Case Study: Valley Health – Winchester Medical Center: Using Automation to Improve Patient Care by Monitoring Pain Pathwaysal Center

By Laura Alt LaLuzerne

Valley Health is a not-for-profit organization serving the healthcare needs of residents in Virginia, West Virginia, and Maryland. Valley Health provides outstanding care to their patients through a system of six hospitals and related facilities, offering patients convenient care that is close to home. One of the Valley Health locations is Winchester Medical Center, a 411-bed Level II Trauma Center located in Winchester, Virginia. Winchester Medical Center is a resource for 400,000 residents, offering diagnostic, medical, surgical, and rehabilitative care, along with advanced critical care services in heart, neurosurgery, oncology, trauma, and neonatal care.

A Unique Approach: Helping patients manage their pain is important to every healthcare facility. Being able to monitor and record each patient’s pain level on an ongoing basis can be challenging, as it takes a large amount of a nurse’s time. According to Lorraine Leake, director of the transfer center and communications at Valley Health, the ongoing charting “takes away time from the patient, so anything we can do to help the nurse, so they are doing more bedside, that is our goal.”

Integrating Two Systems: Leake looked at the various systems available in their facility, trying to find a way to make it easier for the nurses to monitor pain levels. The facility’s call center system streamlines enterprise-wide communications by providing patient room information and on-call scheduling information. A separate system allows patients to enter their pain level with their TV remote control. Leake began working on a plan to get the two systems to work together. Lorraine presented her ideas on merging the data in these systems to the respective vendors, 1Call and GetWellNetwork. The two companies then worked together to integrate the two systems.

How the Pain Pathway Process Works: To start the pain pathway process, a nurse scans a medication given to a patient. Fifty minutes later, the patient is asked on their television to rate their current pain level on a scale of 0 (low) to 10 (high). The result is sent from the GetWellNetwork to 1Call’s on-call scheduling module, which keeps track of the nurse responsible for that patient’s room and pages the appropriate nurse with the result.

Impressive Results: The integration of the two systems was implemented in November 2009. “It is used in every inpatient area, except for the critical care area. It is on 335 beds out of our 411,” Leake stated. Early results showed a 48% average response rate from patients. A time study revealed that checking on a patient takes a nurse nine minutes. Susan Clark, RN clinical manager for the Float Pool at Valley Health, commented, “For a pain scale of 0 to 3, when the nurse doesn’t have to do anything since the patient’s pain is being controlled, it saved 69,066 minutes in a two-month period, which turns out to be 1,151 hours. For a pain scale rating from 4 to 10, where the nurse would have to do something, it saved 74,988 minutes, basically 1,249 hours within a two-month period.”

Meeting Joint Commission Standards: During a recent visit, the Joint Commission staff was impressed with how the pain pathway was set up at Valley Health. The Joint Commission would like all healthcare facilities to have 100% documentation of pain scores. Valley Health’s scores were “originally around 59% and went up to 89% in documentation with the pain pathway. The scores have gone up to 92% with this system in place,” according to Leake. Valley Health quickly found out what an effective process this was. When the schedules for the nurses covering the patient rooms weren’t copied by several departments, the scores went down, giving them a way to prove that the pain pathway process is working.

Benefits of the Integration: Even though the process is automated, Valley Health still knows when something isn’t functioning exactly as they would expect it to. If a patient doesn’t respond to the pain level request, perhaps because their television is off or the patient was asleep, the nurse receives a page that the patient did not respond so the nurse can go check up on that patient.

Although there were mixed reactions to this new process among the nurses – with some of them loving it and some not liking the many pages that they receive – the benefits for the nurses make it a very worthwhile process. “They don’t have to go to the patient’s room, then get the medications, and then go back again. They are there one time, and that saves them a lot of steps,” said Leake.

Fine-Tuning the Process: At first, Valley Health wasn’t planning to use this system in the pediatrics department because they were worried the kids wouldn’t understand it or think it was a game. The pediatric nurses, on the other hand, wanted to have this available for their patients. When it was implemented, it worked very well.

Red Alert Integration: Valley Health also uses an alert notification system. “We are sending reminders out through Red Alert every so many hours, reminding the nurses ‘to chart your medications,’” Leake said.

Clark added, “That has brought up scores on some of the floors that are very busy and always turning over beds and patients.”

Future Plans: This process is currently used with the alphanumeric pagers that the nurses carry, “but our system is set up to send a page to a BlackBerry®, or a cell phone, or any device,” Leake stated. Also in the future, Valley Health plans to use this process to page nurses when patients have finished watching a video or completed educational materials about a particular medication. “We are trying to improve our patient satisfaction scores, our HCAP scores,” Clark commented.

Laura Alt LaLuzerne has worked in the telecommunications industry since 1987. She has also worked as a training specialist traveling throughout the U.S. and Canada, a documentation writer, and is currently the 1Call marketing coordinator. You can reach Laura at 800-225-6035 or laura@amtelco.com.

[From the August/September 2011 issue of AnswerStat magazine]