32 American Nurse Today Volume 9, Number 11 www.AmericanNurseToday.com

COMMUNICATION within a hospital, health system, orclinic is profoundly important. When it breaks down,clinical outcomes may be affected directly. Accordingto The Joint Commission, 62% of accidental deaths and80% of serious medical errors are linked to communi-cation failures. Communication errors also can reducethe bottom line. University of Maryland researchersfound communication inefficiencies lead to $12 billionin excess costs or lost revenue annually.

Successful organizations create consistent, seamlesscare experiences at every stage of the patient’s health-care journey—even beyond hospital walls to conductfollow-up by telephone at home or in skilled nursingfacilities. Communication is the crux of these experi-ences—and communication between nurses and pa-tients is especially important. Not only must we bepresent physically for patients and families, but we alsomust assure them we’re fully aware of and activelymanaging all aspects of their care.

Care rounding and care calls Care rounding and care calls can help achieve a morehumanized approach. • Rounding on patients can improve clinical quality and

promote patient and staff satisfaction. Nurse roundinghas had dramatic effects on care quality and satisfac-tion by decreasing call-light use and patient falls. Patients use call lights to notify nurses of both life-threatening issues and less urgent needs. When pa-tients understand a staff member will be accessible onan ongoing basis via rounding, they tend to reducetheir use of call lights for nonemergency requests.

• Care calls, or postdischarge telephone calls made by

nursing staff to the patient, bring the care journeyfull circle by helping to prevent adverse events andimprove the quality of both patient and caregiverexperiences.When implemented simultaneously, purposeful care

rounding and care calls can yield even greater increasesin patient outcomes and satisfaction. Hospitals can takecare rounding and care calls one step further by hard-wiring these processes using intelligent, integrated tech-nology. This can simplify communication and streamlineworkflows to help nurses work smarter, not harder.When incorporated into care rounding, technology canprovide visibility in workflows, which helps manage-ment identify gaps in nurse communication and rewardhigh performance. (See Alarms for patient falls.)

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Best practices forintegrating

technology into nursecommunication processes

Technology can close communication gaps that separate nurses from patients and families.

By Rhonda Collins, MSN, RN

www.AmericanNurseToday.com November 2014 American Nurse Today 33

Organizations with standardized rounding practiceshave seen improvements in patient experiences, asshown by significantly higher scores on HealthcareConsumer Assessment of Healthcare Providers and Sys-tems surveys. Technology allows these organizations tomeasure patient experiences in real time during a hos-pital stay, helping them to evaluate gaps and deployimprovement interventions.

How mobile technology can improve dischargeeducationResearch shows that one of the most important compo-nents of the patient experience comes at the end of thehospital stay. Whether the patient is headed home or toanother care facility, comprehensive discharge educa-tion is crucial. Missed, rushed, or ignored dischargeteaching leaves both patients and the healthcare systemvulnerable. Conversely, studies show that patients whounderstand their postdischarge care are 30% less likelyto be readmitted or to visit the emergency departmentshortly after discharge.

Poor communication and coordination around thedaily plan of care can pose a barrier to effective dis-charge. The plan of care should incorporate the entireinter- or multidisciplinary team, including rounding, toensure that the team and the patient are “on the samepage” throughout the stay.

During the discharge process, most organizationshave nurses deliver instructions to the patient duringbrief bedside teaching and then provide complex pa-perwork, including details on new medications. But atdischarge time, many patients are anxious or focusedon going home and don’t pay full attention to the in-structions or read through the paperwork fully. A sim-ple solution is to use mobile technology that allowsnurses to record discharge instructions at the bedside,which patients and home caregivers can access later atany time by phone or computer. Blending best prac-tices with technology solutions, nurses can improve pa-tient understanding of and adherence to discharge in-structions by:• recording and attaching live audio instructions,

videos, and pictures from a mobile device• providing access to patient-specific education and

links to valuable healthcare resources• capturing and delivering information using applica-

tions compliant with the Health Insurance Portabilityand Accountability Act of 1996 (HIPAA) and theHealth Information Technology for Economic andClinical Health (HITECH) Act

• creating and sending text reminders, emails, tasks,and care messages to patients

• monitoring instruction retrieval.Recording discharge instructions has shown to in-

crease patient compliance, reduce unnecessary read-missions, and increase satisfaction.

To further reiterate important teaching and clarifypostdischarge instructions, nurses should call patients

48 to 72 hours after they leave the hospital. The care-call process can be hardwired into hospital technologyto streamline and standardize nurse workflows. Tech-nological solutions may include best-practice checklists,call scripts, and even risk-stratification information,which can be used to identify patients at highest riskfor readmission.

Using the performance analytics tool of the technol-ogy solution, hospital management can:• audit discharge instructions and other patient com-

munications• ensure care instructions are handled consistently

throughout the organization• stratify patients most at risk for readmission • monitor staff compliance and competency• identify staff recognition and teaching opportunities.

Closing the gapTo increase patient satisfaction and drive growth andloyalty, healthcare facilities must be committed to pro-viding humanized, seamless care. They can do thismore effectively through such nurse communicationprocesses as care rounding and care calls. Theseprocesses can be implemented into the nurse workflowthrough technology that builds trust and relationshipsand creates connectivity with patients outside the hos-pital walls. Closing the communication gaps that sepa-rate nurses, patients, and families improves patient andstaff satisfaction and clinical outcomes while bringingfinancial benefits to the organization. O

Selected referencesAgarwal R, Sands DZ, Schneider JD. Quantifying the economic im-pact of communication inefficiencies in U.S. hospitals. J Healthc Man-ag. 2010;55(4):265-81.

Jack BW, Chetty VK, Anthony D, et al. A reengineered hospital dis-charge program to decrease rehospitalization: a randomized trial.Ann Intern Med. 2009;150(3):178-87.

Joint Commission Resources. The Joint Commission Guide to Improv-ing Staff Communication. 2nd ed. Oakbrook Terrace, IL: Joint Com-mission Resources; 2008.

Setia N, Meade C. Bundling the value of discharge telephone callsand leader rounding. J Nurs Adm. 2009;39(3):138-41.

Rhonda Collins is chief nursing officer at Vocera Communications in San Jose,California.

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Alarms for patient fallsA serious safety problem, patient falls often result from sim-ple inconveniences, such as items being out of reach. To re-duce falls, healthcare organizations should explore tech-nologies that route service requests to the appropriatecontact or department to ensure patient needs are ad-dressed quickly and efficiently. For example, the moment anunattended patient leaves a bed or chair, an alarm shouldsend a message to the staff member responsible for that pa-tient so he or she can act quickly to prevent a fall.