Victorian Heart Hospital opens without the use of pager devices

A digital evolution is taking place at a new cardiac hospital, where an app aims to solve decades-old communication problems among healthcare staff.

Monash Health Victorian Heart Hospital has recently opened, equipping staff with an app, instead of paging devices.

A new cardiac hospital in Melbourne has opened without the use of pager technology as an internal communication tool between healthcare workers.

Instead of paging devices, the Monash Health Victorian Heart Hospital has opted to equip its staff with a role-based messaging app called Baret, which can be securely installed on personal and hospital-supplied smartphone devices.

The app was created by IT consultancy FiveP and uses the Microsoft Teams platform to tackle some of the biggest challenges in healthcare communications. The first being finding specific clinicians and staff, quickly, based on role type at any given time. And the second – clinicians often need to select the most efficient communication method to reach their colleagues when a range of channels are available.

Over the decades, these channels have grown to include text messages and messaging-based apps, as smart phones have become widely adopted for personal use. According to a recent international study in medical journal Applied Clinical Informatics, more than 50 per cent of medical staff and 33 per cent of nursing staff use an unauthorised messaging platform.

The Baret app aims to create a more seamless message thread between different people who are performing the same role.

Its messaging function means the need for repetition of communication or translation of information is removed, for example, when staff hand over to colleagues between shifts.

Rather than sending a message to an individual clinician via a pager or messaging app, Baret can also eliminate the often time-consuming process of locating the relevant, on-duty and available doctor.

There are costs to inefficient clinical communications, which FiveP flagged as part of its development of the app. In a recent white paper, it noted that communication failure among clinicians causes 70 per cent of preventable “adverse patient events”. Handovers between staff shifts are especially problematic. With 69 million handovers occurring per year in Australian hospitals, the volume is high and the need for communicating with accuracy and speed is essential.

As data breaches and cyber security risks are also becoming more frequent and sophisticated, the need for secure communications, especially in the safe and secure keeping of patient health information, was also a factor in implementing the technology.

“People get frustrated when they can’t do the things that they want to do. And nowhere is that more important than in healthcare,” said Matt Krosch, chief marketing officer at FiveP.

“We’ve interviewed scores of people, and they all tell us they want to work efficiently, and they all want to work safely.

“That’s the two biggest key areas of someone who works in a health service. So our solutions really speak directly to that.”

The tool looks and operates similarly to messaging systems that individuals with smartphone devices are used to using daily, making uptake intuitive.

In opening the Victorian Heart Hospital, the sixth Monash Health hospital in Victoria, associate professor Michael Franco, chief medical information officer and program director of electronic medical records and informatics at Monash Health said: “It’s just a simple, elegant solution to a problem that has just been ingrained and hard to get away from.”

According to Dr Franco, pagers have been historically hard to eliminate from hospitals for a few reasons. “I can think of even up until three years ago, there were dead spots in either mobile network or WiFi range. And you can’t afford that if you’re the doctor who’s on for all the emergency calls. The one thing they had was being really darn reliable, and not being open to those sorts of problems,” Dr Franco said.

“We’re now in an era where hospital grade WiFi networks mean that’s not the case anymore. So it’s just about getting over that inertia and finally going away from pagers and some of the old ways of communicating.”

Because the app uses Microsoft’s platform for organisations, Baret’s users also benefit from the security of the tool.

“One of the other reasons that it’s taken quite a while to move away from pagers has been concerns about confidentiality and security,” Dr Franco said.

“And having this Microsoft infrastructure completely that’s our own Monash Health environment, means that even if someone wants to use the app on their own phone, nothing is stored on the phone.”

He added that the tool has been implemented with the present-day needs of staff and patients in mind: “We wanted to make sure that this hospital really was built for the 2020s … not the 1970s or 1990s.”

The app was initially deployed at Monash Health across their five hospitals in August last year. One key objective of the initial Baret deployment at Monash Health was to reduce the volume of internal switchboard calls, which in turns helps to free up switchboard staff to answer calls from family members and patients. Since the Victorian Heart Hospital opened in February it is already getting volume in uptake.

“We’re talking about 3000 employees on this system and around 32,000 roles clocked on to shifts so far, and we will expand our footprint across the rest of Monash Health in the coming months. It’ll be exciting to liberate doctors and other clinicians from their traditional pagers.”

Meanwhile, at Austin Health, routine paging is being systematically removed from clinical practice, with 40 teams retiring pagers from service to date.

It was within Austin’s hospitals where Baret was originally developed with FiveP in 2021 in close collaboration with frontline clinical staff.

Nicole Hosking, operations director at Austin Health Radiology & Molecular Imaging and Therapy, who led the charge on the initiative, is on a mission to do away with pagers entirely.

She said: “To find a clinical role 24/7 in a rapid, consistent way was our objective No.1, and then two, we wanted to be able to replace several communication methods with a single more contemporary method.

“It was developed with industry – so it was designed to meet current role-based clinical communication needs.”

Ms Hosking’s office provides a window into the fruits of her efforts; two glass vases filled with 136 retired paging devices sit on a desk. She said there are another 250 not in use, ready to be collected.

“Not unlike other organisations, the communication is very complex within the organisation,” Ms Hosking said.

“There was a change in accreditation standards for hospitals where the clinical communication parameters that we were assessed against were broadened.”

As part of this change in standards, Austin Health reviewed its processes and felt that it could improve upon its practices with more contemporary technology.

“We’ve never before seen workforce shortages like we’ve had, but that’s on top of us just being very, very busy people providing patient care.” Ms Hosking said.

“I think there’s always a constant driver in healthcare to look for a faster, more efficient way to do things accurately.

“So there’s a drive there and recognition that communication can always be improved as well. And the technology’s just incredibly easy to use. You don’t need a complex training program. You can literally watch a few introductory videos and off you go.

“We’ve had very good rapid adoption of the technology. And in particular, our use of the application went up significantly when we brought the junior medical staff on board.”

Since rolling out the app between June and December last year, Austin Health has completed more than 200,000 closed loop messaging communications within Baret, which includes more than 750,000 message interactions between staff.

“It really did start from something that Austin Health had identified as something they needed to address,” Mr Krosch said. “But that challenge of being able to communicate in a peer-to-peer sense where you’ve got limited information in an evolving, highly time sensitive environment is something that exists in every hospital in the world right now.