April 18, 2008

StarPanel response rates enhance safety

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(photo by Neil Brake)

StarPanel response rates enhance safety

Weekly audits show that unattended StarPanel messages are dwindling to near zero.

And that's a good thing for patient safety.

“If you're going to wed a messaging system to the electronic medical record, you need to check regularly whether all your account holders are keeping up with their messages,” said Jim Jirjis, M.D., M.B.A., chief medical information officer for outpatient clinics and project chair for My Health at Vanderbilt.

“If someone uses the system to communicate an order to a nurse or an important patient symptom to a doctor, and the message is not read by that provider, serious harm could befall the patient.

“In addition, people will not use a system twice if they find it to be unresponsive the first time. It is imperative that messages get answered reliably if the system is going to succeed,” he said.

Secure electronic messaging between users of the electronic medical record system saves time and effort for busy clinicians. But messaging didn't catch on over night, said Sue Muse, project administrator for My Health at Vanderbilt. When message basket audits began a few years ago, typically between 10 percent and 15 percent of StarPanel messages sat for five days or more without being opened.

Muse and Jirjis began distributing each week's fresh audit results to any StarPanel account holders with unattended messages five days old or older. The audit results also went to clinic managers and clinic medical directors. Repeat offenders got added prodding.

After two years of weekly audits, results have improved dramatically. In some recent weeks, unopened messages have dwindled to as few as one-fifth of 1 percent. More than 30,000 messages are sent per week, and in one recent week only 66 were unattended, compared with more than 3,000 unattended messages per week when the audits started.

“Everybody has come together as a team,” Muse said. “These days people apologize for hitting the audit. This turnaround represents so much teamwork. It still amazes me that we've succeeded in getting these numbers down so low.”

Patients who register to use My Health at Vanderbilt can send messages to certain StarPanel message baskets, depending on how recently they've visited which Vanderbilt clinics. Patients' own message baskets aren't included in the audit; instead, when a My Health at Vanderbilt user leaves a message from the health care team unopened five days or more, the sender receives an automatic unopened-message notification.

“We believe safety in clinical communication is tantamount,” Jirjis said. “And that means quality assurance audits, education and closed loops. We're going to continue the audits forever; we're now remarkably near perfection, and what we're working for is zero unattended messages.”