Tuning In to Patients’ Cries for Help

Stuart Bradford

Tom Kerr of Pittsburgh will never forget the long-distance call from his elderly mother, who was in a hospital in the Cleveland area with a broken leg.

She phoned her son, more than 100 miles away, because no one in the hospital was answering her call button.

Mr. Kerr quickly called the hospital operator, tracked down the floor nurse and asked for someone to check on his mother.

“She had to call me long distance, and then I had to call the hospital long distance,” he recalled recently. “I complained to the hospital about the lack of a response to her call button and received an apology. There was obviously no defense.”

Whether it’s a request for ice water, help getting to the bathroom or a plea for pain relief, an unanswered call light leaves hospital patients feeling helpless and frustrated. And for nurses, often the first responders to these calls, the situation is frustrating too: Short staffing and a heavy workload often make it impossible to respond as quickly as they would like.

Now some hospitals around the country are starting programs to deal with the problem.

Presbyterian Healthcare Services, which operates three hospitals in Albuquerque, began focusing on improving the efficiency of its call light system after hearing complaints from focus groups of nurses and patients.

The company discovered that requests could be handled far more efficiently if call-button calls were sent to a central operator.

That operator can summon support workers via text message to take care of simple requests, like pillows or help with the television remote, freeing nurses to deal with bigger problems like pain relief or tangled IV lines. The hospitals now use the system in 13 units with a total of 400 beds, with plans to expand it further.

“We’ve really fundamentally changed the way we interact with our patients around their needs,” said Lauren Cates, the hospitals’ chief operating officer. “If you press a call light you have no idea if anyone is listening. Now we interact with the patient much more quickly.”

In national patient satisfaction surveys, Presbyterian has moved from the 40th percentile in call response promptness to the 75th percentile. And the company says it has seen a 92 percent reduction in patient complaints about lack of communication.

Moreover, of the 1,400 patient calls the system receives each day, about 10 percent are mistakes, caused by rolling over on the button or mistaking it for the television remote.

“Think about how much wasted time, with 140 errors a day, for our nurses who had to drop what they were doing and respond,” Ms. Cates said. “It’s made a real difference in the productivity of our staff.”

In one case, a patient gasping for air hit the call button, which the operator answered in a matter of seconds. When the operator heard the patient’s distress, she alerted an emergency response team, which rushed to the bed and performed CPR, saving the patient’s life.

At Montefiore Medical Center in the Bronx, a program called No Passing Zone trains all hospital workers — maintenance people, secretaries, volunteers, security officers and, yes, doctors — to stop what they are doing, if possible, and look in on a patient when they see the call light illuminated.

“The call bell is the patient’s lifeline,” said Jeanne DeMarzo, clinical director of nursing. “We need to act quickly and promptly to respond to the patient’s concern.”

As the Albuquerque system found, many call-light requests can be handled by nonmedical staff. When the patient has a medical need, the responder immediately tracks down a qualified employee to take care of it.

In addition, under a “rounding” program, a nurse, administrator or hospital aide must stop by each patient’s room once an hour, regardless of whether the call light is on. “Rounding proactively to address patient needs helps avoid use of the call bell,” said Joanne Ritter-Teitel, vice president and chief nurse executive.

Even doctors sometimes answer patient calls. “Bedpans are certainly one of the things I would happily reach for if a patient needed one,” said Dr. William Southern, chief of hospital medicine at Montefiore. “Call bells are something that me and my entire staff think it’s important to answer. It’s extraordinarily important to patients and their families.”

For patients, changes like these can’t come soon enough.

Walter Rhett, 59, of Charleston, S.C., spent time in the hospital last year for thoracic surgery and needed assistance going to the bathroom after being given laxatives. The cord to the call button device was tangled in the various tubes connected to hospital machines. After ringing for the nurse he waited and waited, but no one arrived. Finally, unable to wait any longer, he soiled his bed and rang the nurse again to be cleaned up. That time, the nurse showed up quickly, he said.

When Liz Farrar, 30, of Austin, Tex., was trying to breast-feed her day-old son last year, she called the nurse repeatedly for help.

Gestational diabetes during pregnancy had put the baby at risk, and when she did not get immediate help with breast-feeding and, later, a bottle, the baby’s blood sugar dropped and he wound up in the neonatal intensive care unit for five days.

“After the first night, every nurse and doctor were very helpful,” said Ms. Farrar, whose son has fully recovered. “But it makes my temperature rise just thinking about the first night.

“Bottom line, never leave anyone in the hospital overnight by themselves immediately after a procedure or birth, even if they tell you it’s O.K.”