By Janel Nour-Omid
A new Stanford University study identifies several practices that can improve interactions between patients and clinicians at the point of care (Zulman, et al., 2019).
The study recommends that clinicians prepare well for a point-of-care encounter, listen to and acknowledge a patient’s concerns, connect with the patient’s story, and explore emotional cues.
As you might have guessed, time pressures make following these practices difficult for many care providers. Many things compete for providers’ time, including reporting requirements and the next patients waiting to see them. In addition, staffing shortages can make it difficult for clinicians to delegate patient management tasks to others.
These time constraints contribute to burnout because they cause clinicians to spend less time doing what they enjoy – interacting with patients in a meaningful way.
Health care organizations can improve point-of-care effectiveness by establishing a process with the following elements:
1. Gather and curate data relating to point-of-care performance
The Vitalacy team has developed new ways of gathering and curating data that can bring new insights into the time clinicians spend interacting with patients – the most important moments in health care.
These data relate to the actions and performance of care providers on patient care and safety measures such as hand hygiene compliance, workflow effectiveness, purposeful rounding, and clinician fatigue and well-being. Improving performance on these point-of-care performance measures can contribute to better patient and provider satisfaction, as well as to better health outcomes.
Gaining these insights involves using Bluetooth, Internet of Things (IoT) and artificial intelligence (AI) technologies to gather data about where and how long care providers spend their time, with a particular focus on the time care providers spend interacting with patients face-to-face. The data are visualized in real-time maps – an indoor version of a Google or Uber map.
These technologies are integrated within the Vitalacy Patient Safety Platform, which links each care provider to data gathering sensors by the use of something very innocuous – a simple wristband or name badge tag that tracks a care provider’s movements and locations. It’s like wearing a watch or a Fitbit. The core competency of the platform is to help healthcare organizations to better understand workflow, and then how to adjust and improve it to achieve better patient-provider relationships at the point of care.
2. Engage clinicians in point-of-care performance improvement
By engaging care providers in the gathering and analysis of these data, healthcare organizations provide clinicians with the opportunity to contribute to quantitative improvements in quality and safety while demonstrating that the organization cares for the well-being of its care providers.
Care providers receive personalized reports on measures such as hand hygiene compliance, rounding effectiveness, time spent on shift, and miles walked. Once providers understand how their improvements on these measures contribute to quality and safety, their engagement increases even more.
For example, a care provider participating in a Vitalacy work group asked if the platform could track when and for how long care providers interacted in patient rooms. Her question rose from a concern about the high fall rate among severely immunocompromised end-stage cancer patients at the medical center.
This question led to the development of Vitalacy’s purposeful nurse rounding data module, which was implemented for the first time at this medical center. The module identifies which staff member completed rounding in each room, at what time, and for how long. By viewing activity by staff and room, managers can ensure that care provider get alerts when patients have not been visited when necessary and can identify high- and low-performing staff to target education and training.
3. Be mindful of care provider wellbeing
Physicians are not immune from burnout. An Agency for Healthcare Research and Quality (AHRQ) project found that more than half of primary care physicians feel stress because of time pressures and other work conditions. Most reported experiencing time pressures when conducting physical examinations. Nearly a third felt they needed at least 50 percent more time to perform patient care tasks, and nearly a quarter said they needed at least 50 percent more time for follow-up appointments.
Vitalacy has developed fatigue scoring algorithms to notify unit clerks and nurse managers when a nurse has worked frequent or long shifts or walked miles above the norm. Difficult workloads correlate to nurse fatigue, which can cause medication errors and other adverse events.
The financial stakes of managing burnout and turnover effectively are high. According to the Nursing Solutions Inc. 2019 National Health Care Retention and RN Staffing Report, the turnover rate for bedside RNs is 17.2 percent per year and the average cost to replace a bedside registered nurse is estimated at more than $50,000. The average hospital loses $4.4 million to 6.9 million each year due to turnover (NSI, 2019). Nurses providing direct patient care in hospitals tend to have the highest burnout rates.
To improve patient-provider relationships, we need to help our clinicians find more time
Physicians spend an average of more than three hours daily on office visits and slightly more time on what is described as “desktop medicine,” which includes tasks such as typing notes into the electronic health record (EHR), according to a study published in Health Affairs (Tai-Seale, et al., 2017). A University of Pittsburgh Medical Center study that found nurses spending about a third of their time interacting with technology versus only 16 percent on patient interaction and care (Higgens, 2017).
If we expect clinicians to fulfill the point-of-care practices of the Stanford study, we need to find them more time to focus on their patients. To accomplish this, we need to increase our understanding of the patient-provider relationship by gathering and curating quantifiable data that relates to it. By giving patients and providers more of what they want – time and a focus on their wellbeing – we can make patient care more effective and rewarding for both clinicians and those they serve.
Agency for Healthcare Research and Quality (AHRQ). Physician Burnout, July 2017.
Higgens, L, et al. Hospital nurses’ activity in a technology-rich environment. Journal of Nursing Care Quality, July/Sept. 2017, 32(3):208-217.
Nursing Solutions Inc. (NSI). 2019 National Heath Care Retention and RN Staffing Report. 2019.
Tai-Seale, M, et al. Electronic medical record logs indicate that physicians split time evenly between seeing patients and desktop medicine. Health Affairs, April 2017, 36(4).
Zulman DM, Haverfield MC, Shaw JG, et al. Practices to Foster Physician Presence and Connection With Patients in the Clinical Encounter. Journal of the American Medical Association, 2020;323(1):70–81. doi:10.1001/jama.2019.19003