As hospitals begin to define operations within the boundaries of COVID-19’s new normal, they’re taking a more proactive approach to manage critical events along with the often complex and diverse set of risks that occur daily. New insights gained from working on the frontlines of the pandemic are also shaping the path forward to create safer hospitals, operational efficiencies, and better patient outcomes. Read this article to learn how hospitals are taking an innovative Critical Event Management Approach to address three key areas of impact: clinical, safety and security, and high-impact IT incidents.
- Communication failures contributed to 30% of all malpractice claims, 1,744 deaths, and $1.7 billion in malpractice costs over 5 years.
- 93% of emergency physicians say they are not “fully prepared” for patient surge capacity.
- Workplace violence in healthcare is nearly 4 times higher than in other industries.
- Healthcare organizations worldwide reported a 45% increase in cyberattacks since November 2020.
The New Normal: Reshaping the Path Toward Resilience
Balancing competing events with daily clinical operations is nothing new to the healthcare industry, especially given the frequency and severity of natural disasters, cybersecurity incidents, and man-made threats. But with COVID-19, the fast-moving pace of the virus, and the demand for hospital beds and medical care placed an unprecedented strain on hospitals. Every day new insights gained from working on the front lines are re-shaping the way hospitals and healthcare organizations build resilience.
As hospitals begin to define operations within the boundaries of COVID-19’s new normal, we’ve created a Critical Events Management approach that focuses on three key areas of risks: clinical, safety and security, and high impact IT incidents. The approach is designed to help hospitals achieve better patient outcomes, faster, more efficient response times, and a safer, more productive work environment—no matter the situation.
Clinical Events and Communications
Contact tracing, telehealth, digital wayfinding, and clinical communication, and collaborative tools are just a few technologies that hospitals quickly deployed in response to COVID-19. In a short amount of time, they’ve re-engineered ways for patients to receive safe, timely care while mitigating the risk of COVID-19 exposure.
Through contact tracing, hospitals continue to automate important infection control processes by monitoring the location and status of staff and patients and capturing interactions at any given time and place. Potential exposure is then identified and flagged for follow-up.
Hospitals are also creating safer environments through digital wayfinding, which offers real-time communication and blue-dot turn-by-turn navigation to direct the flow of traffic to certain areas of the hospital. Smartphone-based notifications and zone-based routing capabilities enable hospitals to create designated patient zones to keep COVID-19 patients and designated COVID-19 staff isolated from the remainder of the patient population, minimizing the risk of infection.
Telehealth and other communication and collaboration tools have emerged as a must-have for hospitals, given the critical role these technologies have played in creating critical access points to care for patients and providers alike.
Clinicians have also shown how these technologies are creating improved daily workflow efficiencies and patient satisfaction, better patient outcomes, and substantial time and cost savings. On the next two pages, we outline how an effective communication and collaboration plan optimizes decision making, reducing onset to treatment time in high-acuity cases such as STEMI when every minute counts.
Stemi Team Activation:
- EMTs transmit EKG and patient info.
- Nurse receives EKG; pages ED physician.
- ED Physician responds to page.
- ED Physician reviews ECG.
- The charge nurse asked to page the on-call cardiologist.
- The cardiologist calls back.
- Cardiologist reviews EKG.
- The cardiologist and ED Physician discuss the case.
- Charge nurse looks up contact information (phone and e-mail) of the Cath team.
- Charge nurse calls and pages 8+ members of the Cath team and waits for a response.
- Cath Lab team members confirm availability.
- Charge nurse coordinates Cath Lab prep.
- EMTs arrive with the patient.
- Emergency room staff calls to confirm the Cath Lab team is ready for the patient.
- Patient transferred to Cath Lab.
Without clinical and care team collaboration, the workflow, highlighted above, could take upwards of 15 steps, twice as long as it would take with a clinical communications plan in place. More than half of Emergency Departments report that 10% of hand-offs have a communication error, according to a recent Everbridge Survey. Also, many hand-offs require multiple communication methods – between 3.3 and 4.9 channels. The survey found that communications across remote individuals raise the most communication challenges, including waiting for physician responses and incomplete or delayed information.
Steps, 3, 6, 8, 10, 11, 12, and 14, highlighted in red within the illustration above, are key hand-off points. When patient health is contingent on the speed of treatment, a break-down in communication during these steps will increase the timeline even further, placing lives at stake.
In comparison, by replacing pagers and phones with a secure clinical collaboration solution, the timeline above can be reduced significantly, securing the door-to-balloon time goal of fewer than 90 minutes.
DOOR-TO-BALLOON TIME GOAL LESS THAN 90 MINUTES
With a Clinical Critical Event Management Solution, all care team members can be quickly connected on a single solution.
In the case of a STEMI patient, cardiologists and other specialists can be added to the chat instantaneously and review all patient records from past hospital visits.
“What’s essential in the STEMI cases is quick identification – identification can occur prehospital, with our EMS partners, or it can happen as the patient is walking in,” said Martin Hernandez, Director of Emergency Services, DHR Health. “STEMI is essentially a heart attack happening. They are very high-risk patients, and their condition deteriorates very quickly.”
“Using a clinical critical event management solution, we can pre-activate our STEMI team, either from the field or from triage. That’s been essential in getting the patient to the right place, right time, and ensuring quick intervention.”
Secure clinical communications and care team collaboration, are core to creating an efficient coordination hub, powered by technology, a team approach, and critical elements to enhance the patient experience. This approach allows all members of a patient’s care team to be connected on a single solution in a group care team chat, creating an environment for clinicians to easily increase workflow efficiencies, resulting in improved patient outcomes, which has also been linked to increased HIPAA compliance and ROI.
Since implementation of a clinical critical event management solution, Sutter Roseville’s Emergency Department has experienced improved team response time and reduced alarm fatigue due to a decreased pager utilization. Today, the unit secretary activates the Cath Lab team and tech teams with a single click of a button. In addition to activating the Cath Lab team, the new system enables notification of the supporting team including the pharmacy, nursing supervisor, chaplain, social worker, vascular department, and bedside registration, for a more stream-lined, efficient approach.
Safety and Security Communication
In an era defined by COVID-19, some of the most destructive natural disasters including wildfires, hurricanes, tornadoes, and winter storms accounted for significant losses among hospitals.
Further heightening the risk to healthcare facilities is the rise in man-made incidents, including active shooter events. Within the past 15 years, hospital shooting incidents have become a monthly occurrence. According to a recent survey, 32% of healthcare professionals believe the odds of an active shooter incident occurring at their facility are high or very high.
Hospitals that already have infrastructures in place will be better equipped to respond to critical events whether a pandemic or a natural or man-made disaster.
Hospitals are also facing increased rates of workplace violence with health care and human services workers four times as likely to be attacked or assaulted on the job. A recent survey of emergency room physicians found that nearly half reported having been physically assaulted on the job, and roughly 70% said violence has increased in the past five years.
Staff Safety Statistics:
- 4X Healthcare workers are four times as likely to be attacked or assaulted on the job.
- 1 in 5 nurses will be assaulted this year
- 32% of nurses who are assaulted will quit their jobs.
- 70% of emergency room physicians said violence has increased in the past five years.
The World Health Organization estimates that as many as 38% of physicians worldwide have suffered physical violence at some point in their careers.
This year, more than 600 incidents of violence, harassment, or stigmatization took place against healthcare workers, patients, and medical infrastructure, about the COVID-19 pandemic according to the International Committee of the Red Cross (ICRC).
With emerging safety and security risks, hospitals need a reliable, immediate way for staff to call for help and a quick, efficient way for the responding security teams to immediately gain situational awareness and location detection.
An automated critical event management platform engineered to provide comprehensive, multichannel, two-way communication, can provide hospital staff with relevant, up-to-the-minute messaging based on their role and proximity to the event or facility. Example on the next page.
Safety and Security Checklist
A well-orchestrated emergency response plan can help improve response times and de-escalate incidents, ultimately determining the best outcome. Do your hospital’s safety and security program include the following?
- Strong leadership commitment against workplace violence is critical to building an environment of trust and the overall adoption of prevention programs.
- Policies, procedures to help remote and lone workers identify and address problems when they feel at risk.
- Assessment of potential hazards and associated risks for workers specific to their unique work functions and locations.
- Training, protocols, and de-escalation techniques to help staff better respond
- Telecommuting tools and technologies to check in with staff regularly and facilitate rapid notification and response in a crisis.
- Redundant two-way communication channels to help inform employees and receive alerts of evolving crises from workers, enabling “See Something…Say Something” programs.
- Staff safety technology including wearables, badging, and smartphones that provide a discreet, reliable, immediate way for staff to share threats and leverage:
- Mobile and fixed panic buttons to automatically notify first responders and provide real-time feedback about staff location and threat environment including situational images, audio, and video.
- Virtual escort/Check-in capabilities to enable staff to indicate when they are in an unsafe environment and want the added security of virtual escorting or check-in capabilities to provide an additional layer of protection.
- Risk alerts/Area awareness to increase staff awareness of incidents occurring in an area they are traveling to. Monitor public risk alerts or identifies risk areas for staff. Create greater awareness for staff around an area that might have a current incident indicating that they should take appropriate precautions.
- Locate staff during an incident leveraging a multi-modal technology approach to identify all staff who might be impacted by an incident. Technology can look at dynamic locations, typical static locations, and even expected locations to make sure as many staff as possible are accounted for during an incident.
- Incident reporting guidance and investigation procedures empower staff to report an incident with the option to be anonymous.
- Monitoring and review capabilities of adverse events to benchmark against best practices and elicit staff feedback to ensure compliance with policies and procedures.
High Impact IT Incident ResponsePower Your Response
During COVID-19, hospitals worldwide reported an increase in the number and severity of cybersecurity and ransomware attacks. At least 41 healthcare providers experienced ransomware attacks in the first half of 2020, and since then, an increasing number of hospitals have been targeted. Between rising cybersecurity risks, IT outages, unpredictable change management issues, and natural disasters, it’s not a question of whether, but when, a serious IT security or performance issue with a hospital’s digital infrastructure will occur.
Without functioning IT services, safety systems, and EHR systems aren’t accessible, internal and external communications fail, and hospital throughput and efficiency immediately decline.
Downtime not only compromises access to critical patient information and records, but it also can interfere with the processing of time-sensitive lab tests, pharmacy orders, and ambulatory services, as well as critical updates and advisories to staff, and stakeholders.
Within a one-year period, 59% of hospitals reported unplanned EHR downtime. When computer systems fail and hospitals need to revert to a paper-based contingency plan, often staff aren’t familiar or haven’t received the necessary training to carry out more manual, paper processes. This causes disjointed communication and processes, resulting in major delays in care.
Potential long-term implications include the loss of life, reputation, revenue, and operational excellence.
Improving IT Event Response
Although organizations significantly invest in tools to help find and fix IT issues, they often miss a key component in reducing the overall length of an outage and associated costs – optimizing IT incident response.
Once an IT incident is detected, assembling the right team of IT professionals (the response phase outlined below), takes an average of one hour, one of the most lengthy and costly stages of incident resolution. This becomes particularly tricky for hospitals that rely on third-party IT providers for incident resolution. When streamlined processes of communication aren’t in place for working with these providers, delays in reaching key stakeholders and staff occur. This can be especially damaging during ransomware attacks when staff needs to be quickly instructed on how to disconnect devices and prevent further compromise. With the cost of unplanned data outages estimated at $8,851 per minute, ensuring that your hospital has a coordinated incident response in place can reduce the overall length of the outage and associated costs.
By automating IT incident response procedures, hospitals can connect IT, response teams, quickly and efficiently. This increases response team activation and mobilization, reducing the time it takes to resolve incidents while reducing alert fatigue and the impact on operations. Although, each major hospital IT incident will typically present a different set of challenges, having a major incident plan and process in place saves time in the long run and helps limit the negative impact for any business.
An IT incident response system that also features tracking and reporting capabilities can help hospitals better analyze, improve processes, and further reduce downtime.
Given that most hospital IT teams are resource-constrained, an IT incident response system should integrate and extend current IT investments while not over-taxing IT staff. Systems that are extensible to other areas of the health care enterprise (e.g. supporting IT and clinical teams) typically won’t require additional IT resources for integration.
Power Your Response
To build a highly resilient hospital, ask these key questions to determine if your hospital is powered for peak operational response during a crisis, regardless of whether it’s a high-impact clinical, IT, or safety and security incident:
- Reliability: Will your messages reach everyone who needs them, quickly as required, regardless of the recipient’s location or failure of one or more communication channels? Can your platform connect IT, staff, within 5 minutes or less?
- Scalability: Can your platform quickly scale to meet sudden, unpredictable surges in demand while meeting its uptime and performance commitments?
- Security: Does your messaging platform meet the strictest security standards required and can you prove compliance?
- Support: Are technical and customer support for the platform available 24/7/365 and do they offer a “last resort” option to create and send messages if all your communications and infrastructure are unavailable?
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