Improving communication and shortening wait times within hospitals might seem a daunting task, but sometimes it can be accomplished by simply taking a fresh look at what’s already in place.
Content related to health systems science—an understanding of how care is delivered, how health professionals work together to deliver that care, and how the health system can improve patient care and health care delivery—has become more frequent on the United States Medical Licensing Examination (USMLE). The National Board of Medical Examiners includes the topics in its USMLE Content Outline and offers a dedicated health systems science subject examination.
To help medical students, the AMA Accelerating Change in Medical Education Consortium has collaborated with the “InsideTheBoards” podcast to create a health systems science (HSS) podcast series. Each episode of the HSS series offers on-the-go learning by breaking down practice exam questions with expert guests.
A recent episode on teamwork features a conversation with physicians at University of Chicago Medicine who helped develop a tool that connects physicians with nurses to make touch-base conversations more frequent, speed up discharges and open up beds more quickly to patients who need them.
Need for earlier updates
University of Chicago Medicine’s main inpatient care center faced many of the care coordination challenges that typify big academic hospitals.
“The surgery teams round very early, they round very quickly, and then they disappear to the operating rooms or clinics, and they can be difficult to reach during the day,” said Chase Corvin, MD, a general surgery resident. “So when you're trying to provide patient education, when you're trying to arrange transportation for patients to leave the hospital—these are all things that our nursing colleagues are really integral in doing, and we weren't letting them know early enough in the day.”
A similar problem existed in the mother-baby unit: With ob-gyn physicians frequently running off to labor and delivery, nurses often weren’t able to touch base with them to discuss discharge decisions.
Food for thought
It turned out each of the rooms in the inpatient care center was equipped with a communication console with a collection of buttons that could be customized to send text alerts to nurses on duty. For years, it had only conventional uses, such as providing updates on food service.
“I worked at this hospital for over 20 years, and so did some of our nurse leaders, and we had no idea what this console was,” said Vineet Arora, MD, associate chief medical officer for clinical learning environment. “It was the bedside nurse in the ob group who said, ‘I think there is a potential here because when the food people come and they bring the tray, they tell us that their food is here and they press the button and it alerts to our phone.’”
The ob-gyn team customized one of the buttons on the console, first calling it the “MD-in-room button.” In later iterations, staff referred to it as the “MD/APP-in-room button” because it was also used by advanced practice practitioners.
“The purpose of the button was to really let our nursing colleagues know when we were at the bedside rounding on patients to provide an opportunity for face-to-face communication at the bedside,” Dr. Corvin said.
Simple step with big effects
“It doesn't have to be a button,” Dr. Arora said. “It could be anything.”
Besides shaving hours off discharges, the process also has sped up admissions for emergency department patients.
“We are a place on the South Side of Chicago that's at 99%–100% percent capacity on a lot of days,” Dr. Arora said. “So these are important things to think about in terms of efficiency.”
A description of this project was submitted to the 2020 Health Systems Science Student, Resident and Fellow Impact Challenge and selected to be published in the challenge’s abstract book, along with dozens of other notable projects.
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