Writing for NEJM Catalyst, Orlando Health's Kevin de la Roza and Hamish Munro explain how they developed and deployed a secure mobile application for clinicians to communicate with patient family members during surgical procedures—and improved satisfaction rates for both nurses and patients.
Clinicians and technicians at Orlando Health Arnold Palmer Hospital for Children designed the app as part of an initiative launched in 2012 to get modern methods of communication—such as text messages and video—into the OR. The team wanted to create a secure, HIPAA-compliant app that would be easy to use for patients' families and for the patients' providers.
Details on apps
Ultimately, the team developed a communications platform called the Electronic Access to Surgical Events (EASE) that houses two apps: one for the clinical team sending the messages and one for patient families receiving the messages.
For security, the platform does not permit users to save any of the communications on a mobile device, and content vanishes after 60 seconds of viewing. It also features:
- 256-bit encryption;
- Secure cloud-based storage; and
- Individual log in and password protection.
The team designed the clinician app so that:
- Clinicians have to scan a patient's hospital-issued wristband before sending messages, ensuring that the messages are not sent to the wrong patient family;
- Nurses are reminded to update families through an audible notification every 30 minutes—families' preferred update interval based on the pilot data; and
- Clinicians can select 25 pre-loaded phrases in English and Spanish to improve efficiency and facilitate communication with non-English speakers.
Meanwhile, the family app was designed to:
- Facilitate the registration and patient consent form process;
- Allow invited friends and extended family to receive messages, so users do not have to be at the hospital to get updates; and
- Prompt users to participate in a voluntary post-surgical survey on the app.
The implementation plan
The team deployed their apps gradually, starting with surgeons at Orland Health's children's hospital who volunteered to test it out. According to de la Roza and Munro, the team launched the apps in the pediatric cardiac subspecialty on procedures lasting over an hour, and it soon spread to other specialties.
Families began asking for the service when about 15 to 20 percent of clinicians were using the app, de la Roza and Munro write. They add that many patient families learned about the app through internal marketing, clinicians, or other families. The team reached the "tipping point" when EASE covered every surgical specialty as well as the "shortest of procedures."
The platform has now expanded to Orlando Health's six adult hospital campuses. De la Roza and Munro write that while implementation has been slower at other hospitals, largely because of "a larger, busier, and more diverse surgical area," it has been "equally successful."
The team has developed a training manual for providers, which they are required to read before they can obtain login credentials. The team also provided a quick guide with suggested phrasing and visual content.
To gauge how the app affected patient experience, the team assessed more than 3,000 responses to a set of nine questions, developed by Press Ganey, that addressed patient satisfaction and staff communication.
The team found that all patient satisfaction scores rose among families who used EASE. As one patient family put it, "The EASE app was an incredible experience. We were at ease the whole time. We could actually go down to the cafeteria because we knew that the updates were coming. I never thought I would be able to leave the waiting room and now I can. I can't imagine going through this experience without having that app."
Specifically, the team found a:
- 13 percent increase among EASE users who said providers explained care in an understandable way;
- 7.5 percent increase among those who said the doctor kept them informed;
- 7.4 percent increase among those who said the doctor addressed their concerns;
- 6.1 percent increase among those who said providers addressed their emotional needs;
- 4.8 percent increase among those who said nurses explained care in an understandable way;
- 4.3 percent increase among those who said they were likely to recommend the hospital;
- 4 percent increase among those who said staff collaborated to provide care; and
- 2.3 percent increase among those who said nurses kept them informed.
According to de la Roza and Munro, "scores were even higher" for families who received videos and pictures in addition to texts. Families said the additional media helped them understand procedures and feel more connected with their loved ones during the surgery, de la Roza and Munro write.
The team also looked at data from the in-app survey and found:
- 98 percent of users said using EASE reduced their anxiety;
- 99 percent said the nature of images received was appropriate;
- 81 percent said availability of EASE would influence their choice of hospital; and
- Average satisfaction was 9.7 on a scale from one to 10.
The team also got positive responses from clinicians who used the app. "Some of the procedures can go on four or five hours and that can be really tough to deal with unless you're getting decent information all the time," Johnathan Phillips, a pediatric orthopedic surgeon at Arnold Palmer Hospital, said. "This app has really made a huge difference in the way we communicate during surgery."
After a six-month trial period, the team also conducted a survey among 26 nurses who had used the app to communicate with patient families. When nurses were asked to rank EASE on a scale of one ("strongly disagree") to five ("strongly agree"), EASE scored a:
- 4.9, when nurses were asked if it was valuable to the family;
- 4.6, when nurses were asked if it was more efficient than a traditional phone call;
- 4.5, when nurses were asked if it was enjoyable;
- 4.3, when nurses were asked if it was better than a phone call; and
- 4.3, when nurses were asked if it was not disruptive (de la Roza/Munro, NEJM Catalyst, 7/13).
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