Improving patient experience and coordination of care between the patient, their family members and staff is top-of-mind for stewards leading healthcare through these tumultuous times. However, finding effective ways to accomplish great communication is easier said than done. For years, dry-erase whiteboards have been used at the bedside and are the source of great frustration for nursing staff, nursing leadership, hospital administrators and patients. Each stakeholder has different reasons for their frustrations. Why? Because the whiteboards have failed to live up to what they were designed to accomplish. This communication breakdown cascades throughout the entire healthcare system, causing patient and staff frustration while contributing to medical errors and falls, negatively impacting patient safety and the hospital’s bottom line.
This communication breakdown cascades throughout the entire healthcare system, causing patient and staff frustration while contributing to medical errors and falls, negatively impacting patient safety and the hospital’s bottom line.
In May of 2016, a report was released by The University of San Francisco USF Scholarship: a digital repository @ Gleeson Library – Geschke Center. The report is entitled “The use of personalized whiteboards in the inpatient acute care setting and their effect on patient and nurses perception of communication (1).“
The report identified the dry-erase whiteboard as the solution to lack of communication at the bedside. It says, “that any member of the interdisciplinary team may write on [the whiteboard] to relay information about the treatment plan and the nurse can update as needed [and it] is an important tool to improve communication, increase patient safety, and improve patient outcomes.” The proposed benefits for patient room communication boards are noted when it says that, “nurses, physicians, therapists, and patients are all able to refer back to the whiteboard to understand the treatment plan and what to expect next.”
Four-month analysis showed a decrease in scores. “The decrease in scores may be attributed to several factors…”
Two months into the whiteboard study, an analysis of the Press Ganey surveys were performed and the team did in fact notice an increase in performance scores. However, the four-month analysis showed a decrease in scores. “The decrease in scores may be attributed to several factors,” notes the report. “Discussion regarding the use of the [patient whiteboards] slowed down after initial implementation and may have contributed to decreased compliance with use.” Lack of time and pressure from management usually results in lack of compliance with the whiteboards. According to the study, “oftentimes the nurses reported they did not have adequate time to complete the [patient whiteboards] or they did not have adequate resources (i.e., dry-erase markers or erasers).” These results are consistent with the report entitled “Patient Whiteboards as a Communication Tool in the Hospital Setting: A Survey of Practices and Recommendations, (2)” prepared by the Journal of Hospital Medicine. It reports that the number one reason why dry-erase boards at the bedside are not filled out in their entirety is the dry-erase marker. It was reported that “the greatest barrier to using whiteboards was not having pens easily available.” Both studies are in agreement with each other.
Aside from the Press Ganey scores, surveys were performed with staff and patients, delivering evidence-based outcomes to prove that positive results were experienced with this form of communication.
80 percent of patients answered “yes” to the question “do you think the dry erase board (PW) makes it easier to communicate with other members of your treatment team (i.e., nurses, therapists, etc.)?”.
The results from the surveys were positive. They “revealed that 80 percent of patients answered “yes” to the question “do you think the dry erase board (PW) makes it easier to communicate with other members of your treatment team (i.e., nurses, therapists, etc.)?”. The results from 3B North revealed that 75 percent of patients answered “yes” to this question as well. This information is very important in the implementation of the [patient whiteboards], as it shows that patients are engaged in the use of the [patient whiteboards] and that they see the value in their use.”
The report goes on to say that, “the expected results of this project are that patients will report improved perceptions of communication with the implementation of the [patient whiteboards]. As patients and their families begin to see the value in the [patient whiteboards], they will request for them to be updated and the nurses will then begin to see their value as well.” Many will agree that placing the responsibility on the patient and their family to ask for the board to be filled out takes away from the patient experience and will not contribute to consistency and reliability.
As a result, the following SWOT analysis was derived.
(Figure 1 – SWOT Analysis, The use of personalized whiteboards in the inpatient acute care setting and their effect on patient and nurses perception of communication, Cheryl Karn, University of San Francisco, chereal8@gmail.com, Appendix H, pg 31)
Can digital patient whiteboards satisfy the weakness and threat sections of the SWOT analysis?
We will proceed to evaluate each weakness and threat in the chart and, with digital patient room whiteboards, explain proven reasons how the weaknesses and threats can be satisfied and how digital patient whiteboards reinforce the strengths and the opportunities with proven concepts.
Strengths Reinforced with Digital Patient Room Whiteboards
Keep patients informed of treatment plan – Similar to a dry-erase board with a template layout, digital patient room whiteboards display the patient’s information in an organized way, making it easy for the patients to understand their care. The information is displayed with clean and easy-to-read typeface, as compared to handwriting on a dry-erase board.
Encourage patient to be active participant in care planning – With digital technology, nursing acronyms for mobility statuses, diets, NPO and other clinical terms used by healthcare professionals can be simplified on the digital whiteboards to enable the patients and their families to fully understand their care, putting them in a position to support coordination of care initiatives and to actively participate in their care planning.
Weaknesses Solved with Digital Patient Room Whiteboards
Staff time required to utilize whiteboards – Digital whiteboards gather their information automatically from the EHR. With full EHR integration, as nurses document into the patient’s chart, the digital boards display the most current data without distracting the nurses from what is most important: the patient and their care.
Seen as an additional duty for the nurses – Digital whiteboards actually give back to the staff. Along with being easy to use, digital patient room whiteboards completely remove a wieldy, wasteful and outdated workflow from nurses; refocusing their time from writing on the whiteboards to the patient and their family members.
Improve nurse communication scores by up to 11 points, physician communication scores by up to 9 points, pain control scores by up to 10 points, and overall hospital ratings by up to 17 points, and have been proven to be sustainable over time.
Opportunities that Digital Whiteboards Bring to the Healthcare System
Increased patient satisfaction scores – Digital patient room whiteboards have been proven to improve nurse communication scores by up to 11 points, physician communication scores by up to 9 points, pain control scores by up to 10 points, and overall hospital ratings by up to 17 points, and have been proven to be sustainable over time.
Improved patient safety – By simply and clearly displaying the patient’s fall risk and mobility status, patient safety is reinforced. Additionally, connecting digital patient room whiteboards to smart beds can augment patient safety strategies. For example, if the patient is a high fall risk, the digital patient whiteboards can detect their high fall risk mobility status in the EHR and in turn, detect all safety conflicts on the patient’s bed. The digital patient room whiteboard algorithms will determine if the bed is too high, if the rails are compliant, if the brake is engaged and if the bed alarm is turned on. The digital boards display visual alerts in the patient room and nurse station, as well as text the nurse on their phones, to notify them about all current safety conflicts.
Support of the patient-family centered care model – With information so plentiful and relevant, and displayed in such a convenient way, physicians and nurses can use the digital boards as a communication and educational aid during rounds and visits. The digital board is the central meeting place. Digital patient room whiteboards foster a culture of bedside handoff, as well as bedside GEMBA rounding.
Model for policy change in other hospitals – With automated workflows and safety augmentation, digital whiteboards focus staff on preventative measures, rather than just relying on reactionary methods. A culture of prevention is a model that can be adopted all over the health system now that tools such as digital patient room whiteboards exist.
Threats Eliminated by Digital Patient Room Whiteboards
Potential lack of nurse compliance, leading to complications – Most hospitals maintain a dry-erase whiteboard compliance rate between 30–60% for the reasons mentioned above, and complications occur, including medical errors, assisted falls and accidental NPO errors due to lack of compliance. Digital patient whiteboards raise the compliance rates to 100% and are easy to use for staff and patients.
Nurses’ labor time to fill out the dry-erase boards and to keep them updated, totaling over $600k in a five-year period per 25-bed unit (3).
Limited budget for production of permanent whiteboards and supplies – Dry-erase boards on average cost $200 per room and must be replaced once every two years due to wear. It is expensive to have facilities replace the dry-erase boards each time. Markers and erasers are also a cost to consider. On average, each unit (of about 25 beds) consumes 24 dry-erase markers each month. Continual costs also include the nurses’ labor time to fill out the dry-erase boards and to keep them updated, totaling over $600k in a five-year period per 25-bed unit (3). While digital whiteboards may have an initial investment to shift the workload to automation technology, contrast that with using nurses to fill them out and the value of the investment becomes clear.
Conclusion
Dry-erase whiteboards have paved the way, proving that there is merit to utilizing bedside communication mediums. Digital patient room whiteboards are clearly the natural progression, shifting from good to great. When the benefits are combined, healthcare systems entering into 2017 would do well to consider implementing digital patient room whiteboards as a means to benefit from the time-cost savings, performance score improvements, patient safety improvements and overall communication improvements one could expect from stellar bedside communication strategies.
To learn more about MEDI+SIGN digital patient room whiteboards, visit us at www.medisigndisplays.com, or email us at sales@medisigndisplays.com.
1. http://repository.usfca.edu/cgi/viewcontent.cgi?article=1324&context=capstone
2. http://hospitalmedicine.ucsf.edu/downloads/patient_whiteboards_as_a_communication_tool_in_the_hospital_setting_jhm.pdf
3. To read the full Financial Impact Report for MEDI+SIGN digital patient room whiteboards, request your copy at sales@medisigndisplays.com