Real-time locating systems have expanded nurse call features to include advanced work flow functions.

Any hospital in the process of building today will be implementing a sophisticated nurse call system. Advanced nurse call systems also are among the most common upgrades for existing hospitals.

Today’s clinical and high-tech climate has resulted in nurse call features intended to facilitate caregiver and patient communication and maximize clinical workflow. While these systems still include a nurse call bell, their new design and intent are far more complex and feature-rich.

Additional systems such as real-time locating systems (RTLS) and patient education systems are now expected to integrate seamlessly with nurse call systems. Therefore, a strategic, long-term planning approach related to corporate vision, care delivery, processes and thoughtful integration is required.

With a national focus on health care patient satisfaction, it is more important than ever to create an environment of customer service, prompt responses and improved workflow. Advanced nurse call systems can aid in this effort.

Current landscape

In today’s wireless age, a warp-speed change has happened in the way in which people communicate. Texting and smartphones have replaced former methods of landlines and written communication. In health care, communication technology has developed in patient-centered ways.

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For example, the Code Blue feature is the most frequent use of nurse call systems and, indeed, is required by life safety codes. A patient request for assistance through the bedside control is the second most frequent functional use of the nurse call system. This allows direct requests and response between patients and caregivers, often through a speaker placed in the control or on the wall. These calls and the response time can be measured and documented with reports for evaluating staff effectiveness and patient satisfaction.

The use of smartphones has created a device dependency, particularly among younger people. The landscape of clinical communication is slowly evolving to a phone and texting platform, and many hospitals have adopted texting as their primary mode of peer-to-peer communication.

According to the National Council of State Boards of Nursing and the National Forum of State Nursing Workforce Centers, however, more than half (53%) of all nurses are 50 years or older. A population that skews older can be challenging with regard to technology adoption. Over time, this workforce will evolve into a technology-savvy group, but in the meantime, when planning nurse call systems, it is important to identify the demographics and technological competency of the existing workforce.

Many nurse call vendors are promoting workflow optimization features as an important selling point. Workflow optimization can be customized to staff needs and ideas, or the vendor can recommend industry best practices. Workflow optimization features can include interfaces for reminders, environmental services, transport and other needs. As one example, nurse call systems can assist in compliance with the Joint Commission on the practice of rounding for pain assessment. Similarly, to improve hospital throughput, nurse call systems can be used to notify staff of room readiness for patient admission and the need for cleaning after patient discharge.

Involving nursing staff

Facilities often are overwhelmed with the implementation of so much technology at one time, especially with new construction. As a result, they adopt a minimalistic approach, leaving tremendous technological benefits underutilized. While it is essential to start small, the value of creating an unfolding plan that pushes the envelope for optimization and creativity is an ideal state. Appointing an information technology (IT) steering committee to develop a master technology road map is critical for creating this unfolding plan.

It is necessary for facilities professionals to appoint to this committee a clinical champion who understands clinical workflow optimization and the use of technology, as well as the impact on installations, construction schedules and training. Someone with a nursing background is ideal for this position, because only front-line staffers can provide the perspective of technology use with actual patients.

Several professional organizations, such as the Association for the Advancement of Medical Instrumentation, Healthcare Information and Management Systems Society and the Nursing Institute for Healthcare Design, have cast a vision for how nurses can become educated and involved members of the technology design team. It is important to identify the project’s overall goals while driving the functionality discussion.

Drilling down through the master technology plan, a great place to start discussing the selection and implementation of a nurse call system is within an existing committee such as the alarm management committee or a code committee.

These committees are clinically focused and prioritize the safety and quality of patient care delivery. Typically, they already have nurses involved who understand the daily challenges of communication and alarm management. If such a committee doesn’t exist, a nurse call user group is an appropriate vehicle for organizing the investigation, selection and implementation of a nurse call system. This user group also might include representatives from IT and clinical engineering.

Before allowing vendors to enter the picture, the nurse call user group should hold regular meetings with a beginning focus on vision, functionality and implementation. Once a vendor is selected, the committee can transition to coordination and project management timelines. An important task of this group is to develop an alarm management strategy as well as escalation patterns to determine the sequence of events and responses when selected nurse call features are activated. Many institutions across the country have developed excellent alarm management strategies with a focus on decreasing alarm fatigue.

Another key task for this committee is to identify the quality and safety measures they would like to align with the nurse call system. Aligning ongoing quality and safety initiatives with the workflow features of the nurse call system will further enforce these practices as well as enhance them.

One example might include the work of a comprehensive unit-based safety program (CUSP) to enhance the patient safety model. Efforts to reduce health care-associated infections through performance improvement teams that focus on central line-associated bloodstream infections can create reminders or notice when a patient has a central line.

Creating notice that a patient has any indwelling catheter can create a workflow that improves assessment and documentation of efforts to reduce the risk of infection. The nurse call system workflow feature can be used as one of the tools associated with the CUSP’s five basic steps as outlined by Health & Human Services’ Agency for Healthcare Research and Quality: Educate staff in the science of safety, identify defects, engage executive leaders, learn from defects and implement teamwork and communication.

Safety issues also arise when facility managers find themselves constructing a new building and connecting it with an old building. In such situations, a nimble and flexible technology platform can be difficult to achieve. Thus, it is necessary to upgrade the technology infrastructure before implementing any new technology across the system. Having different buildings on different technology platforms is a major safety risk, especially if staff members are moving between buildings.

Working with vendors

While many vendors are knowledgeable about their products, their sales and marketing should not drive the clinical adoption of nurse call systems. Indeed, it requires a person with experience to work with vendors to filter out marketing messages from performance messages.

Early in the process, it is important for the health system to be on the same page with vendors, particularly when nurse call systems are being upgraded at existing facilities. In those cases, there are existing systems that will remain, and those existing vendors will need to work closely with new technology vendors.

While it is not an industry practice, it is beneficial to have a meeting with all vendors present to set the expectations and create a collaborative environment. This will be helpful for future coordination meetings, construction schedules and system testing. Getting everyone aligned with the process and expectations is key to a successful project.

To facilitate this process:

• Create a master list of contacts related to the project, to distribute to those involved in the project, including IT, clinical engineering, nursing and facilities as well as vendor contacts.

• Create a notebook for each system, with product information, cut sheets, photos of unique features and functionality, meeting minutes and decision points. This will be a great resource when meeting with staff to show them the products, features and functionality that will be part of the conversation.

• Host a fair for vendors to set up a demonstration of the technology that will be deployed in the hospital. The cafeteria is a great place to set up such a fair to create interest and question-and-answer time between staff and the product representatives.

• Collect show-and-tell items from vendors to have on hand for staff education. Whether it is a sample of a pillow speaker, an RTLS tag, a smartphone or a system-generated report, it is good to have some items to show staff and to discuss the upcoming installation workflow and operations.

• Conduct site visits. It might be educational to visit other area hospitals that have similar technology, and vendors should be able to schedule these.

• Rather than getting locked into a proprietary environment, put a priority on products with interoperable capabilities.

Coordination and closeout

Coordination with clinical areas for training sessions, simulation events and dress rehearsals will need to be scheduled prior to going live with any system. Follow-up sessions after the go-live date will be advantageous to ensure that the system is optimized and staff do not have further questions.

If an organization has the opportunity to trial nurse call on a single floor, it is a great way to evaluate the system and develop organizational standards for rolling out the system hospitalwide.

Post-occupancy evaluations should be conducted at specified periods after a facility is launched. In general, most staff members are overwhelmed by the amount of learning and training required when deploying many systems at once. If opportunity allows, they often say, they would prefer a phased and incremental approach to adopting new systems.

A caution to this phased method would be that some groups might never return to create additional levels of functionality. Once a system is deployed, other priorities may make it difficult to revisit and expand the functionality and features. However, there is great opportunity to revisit the functionality and use, and take the new nurse call system to a higher level with regard to workflow, safety measures and quality outcomes.

Once the organization has developed and validated the initial deployment plan, it’s important to create an education and training program and projections about when additional functionality will be added. This should be part of the training and service agreement, and nurse call companies have well-trained, dedicated staff for education.

After the system is up and running, it is important to continue a collaborative relationship with the support professionals from the nurse call vendor. Capitalizing on the reporting modules is a useful source of validation for the technology investment made by the health system.

Utilizing the reporting tools and improvements these will generate are important for the clinical services to take ownership of regular reporting and metrics for response time, efficiency and documentation.

It also is important to set up semiannual reviews of the function and use of the system to keep the opportunities for enhancement as a regular topic of conversation. While nurse call systems are an improvement for staff communication, response time and workflow, there is a vast opportunity for nurses to innovate and create solutions that can be associated with the features and functionality of such a growing technology.

Debbie Gregory, DNP(c), R.N., BSN, is a registered nurse and interior designer. She is co-founder and past president of the Nursing Institute for Healthcare Design and is senior clinical consultant for communication and technology services at Smith Seckman Reid, Nashville, Tenn. Her email is

Top trends for call systems

Nurse call system design and operation has advanced rapidly over the past several years in terms of complexity and portability. As they continue to develop, health facilities professionals should keep an eye on the following overall trends:

• Futuristic technologies. Wearable devices, such as Apple Watches, Fitbits and other must-haves for early technology adopters, are in a heavy development phase across multiple industries, as are implantable devices. Although practice transformation is typically far behind technology, these new modalities undoubtedly will enter the health care space. A wearable device that communicates with a nurse call system is conceivable in the not-too-distant future and some health systems are already experimenting with this technology.

• Interoperable designs. Interoperability is winning the match against proprietary systems, especially with regard to nurse call systems. Vendors who “play well with others” are finding much greater success with technology contracts. In nurse call systems, health care organizations will continue to see interoperability and integration with other technologies such as real-time locating systems, and patient education and entertainment systems. In the face of increasing complexity, hospitals are demanding greater simplicity in the form of standardization that allows hospitals to choose best-of-breed technology.

• Increasing nurse involvement. In the past decade, the health care industry has seen a significant change in the involvement of nurses in the design process. Nurses have expanded out of formerly narrow roles as caregivers and into consulting leadership roles that help a health system design work spaces and technology, such as nurse call systems. Nurse involvement will continue to grow in these areas, as hospitals experience improved workflow, greater patient outcomes and satisfaction, and cost savings in the form of more appropriate technology investments.