The Cordless ED: Wireless Phones Can Improve Communication

New telecommunications technology can increase efficiency and improve communication in the ED by allowing direct access to nurses, physicians, technicians, consultants, even patients. Cordless pocket telephones can put an end to annoying delays caused by overhead paging systems, voice-mail, beepers, and "telephone tag."

Some EDs are finding that having clinical staff carry small wireless phones streamlines the communication process from many different angles. The phones are hooked up to the hospital's main system and do not incur air-time charges like traditional cellular phones. The cost varies depending on the system configuration, but the total cost is in the range of $1000-$1500 per phone, including the cost of the system.

Satisfaction ratings are a key selling point with administrators. "This is making us much more accessible, whether it's to EMS or returning telephone calls from medical staff members, so there are definite advantages from a customer service standpoint," says Thom A. Mayer, MD, FACEP, Chairman of the Department of Emergency Medicine at Fairfax Hospital in Falls Church, VA.

Here are some of the ways wireless telephones are used:

• Physicians and nurses. All of Fairfax's emergency physicians and charge nurses carry phones while on duty. "Initially, there was some resistance from some of our physicians to carrying phones around and being accessible, but there were clear advantages to doing it," says Mayer.

Physicians still go through the ED's secretary to make outgoing calls, but the process is facilitated. "When I ask the unit secretary to page Dr. Smith, I can go in and take care of a patient, and the call will come right into my phone number," says Mayer. "The hassle factor goes way down."

The physician can walk right outside the patient's room to take the call, instead of walking back to the phone area. "In the past, many times the doctor would have hung up by the time you got to the phone," says Mayer.

Every phone is used specifically for a certain job title. "We pass the phone on shift to shift, but the same extension is used for each title, such as the charge nurse, so they needed to get in the habit of carrying the right phone," says Deborah Royalty, RN, MED, CNA, the ED's patient care director. Some training was necessary to teach staff how to use the phones, including charging the batteries, she says.

The cordless phones also enable clinical staff to continue working while waiting for return phone calls. "If a physician is behind closed doors, staff doesn't have to scream for them, and if a physician is busy with a patient, he or she can hold the phone up to their ear so they can take a call," says Dotty Kuell, RN, BSN, assistant director of the ED at Moore Regional Hospital in Pinehurst, NC.

Physicians also appreciate the convenience of being able to dictate their notes over the phone from any location. "They can be at the view box and call and dictate anywhere in the department," says Kuell. "Also, when we're in the room and need to order meds, we can call from right there and tell the pharmacy what we need instead of leaving the patient's room to come out and call the pharmacy."

Phone numbers of the individual nurses and physicians currently on call are kept on a tracking board. "Each nurse and physician puts their phone number by his or her name, so if a phone call comes in, the secretary can transfer it to them directly," says Kuell.

• Dealing with MCOs. Wireless phones can decrease delays caused by numerous telephone calls to and from MCOs. "More and more, we have to talk with managed care plans with some version of, ‘Mother, may I see this patient?' or ‘Simon says you have to call this person before you do this,'" says Mayer. "It's much easier to have these phones available to do that."

• ED staff conversations. In Fairfax's 26,000 square foot ED, the phones facilitate communication between personnel who are often not in earshot of one another. "It has improved a whole host of intra-departmental communication, such as allowing a physician to talk to the charge nurse without walking around the department looking for [that person]," says Mayer.

Staff updates on ambulance-borne patients. Fairfax's ED has a separate communications room staffed by a nurse and a communications specialist. "When a call comes in from an ambulance telling us they're bringing in a 79-year-old with congestive heart failure, the charge nurse is called," says Royalty. If the nurse can't answer the phone immediately, the call rolls over to the secretary's desk. The phones provide a direct link from the communications room to the charge nurse, which improves the flow of incoming patients.

The phones are also helpful in transporting patients within the ED, which is separated into acute and nonacute sides. "The charge nurse might use the the phone to call the team leader on the nonacute side to say we're sending a 12-year-old boy with abdominal pain to your side," says Royalty.

• Trauma patients. The ED plans to add phones for the technicians who transport trauma patients to CAT scan and for the recording nurse in the ED's trauma bay. "You could give the recording nurse's phone number to the OR, and they can call the nurse to find out where they are in the trauma and find out if they're going there first or going to CAT scan," says Royalty.

• Streamline patient bed placement on floors. While patients wait to be admitted upstairs, ED staff are often put on hold or left waiting while the floor nurse is paged. At Fairfax, the cordless phones eliminated several glitches in the process. "This way, the physician can contact the charge nurse directly to say we're sending up a patient with a head bleed." says Royalty. A list with the phone numbers of the floor charge nurses is kept in the ED for quick reference.

• Paging. Previously, when ED personnel paged other staff, it was necessary to stay by a phone waiting for a return call. "Now, if the charge nurse pages me at home at night, she does it directly to her phone number in the ED," says Royalty. "That means she can still be out doing her thing. If she's at a bedside, she doesn't have to sit at a certain phone to wait for my call. It also helps me because when she pages me, I recognize the number and know who I'm calling."

• Transporters. Satilla Regional Medical Center in Waycross, GA., uses the phones in its ED to facilitate communication with transporters who take patients to and from their cars, X-ray, and upstairs to the hospital floors. "Before, we used a beeper system and we'd say, ‘A patient in room 10 needs to go to x-ray', but we had no way of knowing if the transporter was on the way to CCU with a nurse and a patient, so he would have to physically stop and find a phone to call us back, " says Lisa Mathis, RN, MSN, Emergency Services Supervisor. "Now, with the phone on his hip, he doesn't even have to stop walking to talk to us." With the old system, the message to the transporter was audible, so the cordless phone also increases patient privacy, she says.

• Patient representatives. At Satilla Regional, the ED's patient representative uses the cordless phone to field incoming calls from the community. "If someone calls up and asks, ‘Is my Aunt Sue down there?' We can funnel that call right to our patient rep's phone," says Mathis. The system has decreased the amount of incoming calls to the nurse's station, she says.

• Patients and family members. The ED at the Methodist Hospital in Houston uses cordless phones specifically for patients and family. A patient information representative carries several phones so that family members can use them in treatment rooms or the ED's family room. "When family members in the hospital call a family member at home, there's always going to be a question they'll want to ask the patient," says Bart Gohr, EMT, the materials coordinator for emergency services. "This way, they don't have to keep going back and forth from the room to the phone."

Previously, family members used the phones at the nurses' station, which was inconvenient. "We've almost doubled our patient census, so our phone lines were always in use," says Gohr. "On comment cards, one of the things patients say they love is having phones brought to them so they don't have to discuss intimate matters out in public,"

The phones can also be helpful for patients who come to the ED alone. "Because we're located in a golf and vacation community, we have a lot of transients in the ED, so having the ability to reach out to their family and have some privacy has been a big customer satisfier," says Kuell.

• Technicians. On particularly hectic days, the cordless phones can be helpful in locating technicians at a moment's notice. "When we're running low on staffing, we'll give the phones to a couple of our EMTs so it's easier for us to find them when we need them," says Gohr.

At Satilla Regional, the ED's mental health technician uses a cordless phone to set up outpatient referrals and placement for patients. "It has helped her to communicate more effectively with the various community resources, shelters, and hospitals," says Mathis.

• Consultants. Going through a third party to contact a consultant is often time-consuming and inefficient. At Moore Regional, every nurse and physician on duty places his or her own calls using individual phones. "If they are contacting a consultant, they make the call themselves, and the consultant calls right back to them," says Kuell.

In the past, the process was inefficient. "By the time the consultant called back in 15 minutes, the physician would have gotten really busy, and nobody knows who called," says Kuell. "When you place a call to another department, you know what you wanted them for, so it just makes everybody happier."

The system also reduces the secretary's workload. "They don't have to hunt around for people to find who called the consultant and what they wanted," says Kuell. "Our pace is so hectic, you can't be sitting around a nurse's station waiting for a call to be returned, and you can't expect secretaries to spend their time looking for people."

[Editor's Note: Two companies that offer wireless telephone systems are: Ericsson Inc, Business Systems, 1 Triangle Drive, Research Triangle Park, NC 27709. Telephone: (800) 373-3875, and SpectraLink Corporation, 1650 38th Street, Suite 202E, Boulder, CO 80301. Telephone: (303) 440-5330 or (800) 676-5465. Fax: (303) 440-5331. SpectraLink Web site is located at ]