OVERVIEWThe value of communication and collaboration among clinicians in the hospital setting is widely recognized, yet rarely realized. To improve such processes, Marin General Hospital has implemented the nation’s first Mobile Care Navigation Network™, which enables clinicians to effectively communicate at crucial care moments.

CLIENTAs the only full-service acute care hospital in the county, Marin General Hospital in Greenbrae, Calif., is committed to providing quality health programs and services that result in superior outcomes to the citizens of the community. Established in 1952 and owned by the Marin Healthcare District, the hospital offers a variety of services, including labor and delivery, cancer care, comprehensive heart and vascular care, trauma services, inpatient pediatrics, and much more.

CHALLENGE“Providing the best care possible in the most efficient manner”: It’s a monster of a challenge that hospitals have been wrestling with for years, regardless of reimbursement or governance model. Marin General Hospital was no exception.

Leaders at Marin General Hospital wanted to finally tame the beast. They realized that if all of the hospital’s disparate clinicians came together and delivered care based on a coordinated plan, while also leaning on evidence-based best practices at each juncture, quality and efficiency would likely improve. But there was one big roadblock making it difficult to go from A to B: Clinicians needed a better means of communication to bring this vision to fruition.

“Our clinicians and staff members are constantly on the move, tending to patient needs,” says Mark Zielazinski, CIO at Marin General Hospital. “We knew that they needed to find a way to communicate efficiently to truly coordinate care. Bringing all interested professionals together at the precise, care-crucial moment could help us deliver exactly what patients needed. But we also realized that doing what it takes might turn out to be a lot easier said than done.”

“ZynxCarebook has broken down

barriers to communication and has

served to flatten the communication

hierarchy. Streamlining these

communications contributes to

enhanced patient safety.”

— Sharon Reid, RN, a case manager

at Marin General Hospital.

MARIN GENERAL HOSPITAL CASE STUDY

IMPROVING COMMUNICATION AND COLLABORATION WITH CONTEXT-SPECIFIC SECURE MESSAGING

• 22% reduction in

readmissions

• 18% improvement

in HCAHPS care

transition scores

• 0.5-day reduction in

average LOS

• 65% drop in pager

interruptions

• 68% improvement in care

team communication

Communication and collaboration in the healthcare setting presents many challenges. Team members are rarely in the same location, making communication a logistical nightmare. As a result, to plan and execute a patient’s course of treatment, team members often have to sift through notes in the electronic health record (EHR), wait until rounds to connect with other clinicians, or try to gather input from others via traditional phone and paging technologies.

Complicating matters was the fact that caregivers were often working with limited information. They often didn’t even know who was on their team, when patients were admitted, or when discharges were scheduled. Even when clinicians did have such information, communication was strained. For example, if there was a question about medications, the nurse typically had to call the pharmacy, find the right pharmacist who was covering the floor, wait to talk to that pharmacist, or leave a message and wait for a call back.

Hospital discharge scenarios were even worse, as this often involved many disciplines struggling to connect and exchange information via a cascade of pages and phone calls (sometimes as many as 40-50), scattered post-it notes, and ad hoc hallway conversations. The situation at Marin General Hospital was not unique; according to research published by the Robert Wood Johnson Foundation, nurses waste an average of 1 hour per day just trying to track down physicians.

However, Marin General Hospital leaders wanted to find a way for care team members to communicate effectively. Unfortunately, relying on traditional devices such as phones and pagers often resulted in frustrating rounds of “hurry-up-and-wait.” In addition, existing information technology systems, such as EHRs, were doing little to support real-time communication. Although an EHR can help caregivers quickly assess a patient’s history, the technology does not help caregivers connect with others to deliver evidence-based care on the spot.

SOLUTIONTo solve the problem, the hospital needed to enable clinicians to connect with each other in real time and to share actionable information during the process.

“That’s not an easy proposition, as we are dealing with an extremely mobile staff and with personal health information that needs to be protected in an iron-clad way,” Zielazinski says.

Text messaging via smart phones and other hand-held devices emerged as a potential alternative. But garden-variety short message service (SMS) texting would not fit the bill. The hospital needed a texting solution that would meet the physical security, encryption, authentication, and audit requirements necessary for HIPAA compliance.

In addition, clinicians did not want to merely pass along static messages, but rather, valuable context-specific information that would enable clinicians to take action at the point of care.

To facilitate this advanced communication, the hospital selected ZynxCarebook, a real-time, secure, mobile care navigation platform that improves patient care by enhancing communications between care providers, while also providing access to evidence-based, context-specific content at crucial care moments. The platform is helping Marin General Hospital quickly form patient-centered care teams, communicate securely and efficiently, collaborate on evidence-based care and transition plans, and direct patient care post-discharge.

More specifically, the tool creates a “virtual huddle,” enabling team members to communicate in real time. Instead of the typical care coordination and discharge scenario, which includes many “errant passes” and “fumbles,” this solution brings all involved parties together precisely when needed.

As a result, Marin General Hospital care providers are now able to collaboratively risk-stratify patients, apply patient-specific interventions, and leverage evidence-based best practices. In fact, with the nation’s first mobile care navigation network in place, the inpatient care team is able to “pick up” patients upon admission and form patient-specific teams around those patients. Once the care team is formed, they collaboratively and proactively assess patient risks, and apply Project RED® and other best practices using dynamic checklists as they coordinate the transition for their patients. Based on a patient’s specific needs and barriers to discharge, the team uses the tool to “invite” other hospital staff, or even aftercare providers, such as coaches from surrounding community organizations, to join that particular care team and collaborate on the discharge plan.

“I love being able to instantly communicate a patient’s discharge plan to the rest of the team and not chase one person at a time. It helps the team plan our day and respond immediately to incomplete issues such as discharge MAR, transportation arrangements, and hospice being set up,” says Sharon Reid, RN, a case manager at Marin General Hospital. “ZynxCarebook has broken down barriers to communication and has served to flatten the communication hierarchy. Streamlining these communications contributes to enhanced patient safety.”

RESULTSAfter using the ZynxCarebook mobile communications solution for just 6 months, care communication, quality processes, and efficiency measures have shown significant improvement.

For example, after implementing ZynxCarebook, 7 of 10 staff members said that they could “easily determine the names of all care team members for my patients,” whereas only 3 in 10 could do so before the intervention. What’s more, after the technology implementation, more than 70 percent said they could “easily or efficiently contact all members of my patient’s care team to notify them about changes to the discharge plans,” compared to only about 10 percent before the intervention. Overall the organization realized a 68 percent improvement in care team communication.

In addition, physicians have observed time savings related to a 65 percent drop in pager interruptions by secure texting via the mobile network.

Perhaps most importantly, Marin General Hospital has documented improvements in the following outcomes:

• A 22 percent reduction in readmissions

• An 18 percent improvement in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) care transition scores

• A 0.5-day reduction in average length of stay for patients 65 years old and over

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