What is Acute Care?
Acute care is active, short-term care for a specific condition. As with every part of healthcare, acute care has a lot of opportunities to continue to improve to provide better, more equitable care for everyone. Improving communication and collaboration are key steps to improving healthcare overall. Continue reading to learn more about various communication and collaboration challenges in acute care, and how technology can address these challenges.
Collaboration and Communication Challenges in Acute Care
One of the major challenges in acute care is communication. Communication failures contribute to 50-80% of sentinel events. A 2016 study estimated that communication failures in U.S. hospitals and clinics were at least partially responsible for 30% of all malpractice claims, resulting in 1,744 deaths and $1.7 billion in malpractice costs over five years.
Communication is especially critical in acute care, as patients see so many clinicians in a short period of time, and any delays or miscommunications can have significant consequences for the patient. Physicians may hand-off a patient to another department, or may hand-off the patient to an on-call or night physician when their own shift ends. This may happen multiple times depending on what the patient is dealing with and how long they are in the acute care facility. There are also numerous non-physician clinicians who work with the patient. And after acute care treatment, patients are often transitioned to a post-acute care facility or are discharged home with follow-up care instructions.
Why is communication such a challenge? There are a lot of contributing factors. As mentioned above, there are many clinicians working with the patient in a short time, and that means more opportunities for miscommunication to occur.
Clinicians are busy, overworked, and seeing too many patients. Then in addition to all the time spent on patient care, clinicians do a lot of administrative work. On average, physicians work 13.5 hours each week on tasks other than direct patient care. Since they are pressed for time, clinicians may unintentionally forget to write down or tell others information because they need to leave or get to their next task. When clinicians do a patient hand-off, they may be rushed or in a loud area, and the clinician taking over the patient’s care may not get a good understanding of the patient’s status and treatment plan.
The tools clinicians use also hinder communication. In most jobs, people communicate by email, instant message, text, or some other real-time internet app. However, healthcare lags behind. Paper workarounds are used in most healthcare settings, even though these workarounds often contain information that is three to six hours out of date. Additionally, 49% of acute care clinicians use email and fax to share data with others during patient transitions.
These modes of communication do not allow clinicians to communicate in real-time, which can be problematic in an acute care setting where decisions sometimes need to be made instantly. If there is no time to track down the latest updates, then clinicians will use the information available to make the best decision they can. However, this sometimes means basing decisions off of information that is hours old.
Having numerous digital and analog forms of communication in acute healthcare settings adds to clinicians’ cognitive load as they try to remember what information is where. They may need to look in five or six different places to find a note. And if a clinician uses the wrong mode to share information, the clinician who is supposed to receive the information may never get it, or may get it so late that it is no longer helpful.
Tech can help improve collaboration by giving clinicians one real-time mode of communication to use anytime and anywhere. CareAlign’s patient notes are updated in real time, so if a nurse makes a note, all the physicians on the care team can see that note instantly. This eliminates the need for paper workarounds and ensures that the entire care team has access to the most updated information at all times, whether they are in the hospital or working remotely.
Clinicians are central to healthcare, so it is important to understand and continuously improve the clinician experience. Right now, healthcare is not too great for clinicians. The 2022 Medscape Physician Burnout & Depression Report found that 47% of physicians reported burnout, with emergency medicine reporting the highest numbers at 60%. 44% of nurses surveyed said burnout and a high-stress environment are why they are considering leaving their job.
Burnout has a lot of negative consequences for everyone in healthcare. Clinicians suffer from numerous problems associated with burnout. Healthcare organizations lose money when clinicians leave the practice, and then they are without adequate providers to serve the community. According to the AAMC, the United States could see an estimated shortage of between 37,800 and 124,000 physicians by 2034. Patients will suffer from this shortage as they lose timely access to care.
Unfortunately, it is not just burnout negatively impacting the clinician experience. Workplace violence has been steadily increasing for healthcare workers. The American Nurses Association has found that one in four nurses are assaulted in the workplace, and only 20%-60% of incidents are reported. How can organizations expect clinicians to work in environments where they constantly fear for their physical and psychological safety?
Improving the clinician experience should be a key goal for acute care organizations. Technology can help clinicians by reducing their administrative workload and cognitive load to help reduce burnout. CareAlign saves clinicians over an hour each day, giving them more time to work with patients or focus on their wellness and personal lives.
EHR and Documentation Challenges
Documentation negatively impacts the clinician experience because of high dissatisfaction with the EHR and documentation processes. Almost 75% of burned out physicians identify their EHR as a contributor to their burnout. Similarly, a Mayo Clinic study found that physicians gave EHRs an “F” on the usability scale, and found that for every one point higher physician rating on the usability scale, there were three percent lower odds of burnout.
In addition to usability issues, there are so many regulations for charting that increases the time clinicians spend finishing their notes. A 2017 AHA report found that health systems, hospitals, and post-acute care providers have 629 discrete regulatory requirements they must comply with. Clinicians get stressed about meeting all these requirements, leading many to copy and paste information from the previous note to help meet the regulations. In a typical note, 46% is copied from a previous note, leading to an increase in median note length.
The problem is that clinicians are given EHRs and told that the EHR can do everything. EHRs were designed to replace analog charts and help with billing and coding. They are not designed for collaborative clinical workflows and care that is done in various locations. When clinicians need to use the EHRs for purposes they were not designed for, it takes longer than it should to do tasks and increases frustration.
For documentation, clinicians can not just take notes in the EHR. They often need to take medical notes in other formats throughout their shift, whether that is paper or text messages or word documents. Then they have to find all this information and re-write it into a cohesive note in the EHR, which takes extra time to repeat work they already did. This repetitive work is an extra unnecessary burden.
The mismatch of technology and workflows impacts more than individual clinicians. As much as 1% of net charges are lost due to charge leakage. Basically, when clinicians take notes in different formats throughout the day, they may forget to add that information fully back into the patient note in the EHR, meaning that that work doesn’t get coded or billed for properly. 1% may not sound like a lot, but for every million dollars of charges, that is $10,000 automatically lost for work that is being completed either way.
There are ways to optimize EHRs to help with different aspects of clinical practice, including documentation. CareAlign can help improve the documentation experience for clinicians with the wiki space that allows clinicians to add to the patient’s note throughout the day. Then, after finalizing the note directly in CareAlign, clinicians can easily upload the note to the EHR, eliminating duplicative work and reducing the cognitive load.
CareAlign also reduces charge leakage. With CareAlign, all of the clinicians’ notes are in the platform, so no work gets lost when it is uploaded to the EHR and billed for. At a large academic health system, with a fully functioning CDI team, CareAlign increased billing by $480 per admission through improved CMI. This can help the hospital get back millions of dollars in revenue for work that they are already doing anyway.
Patients are at the center of healthcare, so it is important to understand how everything impacts patient outcomes and the patient experience. The patient experience is especially important for hospitals because of HCAHPS scores. HCAHPS is a standardized survey that collects data on patient’s experience with their hospital care. The survey provides comparable patient satisfaction data between hospitals and enhances accountability and transparency. HCAHPS scores can impact both a hospital’s reputation and the reimbursement they receive, so it is important for hospitals to do what they can to achieve high HCAHPS scores.
Communication is a big component of the HCAHPS survey and can impact scores, making it a great item for hospitals to focus on to improve the patient experience in healthcare. Better clinician-patient communication is associated with higher patient satisfaction. With better communication, patients understand what is going on with their care, and they feel comfortable asking questions to better understand their health.
Poor communication can have the opposite effect. A study of 2,655 patients found that for these patients there were over 10,000 medication changes at hospital discharge, one in four of which was not followed. Why are such a high number of medication changes not followed? Maybe the patient didn’t understand the directions, maybe the prescription was sent to the wrong pharmacy, maybe the patient can’t afford the medication. Whatever the reason, better communication in healthcare can help the clinicians understand the problem and work to address it, so that patients can be confident that they know how to continue their care after discharge.
Communication among clinicians can also impact patient care experiences. If a patient is told by the resident physician that they can go home at noon, and then a nurse says they haven’t heard anything about a discharge, and then the attending physician comes in and says the patient needs to stay one more night for observation, the patient will be understandably frustrated. It is clear when the clinicians are not all on the same page about the care plan, and this can negatively impact the patient experience and outcomes.
CareAlign can improve clinician-patient communication by giving clinicians clear healthcare data visualization that they can show patients to help them better understand their health. Visuals can help patients take abstract and confusing concepts and turn them into something the patient at least has a basic understanding of.
CareAlign also improves clinician to clinician communication with the real-time updates to the patient note and task management that allows clinicians to list tasks that need to be done, assign tasks to others, and mark when tasks are completed. This keeps everyone on the same page and able to give the patient the same answer to a question since all the information is available to the entire care team.
Rural hospitals face unique and exacerbated obstacles compared to hospitals in metropolitan areas. People in rural areas are older, have less money, have more chronic conditions, are less likely to have health insurance, and have less access to healthcare facilities (and transportation to get there). Even before the COVID-19 pandemic began, rural hospitals had difficulties recruiting and retaining all types of clinicians.
Telemedicine has the potential to be a game-changer for rural health. Telemedicine would allow patients to stay in their home and get care, which could combat difficulties with distance to care facilities and issues with transportation. Telemedicine can give patients access to specialists that are not in the area, and can allow local clinicians to get consultations from specialists when their care facilities do not have specialists in that field. With telemedicine, an emergency medicine clinician can get a video consultation from an endocrinologist 200 miles away in just minutes, with the specialist able to see the patient and patient information. This enhanced collaboration is often not possible in the rural facility itself, which cannot afford to have a high number of specialists on site. Telemedicine can greatly improve access to care and the specialist knowledge for rural residents.
The biggest obstacle for telemedicine in rural areas is not the lack of technology, but the lack of internet access. It’s estimated that around 42 million Americans lack access to broadband internet. And in 2018, approximately 22.3% of rural residents and 27.7% of Americans in tribal areas did not have access to broadband internet that met the minimum speed benchmark set by the Federal Communication Commission, making telemedicine visits unrealistic. Addressing the problems of internet access are a top priority, because technology has the potential to vastly improve care in rural areas.
After addressing issues with broadband access, it is important for organizations to have appropriate tools for clinicians to communicate when they are not in the same location. CareAlign’s shared patient wiki allows clinicians from all over to collaborate on a patient and see each other’s notes in real time, making it almost like they are both in the same physical location, even when they are hundreds of miles apart.
Impacts of COVID-19 on Acute Care
COVID-19 has caused a lot of things to change in healthcare. It has exacerbated stress, mental health problems, and burnout for clinicians, in turn exacerbating clinician shortages. The impact of this may linger for years to come.
COVID-19 has also proliferated telehealth and home care. Some hospitals now offer hospital at home services for stable patients, where the patient has remote patient monitoring devices and clinicians scheduled to check on the patient at set intervals.The idea is to reduce readmissions and issues in care transitions while creating space at the hospital for emergencies. Additionally, telehealth allows clinicians to work remotely and still see patients, and allows clinicians to have specialists provide consultations virtually if the specialist cannot get to the physical hospital.
Because of the increase in telemedicine and home care use, there are more clinicians working in multiple locations. While this can be great in terms of flexibility and increasing access for patients, it can make it more difficult for clinicians to collaborate with the rest of the care team.
Technology can help teams communicate even when they are not in the same place. CareAlign is available on any device with internet access, so clinicians can use the platform regardless of their location. Clinicians can provide updated notes to the patient chart before finalizing the official note in the EHR, allowing all other clinicians on the care team to view the note and adjust their actions accordingly. The task module allows clinicians to assign tasks to specific team members and assign dates and times for the tasks to be completed. This way, even when clinicians are not seeing each other in person, they can clearly communicate important information about what needs to be done for the patient’s care. As care continues to become better designed for the patient, hospitals need to ensure clinicians have the proper tools to communicate in an increasingly more technical field.