The technology of a hospital room has sure changed. Through most of history, a hospital was more a place to isolate patients, and consisted mainly of matresses on the floor. In the last four or five hundred years it advanced to wards full of standard single beds with a staff of nurses and doctors that wandered around and did what they could. It wasn’t until the early 1800s that side rails appeared on beds, and the modern three-segment hospital bed shows up in the early 1900s. In 1945, Dr. Marvel Darlinton Beem invented the first “modern” hospital bed controlled by patient-accessible buttons.
If you have recently been in a modern hospital, you have seen the monitoring devices for blood pressure, temperature, blood oxygen content, pulse rate, breath rate and EKG that not only display their information in the room but also at a nurse’s station. Nurses and doctors use laptops on rolling stands to record medicines given, orders, and other information. All of this data plus the results of X-Ray, MRI, CAT, PET, … scans can be instantly shared with doctors located almost anywhere.
Yet in the midst of all this technology, there is one thing that is still back in the middle of the 20th century: the nurse call button. In some places, it is literally a string hanging down the wall, in many a simple button. I recently visited a relative in a brand-new wing of a very up-to-date hospital. It was a fabulous place, with only single patient rooms, each with a sofa-bed for relatives to use, and with all of the modern medical equipment they could use. Even a heater for the blankets when they had to take a patient out of the room for a test. They had a very nice control for the TV, with a button to call the nurse. There was also a call button on each side of the bed that the patient could reach. If you press the call button, it turns on a light over the room door, and flashes light on the nurse monitor station. That’s all: just an indication that the patient pushed the button.
In every one of these situations, the caregiver has no idea what the problem is. The patient could be having trouble breathing, or in great pain, want a glass of water, or just want to know when lunch is coming. Laws in some jurisdictions and hospital procedures often set the maximum time in which a caregiver must respond to a call. However, those rules do not take into account the type of problem. Clearly it is more urgent to respond to chest pains than a glass of water.
So the caregiver stops what he is doing, goes to the room (possibly having to put on a gown, mask or gloves depending on the patient’s situation), ascertains what the problem is and its urgency, and then handles it. Handling it may require leaving the room, getting something, and returning. If necessary, that means putting on another set of gown, mask or gloves.
The situation becomes even more difficult if the patient cannot verbally describe what she wants. This could be because of a stroke that has impacted her speech, the insertion of a breathing tube or mask, or simply because the patient and the caregiver do not share a language.
Most of us have been in the situation where we could not communicate very well with someone. Maybe on a business or pleasure trip to a foreign country, you had trouble deciphering the menu, asking directions and understanding the answer, or telling the taxi driver where you wanted to go (a problem I’ve had in both Mexico City and New York City). None of these were really serious issues, but image if you were sick or injured: could you have explained your problem to someone? Some of us have had relatives or friends who had a stroke, and observed the frustration that a very intelligent person has in communicating because of difficulty in finding the right words and getting their mouth to say them intelligibly. It is a mind imprisoned in its own body.
Imagine also the frustration of the caregiver, where every visit in response to a call button push may be trivial, or an emergency. Or when the caregiver goes to a patient, then has to go out and get something that the caregiver could have taken to the room the first time if only he knew what the problem is. Or when the caregiver can’t understand what the patient wants, other than he knows the patient is in distress.
One of the companies I am working with has developed such a device that uses, for example, an iPad as the patient’s device. The iPad continues to have all of its normal functionality, but the caregiver communication app has a set of buttons, most of which link to another screen with additional options. So the patient can indicate that she wants a glass of water, or a cup of hot tea; that she needs to go to the bathroom; that she is in pain at what level and where; that she wants to talk to her son, or her priest, or her friend. In addition, she can send a text message to the caregiver, and can receive a text message back from the caregiver. So, “when is my next trip to the MRI?” can be answered with “2PM” without the caregiver needing to actually visit the room.
These messages are all sent to a window at the nurse’s station, and they can be texted to the caregiver’s cell phone so while doing rounds the caregiver can instantly know of another patient’s request and appropriately prioritize the response. The app can also be configured to send the messages to the cell phone of a friend or relative of the patient.
The app also can be easily configured to display another language. In that case, the app displays all of the button descriptions and other text in the patient’s language, yet the messages received by the caregiver are in his native language. The app makes a reasonably good translation even of text messages between the caregiver and patient.
This obviously isn’t the solution in all cases. It will not be suitable for the very young, or those with very limited arm and hand movement, or those that due to medical condition or medicine effects may not be able to understand or use the app.
The nurse’s station application also keeps track of response times and who responded, allowing the hospital nursing staff to monitor performance towards their response-time goals. It also, therefore, provides a record to show how quickly a caregiver actually did respond in case of a “I pushed the button and nobody came for 20 minutes” claim. A large hospital can configure an administrative server that will monitor all calls from all rooms in real time, allowing supervisors to appropriately spread their limited staff to the wards with the most activity.
The last word:
Being in the hospital is no joyous occasion, except maybe in the maternity ward. With the big push on improving health care while reducing its cost, it would seem that a relatively inexpensive device that would reduce patient and caregiver frustration, improve the ability to react to patient requests and reduce the workload on caregivers would be of great interest. You can view the iPad app description and the Press Release.
Keep your sense of humor.