4. Meet and exceed joint commission guidelines for audit trails
On top of walking many miles per shift, nurses must also manage the paperwork trail associated with each patient. The Joint Commission requires documentation for every activity associated with a patient. This includes dates and times for medications given, follow-up care, and other procedural events. Manually logging this information is important, but it takes time nurses don’t really have to spare—time they could be spending with their patients.
Middleware that connects nurse call systems to mobile devices typically has an added benefit of providing an audit trail of events and how they were handled. The software can tie the alert responses to their associated events, which completes the event log and provides data that many sending systems cannot provide. This can be very valuable when attempting to completely track an event and saves nurses the hours of paperwork associated with listing various patient activities. As hospitals now face unannounced audits by the Joint Commission, automating paperwork means reports are ready at the click of a button. Also, this automation increases caretaker productivity, as well as accuracy. But more importantly, it puts the nurse back at the bedside, improving quality of care and patient safety.
5. Control and reduce costs
Hospitals always face tight budgets, even when the economy is strong. In today’s economic climate, cost control is critical, and new initiatives must be rigorously researched to ensure they are worth the investment. Additionally, as Medicare now pays based on performance, hospitals must look for ways to improve the patient experience to receive funding.
For middleware that integrates with nurse call systems, hospitals receive both tangible and intangible returns on the dollars spent. As explored in previous sections, nurses become more efficient and can do more in less time due to a decrease in travel and improved patient communications. It is possible that your staffing needs will change once staff are accustomed to the system and you no longer require a nurse to be tethered to the nursing station desk at all times.
Likewise, patients whose needs are quickly met can help you generate repeat and new business as they will have positive things to say to others about their stay. Nurses too will be happier in their daily work life, reducing attrition and the training costs of bringing on new staff members.

2. Increase patient satisfaction
From the moment someone first hears about your hospital—via friends or family, advertising, or news coverage—his or her perception of its reputation, services, and care are being formed. This perception is often greatly altered (positively or negatively) with first-hand experience once that person has been admitted as a patient. Every interaction with your staff and employees affects the perception of care and ultimately satisfaction. And satisfied patients and their families are among your best resources for generating positive word-of-mouth, repeat visits, and recommendations to others. This is critical in a time where patients have more choice about which facilities get their business.
Communication among the patient and staff members throughout a patient’s stay is critical. The interaction with nurses is essential because it is the most frequent. The way a patient experiences and perceives this communication influences his or her overall satisfaction with the care provided. Not surprisingly, patient satisfaction increases when response times to nurse call requests are provided in a timely manner.
3. Increase nurse job satisfaction
Not only do hospitals face a nursing shortage, but they often have difficulty keeping the nurses they do have. Nurses are overworked and fatigued carrying out patient requests. They walk unnecessary miles each day due to inefficient communication methods that keep them out of touch with patients. This is not only physically demanding, but it also affects staff morale as they feel inefficient and unable to truly care for patients. Ultimately, this lowers retention levels and costs the hospital extra money to train new hires.
Job satisfaction is increased by providing better communication methods that help nurses improve their overall availability to patients. They can stay with patients longer and reduce their travel times. The ability to carry out tasks more efficiently and help more people find comfort in their hospital stay provides a sense of accomplishment. Inbuilding wireless phones connected to the nurse call system via middleware are proven to provide reductions in the time to carry out requests and help nurses do their jobs better.
Reducing the Number of Devices on the Hospital “Tool Belt”
Middleware can help hospital communication and IT managers address the complaint doctors and nurses voice about wearing a communications “tool belt.” This can consist of at least one pager, a cell phone, a smart phone, and an in-building wireless device (i.e., SpectraLink, Cisco, or Vocera).
In fact, the growing trend worldwide is the implementation of these in-building private wireless telephone systems. Coupling these systems with middleware allows hospitals to leverage a single device type for clinical alerts, such as nurse call requests, and one-button callback to patients. They also use these devices to enable communication among doctors, nurses, and patients from anywhere in the hospital.
Best-in-class middleware solutions deliver alerts and messages to a wide array of both in-building phone systems as well as pagers and cell phones. Thus, middleware acts as the traffic cop in the world of communication and messaging, directing critical messages to preferred devices. This gives the hospital flexibility in choosing their array of wireless devices and ensures the appropriate staff members are notified on their preferred device depending on the time of day or day of week, whether in-building or away from the hospital site.

Research Shows a 51% Reduction in Request Completion Time Using Middleware
The University of Maryland conducted a time and motion study with integrated communication systems and found that they reduced the completion time of patient requests by up to 51%4. In addition, the research found that this type of communication “enables clinicians to have more control in prioritizing and responding to requests according to their seriousness.”
Five Reasons Top Hospitals Are Changing the Way They Use Technology
As with many technological improvements, the advent of middleware for nurse call systems has changed the way hospitals approach patient care. Many have looked to these applications to streamline the communications process between patients and nurses, and with great success. Below are the top five reasons hospitals are using middleware to put patients in direct communication with their nurses.
1. Increase patient care and safety
The care and safety of all patients is always priority number one. Your hospital no doubt strives to staff the best nurses and physicians, leverage the latest clinical and security equipment, and provide top-notch treatment. Simply put, middleware that connects your patients to their nurses enables your staff to provide better care and safety. With the ability to quickly assess the priority of a request, nurses can perform their jobs better and provide higher levels of care and treatment. One patient’s request for a DVD and another’s for pain medication are not equal in priority. And yet both can be attended to more quickly with a system that speeds communication, cuts nurse walk time, and allows for prioritization.
Alert and Alarm Noise: Providing Care While Minimizing Patient Irritation
Patients are sensitive to the noise in the hospital environment—much more so than the staff working there every day. A common component in clinical systems such as nurse call, patient monitoring, lab results, HVAC, and security is the ability to dispatch an alert. Consequently, more and more alerts are being generated. Many patients complain about overhead noise, especially in intensive care units. In fact, there is often a perceived delay in the response times to critical alarms and alerts because they are so prevalent. This perception may be affecting your patients’ satisfaction with their overall stay and how quickly they believe they and other patients are receiving care.
On the flip side, Joint Commission surveys have found that one of the root causes for patient deaths was “delayed or no response to alarms.” This can happen when there are too many alarms going off and staff members become desensitized. While the alerts are necessary and often save lives, the challenge for those receiving these notifications has become how to cope with alert overload fatigue. Not only can middleware integrate with your nurse call system to provide a direct link between patients and nurses, but it can also integrate with many other types of hospital systems to speed response. This software becomes a hub for managing and filtering the constant stream of alarms. It helps determine exactly who should get notifications and on which devices to cut down on alert overload. Good middleware solutions will also filter non-critical alarms and send the right alarm to the right person at the right time.

From a pure communications standpoint, there are many steps associated with a patient request—with potential delays at each point:
1. The patient initiates a request using the nurse call button.
2. A light is illuminated or an audible alarm sounds in the patient’s room and/or at the nursing station.
3. The nurse at the nursing station contacts the patient via the audible connection with the pillow speaker to determine what is needed. If bedside speaker communication is not available (i.e., if an older nurse call system is in place), the nurse must walk to the patient’s room to determine the nature of the request.
4. Once the request is understood, the nurse at the station will find an available nurse to assist in meeting the request (via overhead page, pocket pager, or wireless telephony). The available nurse may or may not be the patient’s assigned caregiver.
5. An available nurse stops the activity he or she is currently working on to answer the page. If the request is not urgent and all nursing staff are busy, there is the potential for delay.
6. This nurse either speaks to the nursing station attendant or walks to the patient’s room to understand the request. Both may be required in some cases to clarify the need.
7. Once the request is understood, the nurse must complete it. Carrying out the task may include providing medication, food, beverages, medical assistance, and/or relaying information and requests to a physician on call. If the nurse is not the patient’s assigned caregiver, that person may also need to be involved if the need is specific to previous activities.
8. The nurse completes the request and returns to the previous activity.
9. In some cases, the request may require additional time and attention or visits to the patient’s room for follow-up (i.e., if relaying information/questions to a physician is involved, or if family members need to be contacted, etc.).
In the end, there is the potential for dissatisfaction on three fronts. The nurse likely feels pulled in too many directions at once. The patient who initiated the request may feel it took too long to complete, and the patient whose nurse was taken away to work on the request may perceive a lower level of care.
How Middleware Technology Speeds and Simplifies Patient-Nurse Communication
An effective solution to improving the flow of communication is to link your nurse call system with the mobile devices already carried by your nursing staff. This is done through a real-time communication system often called nurse call integration middleware. This allows patients to contact their nurse directly on their wireless device as they’re on the move, regardless of where he/she is in the facility.
As an example, many hospitals use mobile communication devices from SpectraLink, Cisco, Vocera, and others for nursing staff. These allow nurses to speak directly with the patient to determine the need and priority without extra trips to the nursing station or the patient’s room.

Middleware software “glues” together nurse call systems and in-building wireless telephone systems to allow for quickly connected, two-way conversations between nurses and patients. In fact, the time between the patient pressing the button and the nurse receiving the alert on the phone is less than two seconds.
Why Middleware?
Middleware is powerful technology that provides the messaging backbone for critical alarm and event management in thousands of hospitals today. Not only does it streamline communication, but it simplifies the IT hassles involved with managing many disparate systems that previously weren’t linked.
This application connects disparate alarm and communications systems. In addition to nurse call systems, you can link your mobile staff with point-of-care alerts from patient monitoring, pulse oximetry, ventilators, infant abduction, and lab systems, as well as safety systems for fire, security, and building management, and others.
The software provides a common platform for linking these systems and their alarm notifications to both your existing technology and the mobile communication devices carried by your staff.
This allows the right people to take fast action, improving patient care and safety. The system is also an investment in the future of technology for critical alarm notification and the ever-changing communication device requirements of your staff.