David Pike

Extension Engage – Nurse Call Alerts with Advanced Event Response 

Challenges Concerning Clinical Alarm Management

The Joint Commission states that “the number of alarm signals per patient per day can reach several hundred depending on the unit within the hospital, translating to thousands of alarm signals on every unit and tens of thousands of alarm signals throughout the hospital every day.”1 The Association for the Advancement of Medical Instrumentation further states that between 85% and 99% of these alerts do not require clinical intervention.2 This overwhelming number of alerts received by nurses and other clinical staff members has negatively impacted the care received by patients.

Traditional clinical alert management systems simply notify clinicians an alert has been submitted. Without a more complex alert system that provides data concerning the type and clinical context of the alert, the productivity of the clinical staff is reduced and more serious alerts are not appropriately prioritized. Another risk of these alerts is the onset of alarm fatigue, which is when a nurse or other caregiver is so overwhelmed with alarms they become desensitized or immune to the alert.

Standard Clinical Alerting Process

Clinical alert management in many hospitals is provided by patients pressing a button on their bed to request assistance. Alerts are routed to the unit secretary, who must either page a nurse via a speaker system or use another equally inefficient means of locating a nurse to notify them of the request. Nurses must then visit the patient’s room to investigate the alert before they can begin addressing the patient’s needs. This alert process can increase patient safety issues due to potential delays in care resulting from a time-consuming, inefficient process.

Enhanced Clinical Alerting Solutions

Some hospitals have enhanced their standard clinical alert process through solutions that expedite the interaction between nurses and patients by bypassing the unit secretary and routing alerts directly to nurses via their phones. Some solutions enable the nurse to call a patient’s room to request additional information concerning the alert, which can further reduce the time required for the care delivery process; however, these simplistic alerting systems were not designed for bi-directional voice, event-driven, secure text messaging or health-critical alarms. These pager or email notification systems only address one function in a broader communication process, and their lack of contextual information restricts nurses from appropriately responding at the point of alert reception. These partial solutions can introduce new gaps into an already time-consuming, inefficient process and can increase patient safety issues due to potential delays in care.

Optimized Nurse Call Workflow

While basic clinical alert, nurse call, and messaging systems can assist in improving patient care, an advanced alarm management and notification solution provides a comprehensive clinical event response workflow that intelligently regulates alarms and facilitates care team communications from a single system. Implementing a comprehensive alarm solution establishes a central point of management for hospital-wide clinician and staff alarm notifications, and the solution would avoid redundant, silo-based investments in additional systems to address care alert and communication gaps.

Extension Engage is a unified clinical alarm notification, event-driven, secure messaging, and care team collaboration solution offered by Extension Healthcare. Extension Engage provides the ability to deliver alarms with contextual information, allowing nurses to immediately determine the most appropriate response to each alarm no matter where they are located. Alarms are delivered to nurses via their preferred wireless device, so they are now able to receive vital patient information and engage with the entire care team.

Benefits of the Nurse Call Solution

Extension Healthcare is solely focused on refining the clinical alarm and notification processes that currently exist in most hospitals. Extension Engage assists in addressing these issues, and it provides sustainable improvements in care delivery and associated performance metrics, all through a single system.

  • Decreases Crisis Escalation: Extension Engage helps prevent the escalation of patient crisis and reduces delays in care. By intelligently routing low-priority alarms appropriately and in a timely manner, Extension Engage can prevent a patient issue from escalating into a crisis. Also, nurses can triage alarms and address high-priority alarms more quickly, which improves patient safety and increases patient and staff satisfaction.
  • Notifies the Most Appropriate Clinician: Extension Engage efficiently delegates care responsibilities and facilities levels of services based on clinician licensure. This clinical workflow ensures the most appropriate use of clinicians. As an example, registered nurses can be sent alarm notifications related to high-priority issues, such as medication-related complications or patients experiencing a high pain score, while certified nurse assistants or nurse technicians receive alarms related to patient comfort requests.
  • Enhances the User Experience: Extension Engage offers an optimized interface focused on the needs of the clinician. By working with clinical teams and capturing facility-specific policies, Extension Engage is easily implemented within any existing hospital setting.
  • Improves Patient Monitoring: Extension Engage improves the efficiency of patient care throughout treatment, from arrival to discharge. Extension Engage accomplishes this by simplifying the process of addressing alarms, offering a quiet event response workflow, and assisting hospitals to meet their own internal policies related to patient response times. Also, improved patient responsiveness can enhance other vital areas, including accreditation, reimbursement, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, and local market reputation.
How Extension Engage for Nurse Alarms Works

Extension Engage applies advanced rules to ensure the delivery of near-real-time clinical order notifications to physicians. Extension Engage aggregates and stores data, including alarm, event, clinician location and availability, and other contextual information from multiple clinical and patient information sources. Advanced rules are applied to alarms based on the alarm type to intelligently compile appropriate content concerning the patient’s condition. This information is then delivered to a nurse’s preferred wireless device, allowing them to more appropriately respond to alarms.

Extension Engage’s advanced rules engine assembles, filters, and delivers relevant data to a clinician’s wireless device. Upon receipt of an alarm, the nurse can choose to respond in a number of ways. For example, using pre-programmed buttons on their keypad or smartphone, alarm recipients can request order instruction clarification from the ordering clinician. Secure smartphone and Voice over Internet Protocol (VoIP) texting allows care team members to share patient information without compromising protected health information (PHI). A true collaboration solution, Extension Engage can reduce inefficient gaps in the diagnostic process and reduce key time-to-treatment metrics.

Key Differentiators from First-Generation Medical Alerting Systems
  • Value-Added Alarm Functionality for Nurses
      • Distributes alarms through an advanced rules engine
      • Offers the capability to quickly locate and communicate with individuals and groups using name or role-based staff directory, standard unit roles, presence, and favorites
      • Improves next-step efficiencies through context-based alarm notifications
      • Provides hands-free awareness through distinctive ring/alarm tones and annunciated alarms
      • Leverages existing staff assignments from a variety of sources, such as nurse call systems, electronic medical records (EMRs), or the Extension Engage staff assignment module
      • Delivers consistent clinical order notifications, including desired notification behavior within the hospital network or off-site via cellular data
  • Ease-of-Use for Hospital Information Technology Departments
      • Offers one data center appliance that is completely scalable to a hospital’s needs
      • Supports all enterprise integrations, including EMRs, labs, nurse call systems, real-time location systems (RTLS), clinical document architecture (CDA) documents, and presence (time clock, staff assignment, clinician and patient proximity, etc.), through numerous data protocols, such as Web Services, TAP, and HL7
      • Leverages existing investments in directory services, telephony, networks, and unified communications
      • Balances security and clinical usability through flexible personal identification numbers (PIN)/password protection
      • Ensures complete data privacy through industry-approved security measures, including Health Insurance Portability and Accountability Act (HIPAA) compliance, data encryption, role-based user security, and adherence to each hospital’s data retention policies
      • Reduces dependencies and licensing costs through physical or virtual appliance deployment
      • Facilitates selective expansion of event-driven secure messaging and presence services through standards-based federation (XMPP)
      • Integrates with a variety of medical-grade communication devices
  • System Requirements
      • Extension Engage Alarm Safety Platform v4.0
      • HL7 Data Source
      • Supported Smartphone/Tablets
      • Supported Wi-Fi Communications Handsets
      • TAP v 1.8

1The Joint Commission. “Medical Device Alarm Safety in Hospitals.” (April 8, 2013). http://www.jointcommission.org/assets/1/18/SEA_50_alarms_4_5_13_FINAL1.PDF (accessed October 03, 2013)
2Association for the Advancement of Medical Instrumentation. “A Siren Call to Action: Priority Issues from the Medical Device Alarms Summit.” (2011). http://www.aami.org/htsi/alarms/pdfs/2011_Alarms_Summit_publication.pdf (accessed October 03,2013)


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