Bedside tablets offer a wealth of advantages, from boosting patient satisfaction and enhancing the physician-patient relationship to serving as a support tool for care plans.
Innovators at several organizations are integrating tablets into the inpatient environment to drive more patient-centered care as well as patient engagement with signs of improved outcomes as a result.
Raising the bar
Northern Westchester Hospital (NWH) in Mt. Kisco, N.Y., launched the technology in its medical surgical unit about 18 months ago, according to Maria Hale, MBA, vice president of patient advocacy.
The hospital’s president and CEO, Joel Seligman, instigated the launch as he envisioned the hospital as an innovator when it comes to patient-and family-centered practices.
Seligman wanted to raise the bar and change the status quo of the patient experience, says Hale. “Instead of being dependent on a care provider to bring their medical information to them, usually at a time that is most convenient to the care provider, he wanted information available to the patients in real-time and when they are ready to receive it.”
The bedside tablets currently are in several inpatient units, including cardiology, pulmonary and the medical surgical units, with plans for rollout in the maternity unit. The tablet offers the ability to view medical records, lab results and x-rays, as well as web browsing and listening to music.
Before the interface was designed and built, a patient advisory council conducted focus groups and built a small lab so patients and clinicians could check out the hardware and explore features and uses, Hale says.
Patients have three favorite features so far. One is a button that links to bios of their care team. “They really enjoy being able to see who is taking care of them and having that updated as the care team changes with shifts,” she says.
Second is access to their medication list and third is access to lab values for chronic disease management. Hale speculates that the design of the lab values draws interest as they use a stoplight graphic to show health status (green for good; yellow for borderline; and red for bad).
“We had one patient whose value was finally in the green, and he took a photo to share with his physician. This is what healthcare is about: Getting patients excited to take control of their health.”
A tablet pilot on the cancer floor at Chicago-based Northwestern Medicine proved beneficial for patients wishing to communicate with their friends and family.
The hospital began distributing five iPads more than a year ago, according to Lyle Berkowitz, MD, associate chief medical officer of innovation. “We didn’t dictate what they should use. We truly viewed this as an ‘insight’ innovation project to understand what would happen to both patients and staff.”
The tablets do not link to patients’ online records nor allow communication with providers, but that is in the works, he says. However, they serve as a crucial lifeline for cancer patients, often in for extended stays, who want to stay in close touch with loved ones.
“Many patients have traveled far to come to Northwestern,” he says. Since he couldn’t be there in person, one patient watched a wedding from his bed. In another case, a Jamaican woman could “be” with her family over Christmas using the iPad she borrowed.
The high patient desire for video communication was the top lesson of the intervention, he says. This was taken into account in IT decisions around which software platforms to use and ensuring the network is adequately robust to handle a high volume of data transfer, he says. Other lessons were learned about how to manage the check-out process and cleaning of devices.
“As we think about expanding to more floors, we will now be more prepared from a technical, operational and humanistic understanding.”
Success with cancer patients
At the Ohio State University (OSU) Wexner Medical Center, a small tablet pilot yielded enough success that the institution is planning a full rollout in its new 300-bed cancer hospital in mid-January, according to Milisa Rizer, MD, MPH, CMIO of OSU’s Department of Family Medicine.
During the pilot, OSU distributed 22 tablets which rotated among 187 patients primarily in the cardiac and cancer units. The tablet linked patients with their medical record and lab results, and included the ability to communicate with the care team.
“We were very successful on the cancer floor,” she says. However, in the cardiac
unit, where patients tend to stay for two to three days, “we were not as successful. By the time patients got the hang of it, they were ready to be discharged.”
Oncology patients, however, love the tablet and use it mostly to communicate with medical center staff. “It’s so interesting, in this age of patient empowerment, the strength this brings to the patient to truly see their results, and not be told their results,” Rizer says.
Interactions & satisfaction
Bedside tablets improve both patient-physician relationships and patient satisfaction. At OSU, data showed the tablet intervention had a “very positive” impact on patient satisfaction scores in the cancer unit.
“It makes the patient a much more informed consumer,” Rizer says. Physicians were initially hesitant but now they love it. And, patients appreciate the opportunity to ask more specific questions. Physicians also liked that they could prevent patients from retrieving certain, more sensitive results, so they can guide that conversation.
At Westchester, surgeons enjoy the ability to show patients actual images on the tablet. “It’s really up close and personal,” says Hale.
The nurses embrace the technology as a part of daily interactions with patients. For example, they can work with patients when ordering their food, which is personalized for each patient’s nutritional requirements.
Maureen Lopez, director of clinical informatics at Westchester, adds that patients can see what time during the day medications are taken. Nurses can work with patients to process their questions and do teach back to ensure patient understanding, she says.
Also, the care team is informed if a patient watches an educational video. The tablet is linked to the patient room’s television, and includes a directory of programming on different disease states. This helps nurses engage patients on the content, Lopez says. Other functions include: sign language and language interpretation; a security feature so patients must scan their bracelet to access the data; and video technology.
Also, the tablets can play white noise, which not only enables a patient to rest better but signals to the care team what kind of environment the patient desires. “Technology doesn’t just have to be a visual aid, but a conduit for greater patient comfort,” she says.
The demographics factor
The tablets largely are embraced, but not everyone is on board. For example, when OSU attempted to distribute tablets to patients in the postpartum unit, the patients preferred to use their own technology but couldn’t because of a firewall, says Rizer. “We were challenged with that.”
Some older patients were hesitant to use the technology, says Hale. NWH formed a volunteer program called the Patient Activation Volunteer Educators, or “Pavers,” to tackle this problem. The volunteers round on each floor to introduce the tablet and show patients how to use it.
At first, patients figure out what interests them, even if it’s just playing sudoku. From there, they may learn how to send an email to a loved one and learn about other device features. “Tablet adoption for both patients and staff has been a challenge, but we realize that this takes time. Right now our focus is to meet the patients where they are,” she says. “It’s about baby steps, ease of use and making sure the tablet brings value.”
‘Bring it on!’
For organizations looking to use bedside tablets, Berkowitz advises to start small. “Start with a pilot to gain insight into how your patients will use the device, how your staff will manage the process and how your IT infrastructure will support it. [This] will let you quickly gain a significant amount of knowledge so you can make the mistakes in a lean, small environment before spreading out further,” he says.
As clinicians grow accustomed to tablets and they become part of the daily routine, there is no going back.
“The technology gives you the vehicle to pursue innovation,” says Lopez. “Now that we have it here, the staff and the patients are saying to us, ‘Bring it on!’ and ‘What’s next?’”