When you mention electronic medical records to some physicians you get mixed responses. Some love them and some…well not so much. These tech heavy platforms promise to streamline workflows and reduce error with drop down menus, some degree of artificial intelligence in providing warnings when you stray too far from acceptable practice but for some who are not so tech savvy they are more of a pain. I have to admit I am in the camp of believing they are a good thing for patient care as I work in one centre with expanded EMR services and one without and I do find a number of benefits to working with a more robust EMR platform but I respect that not all do.
The cell phone on the other hand is everywhere and even the most tech fearful often carry one including most of the parents we care for. What caught my eye this month was the article by Globus O The use of short message services (SMS) to provide medical updating to parents in the NICU in which an EMR system is described that sends parents a text message at a pre-specified time regarding their infants condition. I had a visceral reaction at first thought thinking “would I want my cell phone number sent to families?”, “how much time out of the day would all of this take?” and to be a little old fashioned “can’t we just talk on the phone?”. I am sure there are many other questions that others would have as well. Having said that as I read through the paper I warmed to the concept and by the end questioned whether we could do the same!
It turns out the SMS message comes from the EMR and not the personal cell phone of the bedside nurse and is sent out at 9 AM each day. Each nurse requires only 30 seconds of their day to populate a few questions during the night shift and then the information goes out to the parents.
“The text message includes one-sentence prefaces and conclusions and provides updated information that includes the location of the infant’s crib (room and position), the infant’s current weight and whether medical procedures, such as head ultrasound, cardiac echocardiogram or eye examination, were performed. Information regarding acute events or deterioration of the infant’s medical condition are not included in the SMS, but are delivered personally to the parents in real time.”
This last sentence is important. The SMS service will not notify the family that their infant is receiving chest compressions but is there to give them “updates”. The sceptics out there will likely comment that this should be the job of both nursing and medicine to regularly update the families but thinking about it, how many parents are not there everyday and when they are out of sight how many physicians regularly call them to provide them updates? No doubt there are some but I would think they are not in the majority.
But is it effective?
The measurement in this case was through surveys of nursing and families both pre-implementation and afterwards. Provided in the table below are the scores (means +/- SD) in the pre and post implementation phases of the program.
|Statement||Pre-SMSi N=91||Post SMSi N=87||P-value|
|The physician was available when needed||4.1+/-0.9||4.4+/-0.7||0.002|
|The physician was patient in answering my questions||4.6+/-0.7||4.9 +/-0.4||0.002|
|I felt comfortable approaching the physicians||4.3+/-1.0||4.7+/-0.6||0.001|
|I felt comfortable approaching the nurses||4.4+/-0.8||4.6+/-0.6||0.02|
|I regularly received information from the physicians regarding my infant’s medical status||3.7+/-1.3||4.1+/-1.1||0.03|
These are some pretty powerful outcomes. The use of what many consider an impersonal form of communication (how many times have I looked at people texting furiously and thought JUST PICK UP THE PHONE!) actually appears to have improved the approachability of the staff in the unit and facilitated information transfer more easily.
One other important finding was that when surveyed pre-intervention staff were somewhat sceptical that this would help and moreover were concerned that it would interfere too much with work flow in the day. Evaluations afterwards did not support these fears and many felt it was an improvement. In the end the total time spent on this by nursing was estimated to be no more than 30 seconds of each day! From the parent’s standpoint they certainly saw this as an improvement.
At least in our centre we are moving slowly but steadily towards a fully functioning EMR. Will we have this capability in the software that we use? After reading this I hope so. I can see how receiving a daily morning message would prime the family to interact with staff on rounds. The added benefit is that by knowing that the information would be ready at 9 AM, families could be present with questions already formulated in their minds. How often do we encourage families to be on rounds and have them listen to a tremendous amount of information and then turn to them with the standard “any questions?”. While I am sure many of us try and explain matters in lay terms, giving parents a change to mull over the issues first could well enhance the interaction they have with our team in a meaningful way.
Time to look into whether this is possible…