts, but also enables voice communication between mobile staff members and patients. Today’s nurse call market is proposed for the integration of additional information from the location and admit, discharge, transfer systems into what have traditionally been nurse call applications.5 Communication between the medical team members is also very important for patient care. The average time for pharmacists to locate the most responsible nurse for a medication problem was reduced from 4.2 min to 1.8 min by the smartphone nurse call system. Similarly, the average time for a medical technologist to locate the nurse for a blood sample problem was reduced from 3.8 min to 6 s. In addition, after the new project was carried out, the lost message rate to the most responsible nurse was 0%. This would critically improve patient care. In a study of clinical communication on internal medicine wards, residents were provided with smartphones.6 To reach the most responsible resident for a patient, a smartphone designated as ‘‘Team BlackBerry’’ was also carried by each senior resident and then passed to the resident covering the team at night and on weekends. Nurses were able to send e-mail messages or call smartphones directly. The result showed that residents strongly preferred the smartphones over conventional paging and felt that it improved efficiency and communication. Although nurses perceived a reduction in the time required to contact a physician (27.6 versus
108 TELEMEDICINE and e-HEALTH F E B R U A R Y 2 0 1 5
11 min), their overall satisfaction with the physician’s response time for urgent issues did not improve significantly. Residents strongly preferred e-mails as opposed to telephone calls as the prime method of communication. Another recent study encouraged nurses to communicate with residents by email with smartphones.7 The result showed that of the e-mails from nurses, 39.1% were requests for a call back, 18.9% were requests for a response by e-mail, and the remaining 42.0% indicated no response was required from physicians. For the messages requesting a response by e-mail, only 50% received an e-mail response. E-mail responses had a median response time of 2.3 min. Content analysis revealed that messages were predominantly nonurgent. This is the current picture of the communication among physicians, nurses, and other healthcare professionals7 and may affect the development of information and communications technology for improving clinical communication. A verbal interaction lacks documentation of communication, but it is the most effective way for health service, although most people, including residents, prefer e-mails as opposed to telephone calls as the primary method of communication.6 Nevertheless, our findings provide an effective communication among the patient, the most responsible nurse, and other healthcare professionals with the smartphone nurse call system. The cost of the nurse call system is another important issue. The cost for a traditional analog nurse call system was NT $480,000 (US $16,000) per ward (50 beds) and NT $10,000 (US $3,300) per bed. In contrast, the cost of the smartphone nurse call system was reasonable, at NT $150,000 (US $5,000) per ward, and it could save NT $6,875 (US $2,291) per bed.
Conclusions and Implications With the trend of technologized society, the focus of medical care systems has turned to efficiency for patient care. Integration of the cloud and information technology into nursing care service would facilitate the communication and efficiency of the nursing care. After implementation of the smartphone nurse call system, patients received a more rapid response from the most responsible nurse. This improved patients’ satisfaction and reduced the number of complaints about a longer waiting time due to the shortage of nurses. Therefore, the quality of medical care is improved, which benefits the patient, family, and medical staff members as well.
Disclosure Statement No competing financial interests exist.
REFERENCES 1. Bahlman DT, Johnson FC. Using technology to improve and support communication and workflow processes. AORN J 2005;82:65–73. 2. Guarascio-Howard L. Examination of wireless technology to improve nurse communication, response time to bed alarms, and patient safety. HERD 2011;4:109–120.
SMARTPHONE SYSTEM FOR NURSING CARE
Address correspondence to: Shu-Ting Chuang, MS, RN Nursing Department Taichung Tzuchi Hospital 88 Feng Hsing Road, Section 1 Tanzi, Taichung 42743 Taiwan
3. Restuccia JD, Cohen AB, Horwitt JN, Shwartz M. Hospital implementation of health information technology and quality of care: Are they related? BMC Med Inform Decis Mak 2012;12:109. 4. Ongenae F, Myny D, Dhaene T, et al. An ontology-based nurse call management system (oNCS) with probabilistic priority assessment. BMC Health Serv Res 2011;11:26. 5. Unluturk MS. Advanced nurse-patient communication system. J Med Syst 2012;36:2529–2536. 6. Wu RC, Morra D, Quan S, Lai S, Zanjani S, Abrams H, Rossos PG. The use of smartphones for clinical communication on internal medicine wards. J Hosp Med 2010;5:553–559.
E-mail: [email protected] Received: April 14, 2014 Revised: May 4, 2014 Accepted: May 8, 2014
7. Smith CN, Quan SD, Morra D, et al. Understanding interprofessional communication: A content analysis of email communications between doctors and nurses. Appl Clin Inform 2012;3:38–51.
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