Nurse call systems have always acted as a simple but essential alert service in hospitals, even when they consisted only of coded alert flags or colored lights outside of patient rooms. But as technology evolves to adopt Internet protocol networking standards, call systems are becoming part of a sophisticated communications infrastructure that not only connects patients with nurses, but also pushes information from electronic health records and hospital information systems to mobile devices.
Despite the potential, newer call systems require careful up-front evaluation by hospitals to make sure the package under consideration is mature and reliable. Arkansas Children’s Hospital, Little Rock, is evaluating IP-based nurse call system technology for use in a $115 million addition. Among questions staff members ponder as they sit in on a series of vendor product demonstrations is how well each company may be able to satisfy a combination of clinical and technical needs.
“At the end of the day, nurses just want to provide care,” says Lori McCauley, director of telecommunications. “We also have to make sure [the system] is backward compatible with the current core systems we have in our telephony and IT infrastructures.”
A Smarter System
Part of the attraction of IP-based call systems, from vendors such as Dukane Healthcare Communication (now part of GE Security), Intego Systems and Rauland-Borg Corp., is the ability to enhance the simple nurse-alert capabilities of traditional systems by linking to clinical applications.
In addition to integrating nurse call systems with a hospital information system, hospitals can connect them with pocket pagers, voice over Internet protocol telephones, radio-frequency identification tags, and a host of other wireless devices that accommodate the mobile information needs of nurses, says Lori Dickinson, senior technical account manager with Vocera Communications.
Centralization can make call triaging more efficient, says Joe Hill, director of sales and marketing for Intego Systems. Alerts may be routed to a nurses’ station for a clinician to evaluate and forward as necessary to a caregiver, technician, clinical aide or housekeeper.
“Sixty-plus percent of all of the calls that come out of a patient’s room have nothing to do with the caregiver,” Hill says. Without effective triaging, nurses may respond to alerts only to find the patient requires something like more ice chips or assistance turning on the television.
For requests that need a clinician’s attention, an IP-based call system can send detailed messages to a nurse’s mobile device. For example, the message may note that the patient requires pain medication, and thanks to links to the EHR, it may also remind the nurse of the appropriate drug and dosage, says Tom Leonidas Jr., vice president and health care practice leader for the consultant Sparling.
Interfaces Increase Cost
Cost is one of the key factors that influence when or if a hospital should move to an IP-based call system. Prices vary widely, depending on the call-system options a hospital chooses, Leonidas says. An organization should budget about $3,500 per bed for a basic IP-based system, but the price could rise to $7,500 per bed or more when capabilities such as interfacing with pocket pagers or wireless phones are added, he says.
Hospitals that anticipate integrating an IP-based call system with clinical applications should also identify whether the vendor offers pre-built interfaces to easily connect the two systems. Because of their relative newness to the market, many call systems don’t have a wide variety of such interfaces, which require IT resources to create custom connections, Leonidas says.
Ongoing Support Needed
During its selection process, Arkansas Children’s invited five nurse-call vendors to make presentations to a group of staff members from IT, telecommunications, nursing and other relevant areas. After some initial presentations, McCauley says she sees similarities among the products, with some notable differences in their user interfaces. “Some are easier on the eyes than others,” she notes.
Rod Smith, director of information technology at the hospital, is concerned about vaporware—products that never seem to emerge from development to actual delivery despite a company’s promises. “Some companies seem like they may be a little bit more advanced in their technology. Others are saying, ‘This [feature] will be available at this point in time,’ ” he says.
To avoid vaporware, the hospital plans to visit reference sites and perform test drives in its internal lab. “We never buy anything before we try it out,” Smith says.
Leonidas warns that hospitals need to consider one other factor before signing the check: ongoing service quality and availability. “Where the rubber really hits the road once you buy the system is whether there’s support locally once the contractor is gone,” he says. “I’ve seen hospitals put in a new nurse call system and later pull it out because they couldn’t get somebody out to the site to fix it.”
Alan Joch is a freelance writer in New Hampshire.