Title: Wireless Documentation and Paging Using Speech Recognition in Long Term and Acute Care
1Wireless Documentation and Paging Using Speech
Recognition in Long Term and Acute Care
Marta DePaul, MBA Debra Wolf, RN, MSN,
PhD October 31, 2008
2Analysis of Process Issues
- Manual
- Documentation
- Orders
- Data entry
- Plan of Care
- Coordination of Care
- Intrateam communication
- Missing-medications
- Safety
- Equipment failure
- Errors
- Duplicate information
- Patient Education
- Pharmacy Staffing
3Analysis of Process Issues
- Manual
- Documentation
- Orders
- Data entry
- Plan of Care
- Coordination of Care
- Intrateam communication
- Missing-medications
- Safety
- Equipment failure
- Errors
- Duplicate information
- Patient Education
- Pharmacy Staffing
4Technology Solutions
Technology Solutions - Desired Functionality of
Systems and Devices
- Voice activated
- Bedside
- Wireless
- Biometrics
- Handheld
- Integrated
- Global accessibility
5Technology Solutions
Technology Solutions - Desired Functionality of
Systems and Devices
- Voice activated
- Bedside
- Wireless
- Biometrics
- Handheld
- Integrated
- Global accessibility
6Care staff wear light-weight headsets and
communication devices. Throughout the shift,
they access the latest care plan and use verbal
cues for documentation.
Charge Nurse enters residents care plans into
AccuNurse intranet site. AccuNurse converts care
plans into easy-to-follow voice messages.
AccuNurse converts responses into text and the
information is updated in the AccuNurse database.
Nurses can view completed tasks and reports in
real-time.
As care is completed, care staff tell
AccuNurse so documentation is completed at the
point-of-care.
7AccuNurse in Action
Staff multi-task while recording activities
What was the of meal eaten?
50. Say the fluid intake in ccs.
240
Which meal?
Meal done
Breakfast
240
50
8Why AccuNurse outperforms paper
Example Identifying residents who did not have a
BM in last three days
Find all ADL books for analysis (5 minutes)
Review each record for no BM in last 3
days (1 minute per resident)
Create list of residents requiring
intervention (5 minutes)
Based on a 60 bed unit and completed daily 75
minutes/day to manage this report 525
minutes/week 8.75 hours/week 455 hours/year x
RN rate of 22.50/hour 10,237
Log into AccuNurse (2 seconds)
Select unit reports (2 seconds)
Select unit reports - BM (2 seconds)
BM report for entire unit (5 seconds)
Analyze report (15 seconds)
Select last 3 days (4 seconds)
30 seconds
Based on a 60 bed unit and completed daily 0.5
minutes/day to manage this report 3.5
minutes/week 3 hours/year x RN rate of
22.50/hour 67.50
9Comparing Paper to Voice-Assisted Care(60 bed
unit)
- Report Paper AccuNurse
- Ensure documentation is complete 10,238 585
- BM for 3 days 10,237 68
- Documentation of I/O 7,917 1,399
- Skin observation 5,148 355
- Documentation of vital signs 1,943 641
- Unit meal intake 1,260 11
- Intake output (I/O) 540 11
- Unit weight 180 1
- 37,463 3,071
From a human resources perspective, paper is more
than 10x the cost of AccuNurse
Source 3 facilities using AccuNurse
Voice-Assisted Care
10Comparing Paper to Voice-Assisted Care(120 bed
unit)
- Report Paper AccuNurse
- Ensure documentation is complete 20,476 1,170
- BM for 3 days 20,474 136
- Documentation of I/O 15,834 2,798
- Skin observation 10,296 710
- Documentation of vital signs 3,886 1,282
- Unit meal intake 2,520 22
- Intake output (I/O) 1,080 22
- Unit weight 360 2
- 74,926 6,142
From a human resources perspective, paper is more
than 10x the cost of AccuNurse
Source 3 facilities using AccuNurse
Voice-Assisted Care
11UPMC Senior Communities Seneca Place
- Direct influence on turnover in 90 days
- 74 decline in LPN turnover
- 40 decline in CNA turnover
- Reimbursements increased
- Medicaid is up 9 over last year
- Medicare is up 4.5 over last year
- Reduced time spent generating reports 95
- Reduced time spent searching for staff 83
- Eliminated all CNA paperwork
- Quieter environment
- ROI in less than three months
When we reviewed the initial results, it became
apparent that quality of care and CMI improved as
well as a significant increase in staff
satisfaction. Theres little doubt that
voice-assisted care is a good investment that
fits UPMC Senior Communities corporate
vision. Jim Palmer Chief Operating Officer UPMC
Senior Communities
12UPMC Senior Communities - Cranberry
- CMI increased 1.37 to 1.46 or 4.6
- Medicare reimbursement increased 5
- Reduced time staff spends on generating reports
by 49 - Reduced time spent searching for others by 91
- Reduced high-risk residents with pressure ulcers
by 75 - Reduced short-stay residents with pressure ulcers
by 43
With AccuNurse, we can document and perform
other tasks at the same time, so it helps
tremendously with time management. Our team can
be out on the floor working, as opposed to
sitting or standing somewhere documenting. Jerry
Radaker, RN, DON UPMC Cranberry Place
13PUMH Cokesbury Village
- Replaced touch screens with voice-assisted care
- Results after just 90 days
- Reduced time for end-of-shift reporting by 30
minutes per CNA per shift - Significantly reduced nursing staff overtime
- Eliminated almost all CNA paperwork
- Improved survey results
Prior to AccuNurse, we had three overlapping
shifts of 8.5 hours each. That half-hour overlap
was used for CNAs to do their documentation and
reporting. But thats no longer needed. Theresa
Green, RN Quality Improvement/Staff Educator
14PUMH Manor House
- Reduced overtime by 35 for licensed nursing
staff and CNAs - Completely eliminated cumbersome paperwork
- Improved state survey and insurance assessment
results - Improved quality indicators by decreasing the
prevalence of weight loss in residents from 15.9
to 0 - Warmly received by staff, residents and families
With AccuNurse, you walk and work constantly
and that means better care for residents,
improved productivity and efficiency for our
staff and better accuracy in documentation for
our facility. In this industry, thats a
significant trifecta win. Scott Fenton, RN.
Director of Health Services, PUMH Manor House
15PUMH Country House
- Successfully challenged a G-tag citation with
AccuNurse documentation and won the appeal - Reduced overtime
- 70 for LPNs
- 64 for RNs
- 10 for CNAs
- Reduced turnover for all nursing functions by 19
- Cut dietitians paperwork over 35
AccuNurse helped me stand my ground and be
successful in our survey citation dispute.
Without the impressive presentation and thorough
documentation, the surveyors would be left to
question the care that had been delivered.
AccuNurse paid for itself right then and there.
Kim Drake, RN. Director of Health Services, PUMH
Country House
16Evangelical Manor
- 2 units, 120 bed facility
- Old process
- Overhead page or search for someone
- If no response to the first page, they paged
again - Integrated with Nurse Call system and eliminated
overhead paging - In 14 days AccuNurse processed over 2200 nurse
calls automatically
We respond 50 faster to resident needs
Suzanne Lachman Director of Long-Term
Care Wesley Enhanced Living
17Church of God Home
- Improved CMI from 1.27 to 1.34 in 7 months
- increase from CMI improvement 105,000
- Reduced licensed staff and CNA overtime 24,000
- Reduced time spent calling and searching for
staff by 75 - Eliminated virtually all CNA paperwork
- Reduced time spent by CNAs on end-of-shift
reporting - Zero deficiencies on last state survey
We have achieved every one of our objectives. On
the reimbursement side, we saw our case mix index
increase from 1.27 to 1.34 in just seven
months. Carson G. Ritchie President and
CEO Church of God Home, Inc.
18NIA Case Study Kendal at Longwood
- 7 reduction in total labor hours
- Reduced CNA paperwork
- Reduced nurse overtime
- Less searching for assistance
- Annual labor savings of 158K
- ROI in 7 months
With AccuNurse, our staff is spending less time
on paperwork, documentation and chasing down
staff and spending more time with
residents. Rich Lysle Executive Director Kendal
at Longwood
19Current Clients
Nicholas County Nursing Home
Knox County Nursing Home
20Research
- Background research
- Three group interviews
- Shadowing
- Workflow Analysis
- Alpha Trial at University of Maryland School of
Nursings Simulation Laboratories
21Acute Care Projected Benefits
- Reduce
- Documentation time
- Response time for pages
- Infection/Pneumonia/Pressure Ulcer rate
- End-of-shift reporting time
- Time spent searching for staff
- Time spent generating reports
- Time between care and documentation
- Increase
- Accuracy of documentation
- Compliance with policies
- Nurse satisfaction
- Patient satisfaction
22Butler Memorial Hospital
- 75 reduction in documentation time
- Eliminates time spent coordinating tasks before
shift - 90 reduction in time spent searching for page
information - 100 compliance on patient verification
23Questions
- Thank you! For further information, visit us at
- http//healthcare.vocollect.com
- Debra M. Wolf, PHD, RN
- Debra.wolf_at_sru.edu
- 412-298-9578
Marta DePaul, MBA mdepaul_at_vocollect.com 412-829-8
145 x1232