ED Spotlight on New Technologies

Communicate with bone conduction

Cutting-edge bone conduction technology can enhance the results of MedTeams training, says Robert Simon, EdD, chief scientist for the crew performance group at Dynamics Research Corporation in Andover, MA. "One of the major problems with care in the ED is staying in touch with one another," he notes. "Being able to ask questions without having to find an individual staff member would be valuable, so we are studying bone conduction technology."

Bone conduction technology consists of a headset that attaches [like] earphones, but the ears are not obstructed. A battery powered communication system is hooked to users in the ED. Physicians can still use stethoscopes because their ears are free, and no microphone blocks the user’s mouth.

"You can talk to anybody at any time, in a very quiet way," says Matthew Rice, MD, FACEP, medical corps chief at the department of emergency medicine at Madigan Army Medical Center in Tacoma, WA. "We can communicate with other people on our team efficiently and quietly."

It can be difficult to keep a team together in a busy ED, says Gregory Jay, MD, PhD, FACEP, director of emergency medicine residency research at Rhode Island Hospital in Providence and one of the device’s designers. "In addition to using techniques such as checkbacks,’ and maintaining situational awareness, a little technology can help the team be more cohesive," he adds.

Technology should only complement changed behaviors, says Jay. "The technology should not come first. The improvement in behavior has to come first," he stresses. "Otherwise, it just becomes a new type of dysfunctional system."

Bone conduction headsets are a proprietary technology produced by a Japanese company, Jay reports. "This could result in a quantum leap in efficiency and safety," he says. "The very significant errors you hear about are not result of single error, but a series of tiny errors that lead up to a big error."

"One of those tiny errors may be that the patient has a fever," says Jay. "Of course the nurse will document that on the sheet, but there is no guarantee that the physician is going to look at that before the patient is discharged, and that piece of information may change things." The bone conduction headsets make it much easier for a change in a patient’s status to be communicated, he explains.

The technology works in tandem with all the MedTeams concepts, Rice stresses. "This is going to come a long way in having ED staff feel intimately connected and that they are working together as a team," he says. "Staff will have the comfort of being able to instantly communicate."

Effortless communication will result in staff being more likely to raise issues about patient care, says Rice. "Staff will be able to ask questions and bring up issues which they may not have in the past. So we may potentially avoid more errors because people will feel more accessible," he explains.

The technology will have a major impact on efficiency, Rice predicts. "There is no doubt in my mind that this device is what is necessary to take a significant leap into the future of how we practice emergency care," he says. "There are improvements not only in our ability to communicate, but also in getting tasks accomplished. This also relieves a fair amount of physical exertion in getting around."

However, the technology should not be forced into an inefficient system, says Rice. "To try and make it work when you don’t have the efficiencies necessary in human behaviors, is the wrong way to do things," he advises. "Don’t use technology to try and change behaviors. Instead, use the opposite approach. Change behaviors and then enhance that with technology."

A prototype system is currently being tested at Madigan’s ED. "There are still some glitches we need to work out, but the system works well," Rice reports. "I would say there is a 30-40% improvement in ability to communicate with people using this technology."

The prototype will be refined over the next few months, says Rice. "The technology was set up with a lot of forethought to make it user friendly, but after some refinements it will eventually take only a few minutes of training, as opposed to an hour or two," he predicts. Over the next 12 months, the product is expected to be upgraded twice, and become commercially available within two years.

Currently, the [headsets] are not used 24 hours a day. "Because of some limitations on battery life, we can’t use it 24 hours a day yet, so we tend to use it on certain shifts," says Rice. "We are working on ways to have a rechargeable battery fitted into the system instead of one battery with limited life. We also plan to add more channels, and enhance the aesthetics of the system so it looks even less obtrusive."

The ED is collecting data on the [headset’s] effectiveness. "We compare the shifts when the [headset] is used and not used," says Rice. "Staff answer a questionnaire on how communication went, so we can compare [results] with and without it."

Currently, 10 headsets are used by ED staff to expeditiously move patients throughout the system, says Rice. They are distributed between the staff physician, the senior resident, team physicians, charge nurse, triage nurse, staff nurses, and clerks.

Here are several ways the headsets are being used at Madigan’s ED:

Communication between charge and triage nurses. "We have about 30 yards between where the charge nurse and triage nurse have their specific worksites," Rice says. "When there are bursts of activity, the triage nurse asks for help or asks what beds are available so patients can go directly there," he explains."

Previously, the triage nurse had to walk back and forth to accomplish these tasks. "Thirty yards doesn’t seem very far until you have to walk it a couple of dozen times a day," says Rice. "This way, the nurse can push a button and talk to the person directly in a confidential way."

Physicians and nursing staff can share concerns about patient needs. "We have 24 beds, and the physician is going to be somewhere taking care of a patient. So if a question arises, the nurse or physician need to track each other down physically or overhead page them," says Rice.

"This way, you turn a knob, push a button, and can instantaneously communicate with the person," says Rice. "You have almost instant communication with the person you need, without the patient being able to hear what the conversation is about. You also don’t have to spend time tracking them down."

Transferring calls. Phone calls can be transferred directly to a staff member, so they don’t have to go to the phone. "The system has a component that transmits the digital phone signal into the infrared system, and then transfers the phone call through to the location where the individual is to receive the call," says Rice.

The system works essentially like a portable phone, but more efficiently. "You can talk on the phone with the calling party from wherever you are located. That saves a lot of time with physicians running to the phone and returning to their work site," says Rice.

Placing orders. "Orders can be instantly placed between the physician and the clerk who does the ordering," says Rice.

Prehospital care. "There will be some efficiencies with prehosptial care. Currently, we don’t have this rigged into our bay station calls, but eventually we will be able to do that," Rice says. "Of the 30-40 ambulance calls we receive every day, we will be able to assign a physician to a specific channel so they can transmit information to prehospital providers, rather than having to come to radio to respond. That way, one person won’t have to go back and forth between the work area and bay station."

Observation unit. "We have some efficiencies here, because the nurse that staffs the observation unit doesn’t have to come out and look for a doctor when they need orders," says Rice.

Lab and x-ray. "There is a potential to tie in our lab and x-ray folks where they are included in the system and can call and ask questions to a particular provider without having to call them on the phone. That would save a little time for everybody," says Rice.