Imagine a world with less paperwork, real-time access to patient data, improved workflow, and enhanced outcomes. A world where clinicians have personal digital assistants (PDAs), receive consultative services through electronic intensive care units (eICUs), and remotely monitor the care of isolated patients in the comfort of their homes.

If you think this sounds like something from a futuristic novel, you couldn't be farther from the truth. Today, in many healthcare facilities across the nation, nurses in clinical practice no longer need to return to a central location to access patients' medical records, know individuals' current status, or check the most recent physicians' orders. Administrators are maintaining information by using database management tools, and educators are in the midst of technology driven instruction with online classes using the Internet.

Practicing clinicians are utilizing wireless technology to save time, money, and lives - and as a healthcare traveler, you have the unique opportunity to encounter this cutting-edge phenomenon firsthand. By choosing assignments with technology in mind, you not only can practice in exciting and challenging environments, but also become involved in the birth of new care delivery and case management systems. Adding to your already extensive knowledgebase, this experience can enhance your marketability and increase your value as a consultant to institutions nationwide.

WHAT IS WIRELESS TECHNOLOGY?
Wireless technology is a communication system in which electromagnetic waves carry signals across airwaves rather than over a cable, for the purpose of obtaining or sending information and/or services. Three types exist: fixed wireless (radio antennae), mobile wireless (cellular phones), and satellite.

Many recent technological advances are boons to this concept. The decrease in weight and size of mobile and hand-held devices, as well as reductions in equipment costs and the integration of browser-based applications, are making web-based applications more useful for physicians and nurses.

In "mobile healthcare" as it has been called, this technology enables point of care decision making, allowing practitioners to communicate without needing to be at a workstation, indoors, or even physically connected. The system can keep patient records current, fill or change prescriptions, check insurance information, and generally synchronize data to provide quality care. It has also been used to evaluate staffing levels and as input for employee performance evaluations.

BENEFITS OF CUTTING THE CORD
Of course, for clinicians in general and mobile professionals in particular, wireless technology in and of itself is not a new concept. "Beyond pagers," says Rosemary Kennedy, MBA, RN, a manager for Siemens Health Services, "the mobile phone is probably the most common equipment being used today by traveling nurses." PDAs and wireless access to the Internet follow close behind.

Even though wireless technology has been around for a while, healthcare organizations have been slow to embrace it. Instead, facilities have relied on traditional automated information systems - laboratory, radiology, pharmacy, and patient order management and results reporting departments - that typically have not aided clinicians at the point of direct patient care.

But now that the phenomenon has caught on, somewhat of a revolution may be taking place. Growth seems to be driven by the need for better health data and charting at the bedside. Wireless communication has already been proven to increase work quality, efficiency, and cost-effectiveness. The system eliminates manual data input and saves valuable resources.

It is being promoted as a medium for error reduction as well, according to Cheryl Smith, author of Is Wireless Technology at Hand for Healthcare? With the current national focus on patients' rights and medication errors, the ability to provide time-sensitive data immediately is key to positive outcomes. Compatible with the mobile attributes of present day healthcare, wireless data networking is also seen as a decision-support system, not simply a collector of data.

She notes that a recent survey, taken prior to implementing a wireless admission assessment, found that nurses spent 45 minutes completing manual documentation. Six months after the system was in place, the time necessary for performing an admission assessment was reduced to 25 minutes.

HOW IT WORKS
"The nurse executive and clinical staff are under tremendous pressure to integrate vast amounts of complex information in order to make quality decisions," states Ms. Kennedy. To assist nurses and other healthcare personnel in assimilating the considerable amounts of data gathered during a patient's stay, some acute care facilities have implemented wireless decision-support systems, with comprehensive collection and monitoring components. Centralized data management stations assemble information from patients' and nurses' remote devices.

This enables physicians and other members of the healthcare team to review data from various locations, thereby monitoring patients' conditions from admission to discharge and providing continuity. Access to this data promotes effective care and allows the patient to return home quicker and in better health. Explains Ms. Kennedy, "The 'application' collects the data, analyzes it, and even makes care recommendations in response to the information collected."

What this means for travelers is simple: Wireless technology can uncomplicate many of the challenges encountered on assignment. In particular, you would be able to access your facility's policies and procedures, patient education files, and key contact information with the touch of a button. Depending on the system in place, you may even have the added benefit of support services from off-site colleagues. Further, experts believe this communication system will help nurses nationwide to maintain the same standard of care at the bedside for observation and patterning.

PILOT STUDIES
With many facilities across the country being used as testing sites for new wireless products - like pen-based portables and personal digital assistants - travelers might have the opportunity to participate in state-of-the-art care sooner than expected. For example, the American Academy of Neurology is managing a nationwide program to evaluate compliance with treatment guidelines in patients with ischemic stroke. In this setting, the University of Florida Department of Neurology at Shands Jacksonville in Jacksonville, Florida, is the site for a pilot project of data acquisition and transmission using hand-held devices (Palm).

When Barbara Quinn, MSN, RN, CDMS, CCM, the stroke program coordinator, arrived at Shands Jacksonville in 1999, paper charting was the norm. She found it very labor intensive and has since progressed to an Access data bank and Palm Pilot. The information gathered by this nurse and two neurologist colleagues is used for quality assurance in patient care.

How does the process work? Since it is essential to know the date and time of when a person suffers a stroke in order to administer treatment, it was determined that this and other relevant information should be housed in a new database, coupled with content from a national databank that includes suggestions for appropriate patient care. Together, the data will be used to standardize guidelines in treating stroke patients.

Within a short time, the institution received a 490 percent return on investment and 10 percent additional captured inpatient charges. The cumbersome paper trail - a point of dissatisfaction for nurses - virtually disappeared, billing processes were streamlined, and communication between physicians and support personnel improved, as did staff efficiency and workflow.

Critical care travelers would be hard-pressed to find a more exciting environment than that at Sentara Healthcare. Implementing eICU technology in four units at three of its facilities - for a total of 50 ICU beds - the organization provides staff with consulting services from intensivists and critical care nurses at remote sites. These practitioners assist clinicians via computer in monitoring patient care, promoting early detection of problems and prevention of complications, as well as facilitating transfers when necessary.

As reported in recent issues of Critical Connections and Advance for Nurses, cameras, microphones, and speakers placed in each room allow for off-site providers to view and communicate with attending staff as well as patients and their families. Bedside data is collected continuously and available for review in real-time, along with health and treatment histories, prescriptions, lab results, and notes. This technology promises to reduce medication errors, eliminate omissions in charting, and identify problems early so timely interventions may be implemented. It also does away with potential misinterpretations from inaccurate transcription or illegible handwriting. Described as a "significant recruitment and retention tool," the eICU improves teamwork and collegiality between nurses and physicians while reducing stress.

All indications are that the system has had a positive effect on care delivery. Consider Sentara Hampton General Hospital, where it was implemented in September 2000. In "E-ICU: The Future is Now," Mary David, MSN, RN, CCRN, and Susan Jones, EdD, RN, CCRN, note that the concept offers a solution to the shortage of intensivists and critical care nurses nationwide and especially in rural areas. "[E-ICU's] presence, via remote monitoring, in our critical care units has reduced severity-adjusted hospital mortality by 25 percent, ICU length of stay by up to 17 percent, and resulted in a savings in healthcare costs of more than $2,000 per patient."

OUTPATIENT SETTINGS
Mobile healthcare professionals who contract in outpatient settings also benefit from wireless technology. Electronic Medical Records (EMRs) allow data to be entered from the time patients schedule an appointment, through nursing assessments, physical exams, and completion of insurance claims.

HOME HEALTH APPLICATIONS
Of course, this concept has spread outside healthcare facilities into patients' homes as well. Home health nurses use wireless technology to conduct "video visits" to homebound patients, gathering objective and subjective information. Portable monitors accurately measure certain critical factors, such as vital signs and blood chemicals, and provide warning signals for lethal heart rhythms. Patients are monitored directly following surgical procedures, and real-time information may be sent to attending physicians or nurses.

Since providers' expertise is immediately available for high-risk patients, without the need for ED visits, early warning devices are reassuring to individuals and family members alike. Connected to caregivers by cell phones and PDAs, patients with chronic diseases can go about their activities of daily living, playing an integral role in managing their own care. Compliance with drug therapies may be further enhanced with new cell phones that provide short messaging service (SMS) capabilities with reminders (including prompts for taking medications on time) as well as real-time updates.

Many home health nurses use pen-based pads to carry patient records and update files with standard on-screen lists. At the end of their shifts, they use a wireless cellular digital packet data network, or standard dial-up, to download the latest patient information to a data center. Able to access patient charts, obtain their schedules, research medical references, and fill out the numerous forms by using PDAs, they can eliminate three to four hours of traditional paperwork.

Two success stories in the home setting involve reduced admissions to acute care facilities for patients with congestive heart failure (CHF). Sentara Home Care Services recently announced a 95 percent decrease in the number of readmissions after a home telehealth system was installed in individuals' homes. Similarly, New Ulm Medical Center Home Health, part of Allina Hospitals and Clinics, reported that none of its CHF patients monitored by the system was readmitted for that condition.

"This way of delivering healthcare brings enormous benefit to sick, elderly, isolated patients with limited access to a healthcare facility," noted U.S. Senator Susan Collins (R-ME) recently. "Telehealth enables thousands of our most frail and vulnerable elder persons to avoid hospitals and nursing homes and stay right where they want to be - in the comfort and security of their own homes. In addition, telehealth clearly provides answers to many of the stresses on our resource-strapped healthcare system."

EDUCATIONAL BENEFITS
In addition to benefiting from telehealth services, growing numbers of patients are utilizing the Internet's resources to become informed consumers, learning more about their health conditions online. Experts believe the Internet could also assist in care delivery and increase patient participation in their treatment regimens by encouraging healthcare providers to answer non-emergency questions by e-mail - a choice preferred by many over being put on hold or waiting for a call back.

For travel nurses, the Internet is the perfect place to continue their education while on the road. "While wireless access to the Internet is expected to increase," notes Ms. Kennedy, "there are more people using a standard wired connection than a wireless one, and this will probably continue to be the case for several years."

Regardless of how professionals connect, distance learning educational programs are extremely popular. Course syllabi, handouts, and readings are posted on the web, electronic data searches make research papers and assignments less formidable, and even examinations are completed in an allotted time frame, at the convenience of individual participants. For a glimpse at the offerings available online, check out HT's Going the Distance department in every issue and on www.healthcaretraveler.com. From CEUs to bachelor's, master's and even doctoral degrees, wireless technology is well suited to meet the needs of today's mobile faculty and students.

BARRIERS TO USE
With all of its benefits, wireless technology does have a few obstacles to overcome in the healthcare community. Barriers include concerns about patient safety and confidentiality, as well as cost and security issues. Also, some patients have been intimidated by computer equipment near their beds. The biggest difficulty, though, has been getting clinical staff to accept the technology. While computers may intimidate professionals who are more comfortable with traditional paper charting, those who have embraced wireless report that the information flow is quick and they have more time at the bedside.

If you have actually experienced the benefits of wireless, reduce the potential for barriers by increasing public awareness. On assignment, educate colleagues who may have questions while implementing the new technology, consult with those executives considering system development, and discuss advantages with patients, particularly the chronically ill and the elderly.

WIRELESS FOR ROAD WARRIORS
Certainly, it is an exciting time for nurses, as technology enables them to take control of their profession in more effective and efficient ways. With wireless continuing to expand, you - as a traveler - have the unique opportunity to experience its dynamics on the road. By choosing contract facilities carefully, you can become involved in the next generation of wireless - from research studies to new equipment to state-of-the-art remote facilities - and share your knowledge with administrators at other, less technologically advanced institutions. "This technology is long overdue," states Ms. Quinn, who admits she could not survive without her hand-held. "Wireless is beneficial and necessary, improving accuracy and continuity of care."

References
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American TeleCare, Inc. (2002, August 13). American TeleCare, Inc. announces 95% decrease in CHF hospital readmissions at Sentara Home Health [press release]. United Business Media, PR Newswire.

American TeleCare, Inc. (2002, July 24). American TeleCare, Inc.: New Ulm Medical Center Home Health reports no hospital readmissions for CHF patients monitored with home telehealth system [press release]. United Business Media, PR Newswire.

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