OTA 2006 Posters

Scientific Poster #112 Injury Prevention

The Use of Six Sigma Methodology to Improve Communication between Orthopaedic Floor Nurses and Orthopaedic Surgeons:
Direct Cellular, Bluetooth versus Indirect Floor Intercom Communication: A Prospective, Randomized Comparison
Gil R. Ortega, MD, MPH1 (*); Sudeep Taksali, MD2 (*);
Ryan Smart, MD2 (*); Michael R. Baumgaertner, MD2 (*);
1University of Texas Southwestern Medical Center, Department of Orthopaedic Surgery, Dallas, Texas, USA;
2Yale University Department of Orthopaedics,
New Haven, Connecticut, USA

Background: Cellular phone use within the hospital setting has increased as physicians, nurses, and ancillary staff incorporate wireless technologies in improving efficiencies, cost, and high quality health care. In their review of wireless equipment in hospitals, the American Medical Association recognized the value of mobile phone technology in healthcare. Six Sigma utilizes a systematic method for perfecting the output of an organization by improving the quality of the system. We decided to use Six Sigma methodology to address our orthopaedic surgeon and orthopaedic floor nurse communication.

Hypothesis: Wireless, cellular Bluetooth communication improves communication between orthopaedic surgeons and floor nurses and minimizes patient care interruption when compared to standard floor intercom communication.

Methods: Through the use of Six Sigma methodology, we used the DMAIC (Define, Measure, Analyze, Improve, and Control) model to gain a quantitative and qualitative perspective relating to our orthopaedic surgeon and nurse communication. The orthopaedic surgeon to nurse communication study occurred while the nurse was actively involved with patient care. Indirect communication occurred by having the surgeon call the hospital floor associate's desk and asking to speak with the nurse. Direct communication occurred by having the nurse communicate with the surgeon by cellular phone and Jabra® Bluetooth, wireless ear piece. The floor nurse answered the surgeon's cellular call by phone ring-activated automatic answering. The study was conducted during peak working hours. An independent observer measured time variables with a stopwatch while the orthopaedic surgeons randomly called via floor intercom system or cell phone. The surgeons asked for patient caregiver confirmation and answers to 30 different patient care questions.

Results: 60 trials were performed with 30 direct, cell and 30 indirect, page communications. Cellular communications showed statistically significant improvements in mean time intervals in response time (Cell = 9 sec, Page = 224 sec) and total communication time (Cell = 28 sec, Page = 241 sec) (all P <0.001). Correct patient identification (Cell = 6 sec, Page = 25 sec) and patient problem and solution time (Cell = 10 sec, Page = 30 sec) did not show any statistically significant differences. Nurse satisfaction ratings were improved with direct cellular communication (Cell = 24 excellent, Page = 6 excellent, Cell = 4 acceptable, Page = 11 acceptable, Cell = 2 unacceptable, Page = 13 unacceptable). Patient care interruptions (defined as interruption with active patient care) were more frequent with indirect page communication 96% (27/28) page vs. 7% (2/27) cell. There were 5 total instances when the nurse participating in the study was not actively involved in patient care.

Conclusion/Significance: Our study demonstrates that Six Sigma methodology may be used to evaluate and improve physician and nurse communication. We hope to transition to direct wireless, cellular orthopaedic communication to reduce medical errors, improve patient care, and enhance both orthopaedic surgeon and nursing efficiencies.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
· The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an "off label" use). · · FDA information not available at time of printing.