Tackling COVID-19 like a Champ - How Michael Garron Hospital is Transforming Clinical Communication and Scheduling
Reduces switchboard volumes by 15-20% per month
Strengthening interdisciplinary collaboration
Centralized & up-to-date scheduling system
"Hypercare has made communication between the members so much easier. Not only does it offer a secure platform to communicate about patient issues, it is a user-friendly platform for group conversations or group announcements."
- Dr. Carmine Simone, Chief of Department of Surgery
Michael Garron Hospital (formerly Toronto East General Hospital) is a 388-bed community teaching hospital in Toronto and serves as a training site for medical students and residents from the Faculty of Medicine at the University of Toronto. It offers a wide range of in-patient and out-patient medical services, and is an anchor partner of the East Toronto Health Partners Ontario Health Team, an integrated care network providing comprehensive and holistic care for patients in the region.
Prior to Hypercare, communications among MGH clinicians was a complicated and fragmented process. Each provider had their own preferred method of contact. Most still used their pagers, but this communication modality often led to missed connections and potential delays in care. A nurse at MGH describes a common scenario with pagers: “While caring for an unstable patient, I paged the intensivist to a phone at the nursing station, but needed to step away to tend to the sick patient; when I returned to the nursing station, I had missed the call back and had to page again, thus delaying patient care.”
Some clinicians preferred to use their smartphones, but that had drawbacks as well. Physicians who wanted a call returned would often encounter interruptions during their patient encounters, and if they missed a call, they would not know who was trying to reach them as the callback number was often through an unlisted hospital extension. Other team members preferred to receive text messages, but this practice was hindered by security and privacy concerns.
No matter which method was chosen, every connection started with a call to switchboard. These switchboard operators are constantly bombarded by phone calls from within and outside the hospital, with upwards of 80% of the calls being internal.
While caring for an unstable patient, I paged the intensivist to a phone at the nursing station, but needed to step away to tend to the sick patient; when I returned to the nursing station, I had missed the call back and had to page again, thus delaying patient care.
Each clinical department was in charge of their own schedule, with administrators and clinicians maintaining them. This created a mix of different formats:
- Hand written paper copies
- Word processor documents (e.g. MS Word, Adobe PDFs)
- Spreadsheets (e.g. MS Excel)
- Cloud-based documents (e.g. Google Documents)
- Electronic scheduling platforms (e.g. Qgenda)
In order to generate the daily on-call schedule for the entire hospital, these various schedule formats would be forwarded to the switchboard operators every day to be collated manually and transcribed into a master schedule. Last minute changes were penciled into paper copies. This often led to time consuming manual entry, missed connections, frustration, and delays in care.
Leaders at MGH needed a communication solution that would reflect the collaborative, team-based approach of modern healthcare and address fragmented communication processes to improve hospital operations and the delivery of patient care.
Preparing for the transition to Hypercare
MGH went through a rigorous process of evaluating multiple options for clinical communication and collaboration tools and selected Hypercare for a number of reasons including:
- Easy to use interface that helped streamline the MGH communication workflow.
- Well thought out features including the ability to send files, multimedia, and images.
- Simple on-call scheduling and locating feature to help ease the burden for switchboard teams.
- Clear clinical focus to help improve workflow efficiency and ultimately, patient outcomes.
Hypercare deployed its team on site to fully explore every facet of their current workflow in order to understand where and how the platform could be seamlessly integrated into their operations. Hundreds of hours were spent talking to and shadowing clinicians, administrators, information technology (IT) managers, privacy experts, and many other users from different departments. Where customizations were needed on the platform to fit workflows better, Hypercare was up to the task and designed new functions. Individualized learning materials were created for each user group to ensure relevant training was provided to each type of user.
Rapid Uptake and Growth
In November 2019, MGH was ready for a phased roll out of the Hypercare platform with its clinicians. The original plan was to start with the division of infectious diseases, and after a trial period of a month, to slowly roll out to different departments. Hypercare was an instant success, and once other departments caught a glimpse of the app and the incredible convenience and improvements it brought, they were clamoring to start using it themselves.
Whereas most deployments of new technology in healthcare is a slow process requiring a lot of hands-on change management, MGH had the opposite problem. The simple onboarding process and easy-to-use interface allowed hundreds of clinicians to quickly adopt the Hypercare solution within a matter of weeks. Eventually the platform was opened up to all physicians in the hospital. As Dr. Patrick Darragh, the Chief Medical Information Officer notes: "The process of onboarding the team was seamless… Hypercare greatly enhanced our clinicians' efficiency and their ability to collaborate, by allowing them to discuss patient and clinical information instantly."
Hypercare integrated into Active Directory, instantly enabling clinicians at MGH to log in to the Hypercare solution by utilizing their existing network usernames and passwords (one less password to remember!). Additional shell accounts were created for those who were not on the directory, particularly useful for rotating and locating staff.
Positive user feedback
The immediate reaction to Hypercare was overwhelmingly positive, from doctors, professional practice, and administrators. The Director of Critical Care Services, Dr. Michael Warner, trusts Hypercare with the sickest patients in the hospital. "Hypercare facilitates secure, seamless and timely closed-loop communication among physicians and other members of the healthcare team. Use of this platform enhances patient care by allowing providers to exchange information about patients from the point of care and to make collaborative decisions remotely through group chat on the app."
Use of Hypercare enhances patient care by allowing providers to exchange information about patients from the point of care and to make collaborative decisions remotely through group chat on the app.
For Dr. Carmine Simone, the Chief of the Department of Surgery, Hypercare has been transformational. "Hypercare has made communication between the members of the Surgery team so much easier. Not only does it offer a secure platform to communicate about patient issues it is a user-friendly platform for group conversations or Group announcements. Thank you for bringing Hypercare to our organization."
New integration into the community previously not possible
The transitions of care between the hospital and into the community has always been fraught with logistic and communication issues. Hypercare has been a game changer not only for those working in acute care, but the community as a whole has greatly benefited from the close collaboration provided by the Hypercare platform. Dr. Nayla Jessamy, a family provider in the East Family Provider Network, uses Hypercare to provide seamless care for her patients in ways previously not possible. "I was surprised how quickly the specialists responded and instantly my question was answered and I had a plan with which to move forward. As a family doctor it has historically been a challenge to get in touch with specialists so this is awesome! And I am so appreciative that they are taking the time to get back to me as I know they are all busy. Love it!"
Dr. Oliver Nguyen, a general internal medicine physician, shares similar thoughts. “We started using it a few months ago. It started out as a convenience (being able to use real names, info, via text) but has ended up being quite practice changing (texting a radiologist for clarification, group chats with multiple consultants, etc). Highly recommend!”
What was once a complicated and error- prone system is now brought onto a single platform. All schedules get updated and pushed out to users in real-time, so they always have the most accurate information.
Reducing switchboard volumes
Since Hypercare was deployed, the number of calls switchboard has to field has dropped by 15-20% per month, and continue to improve as users become more accustomed to the new enhanced workflow.
Responding to COVID-19
During the unprecedented crisis of the COVID-19 pandemic, clinicians have raced to meet the challenge. The information on the ground was changing on a daily basis, and MGH relied on Hypercare to keep their staff up-to-date with the latest evidence and protocols. Hypercare created an early warning system specifically for COVID-19 patients. When a patient’s COVID-19 swab turned positive, an automatic alert was sent via Hypercare to the patient’s attending, the on-call Infectious Disease, and Infection control team. Rather than having disparate multiple phone calls towith individuals to assemble the team and update them on the situation, a single point of contact is created and everyone automatically gets all the necessary patient and location information instantly.
Deeper integration with IT systems
Hypercare makes it easy to integrate with a host of different IT systems. Early successes with integrations with Active Directory and the early alert system for COVID-19 opens the door for a whole host of unique applications. There are projects being discussed about creating early alert systems that draw data from MGH’s EHR platform and other clinical and operational monitoring systems to create automated messages when certain events occur. Several Emergency Department initiatives include sending messages to patients waiting for imaging studies, as well as sending messages to administrators and other resource persons personnel when the department is experiencing a high volume of patients.
A fully integrated OHT
In order for Ontario Health Teams (OHTs) to become fully realized, silos have to be completely broken down. Hypercare has already successfully linked disparate family doctors and community providers (such as care coordinators) to the hospital to avoid unnecessary ER visits and to improve care in the community. Using this as a model, MGH is leading the way to expand this vision to include all healthcare professionals and associated support workers and resources to collaborate on the Hypercare platform.