Vocera, Hospitalists, Nocturnists and DND

Posted by: Kenny Schiff on April 22, 2009

According to the March 12th issues of the New England Journal of Medicine (as reported in MedPage Today), in some regions of the US, upwards of 70% of inpatient care now being taken care of by hospitalists. With the steady rise of these physicians who are primarily hospital employees, it’s no surprise that these doctors are increasingly part of workflow technologies like Vocera.

Communication needs and preferences are very different for different clinical roles, and hospitalists are no exception. The following illustrates a Vocera workflow for hospitalists that accommodate their preferred communication style. It’s a great example of how incredibly creative one can be with Vocera, without being technically burdensome.

Too Much Communication Can Be Counter Productive
Seeing the success that other staff has had using Vocera, the hospitalists at one of our customers believed that wearing Vocera badges would boost productivity for their role. As we worked through designing a Vocera workflow for them, they voiced concern that receiving direct voice calls would be counterproductive.

Instant communication is great thing. Too much communication can seriously impact efficiency and focus. They hospitalists felt they were getting paged too often about trivial matters that can wait. Their preference would be to use Vocera and always be on DND (do not disturb). This way nurses will leave them messages which they can get to when they are available. The hospitalists can call the nurses back from their Vocera badge when they are free.

But, of course, there’s a catch.

Work Teams
Hospitalists often work in teams. So, for instance, Dr. Hass and Dr. Dantz are a team. Since they are not at the hospital at the same time, if one doctor should get called while they are not at the hospital, they want the call to roll over to the other.

Initially a call forwarding scheme was attempted. What they discovered was that if Dr. Hass is called (and he is not logged in), the call forwards to Dr. Dantz (who is on DND), the subsequent message left would be for Dr. Hass not Dr. Dantz. To solve this, we needed to think out of the box.

Solution: Use Alternative Names
We created alternative user names for the hospitalists which are the opposite of their real names (Susan Hass logs in as “Hass Susan”, Victor Dantz logs in as “Dantz Victor”). We created a group called Doctor Hass, with an alternate spoken name of Susan Hass) and made the group sequential with the user Hass Susan the first name in the group and the user Dantz Victor as the second name in the group. I also created a group called Doctor Dantz with Dantz Victor as the first person in the group and Hass Susan as the second name. Now when either doctor is called, the caller will leave a message for the doctor that is logged in.

There are three teams. We created six groups.

But the plot thickens…

At night, when neither hospitalist is at the hospital, there is a nocturnist that will wear Vocera on DND. If neither Dr. Hass nor Dr. Dantz are logged in they want the call (message) to go to the nocturnist.

Solution: Use Groups
We created a group called “Nocturnist.” The doctors who are always nocturnists are entered into Vocera “first name, last name” as well as Dr. Last Name. They are also added to the nocturnist group. The group nocturnist is added to each of the six hospitalists groups as the third name in the sequence, and voila!

Note: Recording Greetings is Important to Making this Solution Work

For each group we recorded a greeting so the caller will hear, “You’ve reached the Hass/Dantz group. Please leave a message and one of us will return your call shortly.” To make this work transparently to the calling party, we had to record the same greeting for both the Doctor Hass group and the Doctor Dantz group–same process for the other groups. We also recorded one for the Nocturnist group so it is heard when that group is called directly.

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