Wireless devices keep nurses connected

When a nurse needs help in the old Rhode Island Hospital emergency room, chances are she can just look around, spot a colleague and call out to him – if he doesn’t notice her himself, maybe he’ll hear a commotion or see the crisis from across the big, open room.

In the new emergency department, that’s less likely to happen. It’s just too vast, too labyrinthine, too private. There are walls between the patients, not just curtains. And teams now working, for the most part, in a single space will be in separate, specialized units.

The change “is going to be one of the challenges for the staff, who are used to being able to see and feel everything that’s happening,” acknowledged Dr. Andrew Sucov, director of the E.D. But new technology is expected to help restore the connections.

When the E.D. goes on line tomorrow morning, every nurse, doctor and other staffers will have a small Vocera Wi-Fi unit attached to the lanyard around their necks. If Nurse A needs to reach Nurse B, she’ll just hit a button on her Vocera and command, “Call Nurse B.”

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Wherever Nurse B is, he’ll hear a soft chime on his Vocera unit, and then he’ll be asked if he wants to accept a call from Nurse A. He doesn’t have to touch the unit – just say “yes” or “no.”

If he accepts, they can talk as if on a speakerphone; if he declines – if, for example, he’s busy with a patient right then – Nurse A can leave him a message.

The emergency department will be the second Rhode Island Hospital unit to adopt the Vocera system. Since November, a team led by nurse Betty Taylor has been using it, as a pilot program, on a 22-bed general medical inpatient floor.

Like the new E.D. sections, Taylor’s horseshoe-shaped unit doesn’t lend itself to easy, face-to-face communication: At any given time, the nurses and assistants may be scattered in a half-dozen different patient rooms, down a corridor from one another.

Before adopting Vocera, Taylor said, if a nurse needed help, she’d have to alert the unit secretary, who’d then make an overhead announcement. If they had to find a specific nurse, they’d ask that she turn on her patient’s help light to let her colleagues know where she was.

It was noisy, disruptive, and not terribly efficient, Taylor said, and it went on “all the time,” because the nurses work as a team and often need one another’s help.

Vocera, she said, “has been very effective for us.” The overhead pager is rarely needed now – even group announcements can be made over the wireless units – so “it’s a lot quieter” on the floor, “and the patients aren’t hearing everything.”

The system also allows the nurses to keep working even as they talk to one another. And because the Vocera units are voice-operated, they don’t have to break a sterile environment, for example, to press a button or pick up a phone. They can even page a doctor and have the call go through to their Vocera unit, rather than to the floor phone. Conversely, if they’re on a Vocera call and they want to speak privately, they can transfer the call to a phone.

The system will make a huge difference for the staff in the new emergency department, said David Hemendinger, chief technology officer for Lifespan, Rhode Island Hospital’s parent company. About 250 people will be using the Vocera units there, he said.

“It’s not only a question of the size, but the complexity of that environment – the way we’ve got it broken up,” Hemendinger said. The Wi-Fi system will keep the staff within units connected, he said, and help overcome the distance between the nurses.

But going from face-to-face communication to Voceras does require intensive effort, too. Every day last week, E.D. staffers got special training to use the units.

Within the E.D., the Vocera system will be part of a larger-scale wireless setup that also includes a wireless computer network and Wi-Fi workstations on carts for the nurses, Hemendinger said.

“That’s the beauty of this whole thing – you can run all this separate technology off that same infrastructure,” he said.

Eventually the whole Rhode Island Hospital campus will be hooked up, Hemendinger said, and both the Miriam Hospital and Newport Hospital are launching Vocera pilots within the next few months.

“It creates a cultural change on the floors, so it’s kind of a slow process,” Hemendinger said. “It will probably take a year to a year and a half.”

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