According to the Leapfrog Group, more than 50,000 deaths in U.S. intensive care units could be avoided by implementing Physician Staffing Safety Standards, which focus on having such units managed or co-managed by intensivists. The standards emphasize that, when these specialists are not on site, they need to return calls or pages and arrange for certified physicians to reach patients within five minutes.
At most hospitals, where nurses sometimes can’t even find the right number to call, this goal is as daunting as climbing Mt. Everest. But at St. John Hospital & Medical Center in Detroit, 86% of calls from the critical care units to intensivists are answered not just within five minutes, but in real time.
St. John is improving patient safety in its ICU and other departments by solving a problem that most hospitals ignore — the errors, delays and miscommunications that often occur when they try to contact physicians. Considering that a 300-bed hospital contacts physicians, on average, about 180,000 times each year, or 500 times a day, even a small percentage of breakdowns could have an adverse impact on patient safety and quality of care. Since July 2008, nurses and other clinicians at St. John have been using a clinical communications system called PerfectServe to make simple, one-call connections with the hospital’s more than 1,500 staff physicians and residents.
“Doctors are on staff at various hospitals, and their call schedules, contact preferences and instructions can be very confusing,” said Paul A. Cullis, M.D., the chief of neurology at St. John. “With PerfectServe, you dial one number and the system contacts the right doctor every time according to his or her preferences. Nearly a dozen Detroit area hospitals now use PerfectServe, which I believe has greatly improved how we practice medicine in this city.”
For example, Dr. Cullis and his neuro/stroke team began using this system earlier this year to expedite care for patients with acute strokes. Callers dial one number and follow prompts to provide information on the patient’s age, race, sex, and onset time and type of symptoms. The system automatically assembles a code stroke message, analyzes the team members’ call schedules and notification rules, and routes the message to about 30 people, including the stroke coordinator, pharmacists, interventional radiologists and neurologists. Some receive only “FYI” notifications, but those who are “active” are required to acknowledge receipt within 15 minutes. The system automatically re-notifies those who do not respond and documents every call. Today, the response time for the two key decision-makers (the staff interventionist and on-call neurologist) is less than five minutes.
