Improving Workflow and Patient Care with Voice

In the skilled nursing home environment, the two most important things are the quality of care provided to residents and maintaining financial stability. Church of God Home, a Carlisle, Pa.-based continuing care retirement community that offers independent, assisted-living, and skilled nursing care units for about 200 residents, has improved on both of those since deploying AccuNurse, a voice-powered work management, documentation, and communications system from Vocollect Healthcare Systems, about a year and a half ago.
“There is no doubt that AccuNurse has played a significant role in our outstanding care record,” says Carson Ritchie, president and CEO of Church of God Home. “Growth in the development of our community, increased self-esteem among the residents, and high morale among the employees are good indicators of our organization’s health. When they are achieved in an atmosphere of financial soundness, we are assured that our mission is being carried out effectively and efficiently.”
AccuNurse is a voice-activated, hands-free and eyes-free system that blends proprietary speech recognition and text-to-speech technology with back-end process improvements. With the system, nursing staff members pick up a lightweight headset and small belt-worn computer terminal at the start of their shifts. After logging into the system with their voices, a central patient care management system relays voice-guided instruction on their daily assignments and guides them through detailed care plans for each patient under their care. Staff members dictate back to the system to document the care as it takes place.
Staff members also have immediate access to a patient’s full medical history and critical information. Doctors, dietitians, physical therapists, pharmacists, and other caregivers enter a patient’s critical care needs into the system when a patient enters the facility, and can update the information as the patient’s needs change.
“If a doctor puts a patient on a specific medication and the nurses’ aide is not aware of it, it could spell disaster,” says Roger Byford, president of Vocollect Healthcare Systems. This system eliminates that risk.
“AccuNurse is a good way of recording what they did, and ensures that they do not forget or overlook what needs to be done,” Ritchie says.
Church of God Home has a full-time staff of about 175 people and about 90 volunteers. “All our nurses aides and supervisors have them on every shift,” Ritchie says. “Staff acceptance is high. At first it was a big deal, but now they go about their day without even thinking about it.”
A built-in Silent Paging function also allows staff members to contact a single coworker or put out a system-wide message instantly, quietly, and without ever having to leave a patient’s side. Searching for coworkers, paging over the facility’s intercom, and interoffice phone calls within the nursing department have all been reduced by as much as 75 percent. This component of the system also ensures faster staff response time to any incident.

REDUCED PAPERWORK
Perhaps one of the biggest benefits so far has been the elimination of end-ofshift paperwork, reporting, and information exchanges. That alone has saved the facility more than $150,000 in staff overtime that is no longer required. “Previously, at the end of their shift, they had to document all that they did during the day. They stayed later to do that, and we had to pay them overtime,” Ritchie explains. “Now, we also see faster shift changes because the shift that’s leaving does not have to stay to advise the staff coming in about what went on during the day, what they did, etc. It’s all there for them over the headsets when they come on [duty].”
Documentation is also more accurate as the system automatically logs all patient care activities as they happen. That is a huge advantage when it comes to filing for Medicare and Medicaid reimbursement, the main sources of revenue for a nursing home. The level of reimbursement that a facility receives is based on a case-mix index (or CMI), which is calculated according to the average number of minutes that staff needs to care for each patient individually, given the patient’s special physical and mental conditions. With the improved documentation that AccuNurse provides, Church of God Home has seen its CMI rise from 1.27 to 1.34 in the first seven months after installing the system.
Of its estimated 200 residents, 109 are currently housed in the nursing home environment and most require special care. “Each small point in the CMI equals about another $15,000 in revenue a year,” Ritchie explains. “If we couldn’t accurately document what we did for each patient, we wouldn’t get paid for it.”
“Nursing homes work on small margins as it is, and missing reimbursements can have a significant effect on their bottom line,” Byford adds.

HIGH RATINGS
In addition to meeting its residents’ daily care needs, Church of God Home has also received exceptional ratings in its most recent annual review by the Pennsylvania State Department of Health’s Healthcare Regulatory Services Agency. Its experience in achieving a superior survey outcome is a powerful testament to AccuNurse, Ritchie says. “We’ve achieved every one of our objectives with AccuNurse,” he states, “and AccuNurse helped us achieve an exceptional outcome in the state’s annual inspection process, which is rigorous.”
AccuNurse was originally developed by Adherence Technologies, which was acquired by Vocollect in March 2006 and rebranded as Vocollect Healthcare Systems. The technology mirrors voicedriven labor management systems that Vocollect has marketed for warehousing and logistics operations for years.
In addition to Church of God Home, AccuNurse has also been deployed at Falcons Landing in Potomac Falls, Va., a retirement community owned and operated by the U.S. Air Force Retired Officers Community; and Kendal at Longwood, based in Kennett Square, Pa.

CHURCH OF GOD HOME At a Glance: _LOCATED IN CARLISLE, PA. _ AFFILIATED WITH THE CHURCH OF GOD. _ HOME TO 200 RESIDENTS IN INDEPENDENT, ASSISTEDLIVING, AND SKILLED-CARE UNITS; 109 OF THEM ARE HOUSED IN THE NURSING HOME. _ A STAFF OF 175 FULL-TIME EMPLOYEES AND 90 VOLUNTEERS, MOST OF THEM IN THE NURSING DEPARTMENT.

“We’re still in the early stage of deployment and growing our user base,” Byford says. “There are about 17,000 nursing homes in the United States. The system is really quite scalable. Though the average nursing home has about 100 beds, some of the larger ones have 600 to 800 beds, so there’s really a very large opportunity for us.”
For Ritchie and Church of God Home, the results have been outstanding. “There have been a lot of intangibles to our return on investment that we can’t measure. Our experiences with Vocollect have been very positive. AccuNurse has definitely improved our quality of care,” Ritchie states.
“Vocollect worked with our staff to make sure everything was installed correctly and up and running. We’ve had them back every six months or so to make sure that the system is working properly and that we’re using it to its maximum capabilities. We’ll continue to have them here, and the staff is 100 percent committed to the system,” he concludes.