Last month, The New York Times Well Blog had an interesting story about call light usage in hospitals and an innovative change that is reinventing a necessary evil.
I use the descriptor “necessary evil” because call lights; while they are the lifeline for patients in the hospital, they can at the same time disempower them to feel as if they are at the mercy of the voice at the other end. From the side of the nursing staff, managing and answering call lights can be a distraction and interruption to the tasks that need to be completed and the work that needs to be done during an already busy shift.
Research is starting to emerge related to patient satisfaction, nurse burnout, and fatigue related to call light use. One study, published in March of this year in Computer, Informatics, Nursing looked at call light data from 5 acute care nursing units at a community hospital in Michigan. The authors identify the shortcomings of the information review; size of the hospital, location, the call light system used by this institution, and task priorities of the nursing staff: making it difficult to generalize the findings of this study to hospitals and populations across the country. The conclusions were no less interesting. As with previous studies, the data points to higher rates of call light use correlating with longer staff response times. What was a surprise to the authors of the study: the length of stay was actually found be converse of the proposed study idea. The shorter the length of a patient’s stay, the higher the rate of call light use, and the longer the staff response times. Reading this study, I was also initially surprised by these findings. In retrospect, it makes sense. Answering call lights does lead to call light fatigue. I will state this openly and honestly. If a patient uses the call light every 10-15mintes to ask for something or ask a question after 2 or 3 hours the first thought to run through your mind is ” What do they need now?” In nursing units with high turn over (i.e ICU) patients tend to be admitted during emergent and stressful situations. They are scared, unsure, concerned, uninformed, confused, suffering, and have pain. It is important (though not always easy) to always keep this in mind. The fact still remains: we are human and prone to exhaustion and impatience. What I always go back to is…… How do we change the system to make it better for everybody? Fortunately, there are many people already asking this question and working towards solutions.
Presbyterian Healthcare Services in Albuquerque, NM has developed a system that completely changes the way call lights are answered, information is directed, and patient care and service is provided. The innovation of the call light system at PHS directs the call lights to be answered by a central operator and patient needs are dispersed by text messaging to the appropriate staff member. (This is a phenomenal idea to me).
When you look at the numbers that PHS provided from their data analysis on call light usage; call lights were used on average 1400 times per day and 140 of those hits were by accident. It is important to examine this data and think of it in regards to nursing time (dollars) and productivity. Of the 90% of patient calls that were needs, I’m curious how many were things that could be met by ancillary staff (bathroom, water, ice, TV problems, etc.) and how many calls needed to be responded to by a Registered Nurse. Being able to direct care and needs down appropriate channels from the instant the call button is pressed saves immense nursing time and energy and from a hospital standpoint that translates into efficiency and dollars.
The magic of this system: it gives a high level of respect to the needs of the patients, allows staff to prioritize calls, and meet the needs of all patients on the unit and at the same time gives credence to the work load of their nursing staff.
What is becoming more common at institutions around the country is intentional hourly rounding. I am a big advocate of this. I worked at an institution 8 years ago that after the implementation of this program on their neuro floor their patient fall rate went to zero. Their program came with hourly rounding and automatic toileting every 2 hours. It sounds like so much more work and getting staff to “buy into” this concept, participate actively and consistently are barriers to implementing these programs and making them successful. However, by anticipating and meeting the needs of patients; they don’t try to get out bed (they don’t have to go to the bathroom), don’t fall, and the usage of the call light plummeted because trust had been built and they knew someone was coming back.
Hourly rounding is not a new idea. It has been around in practice or nearly 20 years. I think now health care organizations are coming back to these concepts realizing the impact that small things have on big outcomes: such as on patient satisfaction. In the ICU, the staffing is just different from general nursing floors. We have 1-2 patients and we are in and out of their rooms so much more frequently. It is still easy to forget to ask the patients and their families if they need anything or if there is anything we can do for them. At all levels of care, throughout a hospital working to anticipate and meet patient needs is an important part of building trust and relationships.
Putting systems in place within an organization that can accomplish increased patient satisfaction, improved patient outcomes, increased staff retention, decreased nurse burnout, and build nurse-patient relationships with just the touch of a button is not simple or easy: it should be everyone’s goal.