Call bell response times: More than just timeliness

As a patient on the ward at the National Naval Medical Center in Bethesda during the beginning of Operation Enduring Freedom (OEF), I had many occasions where I needed assistance from the nursing team. I didn’t track their times of arrival, but I gauged their performance on how they responded to my needs. Overall, it was good enough where I didn’t feel the need to complain about it. I use these two elements as a basis for discussion of response times and whether they are worth tracking. Is it a fair question on the HCAHPS survey?

Let’s look at the current tempo of our wards since the pandemic. The wards have been busy, without question. Looking at the census of many inpatient facilities, they have increased over the last year and a half by 50%; more in some areas where the COVID-19 rates have been higher and more intense. Increased alerts and duties have been instituted on the wards and the nursing staff, which have made the work more comprehensive, and in some cases, overwhelming. However, a fundamental duty of the nursing staff is to respond to the call button of a patient. You may ask, is this totally on the nursing staff to take on? Depends on who you talk to.

This writer’s opinion is that it is a team effort. For example, as a Patient Experience Officer, I find myself called upon to speak with inpatients on a regular basis about their concerns or if they just want to provide input on their stay. If I see a call light blinking and I notice that the nursing staff is slammed, do I just walk by the room and do nothing? Well, that’s not me, and I can’t do that and be happy with myself. I think it’s incumbent upon me as a team member to at least look in on the patient and ask if there is something I can do. If nothing else, the patient knows that someone saw the call light and is acting upon it.

The real issue for response is not just the timeliness. It is also the quality of the response. For example, a hospital in Fresno, CA tracked the times that a call light was answered. It turned out that the average response time to a call light over a six-month period was 1 minute and 43 seconds. Not bad, right? Their expectation was that their HCAHPS scores would be amazing. Not true. Their scores continued to decline. So they then looked at the quality of the response. As it turned out, nurses were attending to the call lights in an efficient way, but the patients were not satisfied with the response.

A real-time survey was then implemented to gauge both the timeliness of the response and whether the patient was satisfied with the result of the response. The survey was able to break down the reason patients pressed the call button and whether that reason was acted upon and resolved. It turned out that the average time needed to satisfy the patient’s reason for pressing the call button was over 4 minutes. The survey indicated that while nurses were responding timely, they were then called away before they could completely satisfy the reason the patient pressed the call light in the first place. As you can see, the challenge was having enough time to completely satisfy –  and maybe even delight – the patient, which was more time-intensive than originally anticipated.

So they decided upon a team approach by implementing “No Pass Zones.” This meant that not only the care team would respond to a patient call button but anyone who was in the area could help. If the reason the call light was pressed could be handled quickly, such as the patient had dropped something, a non-nursing staff member could take care of that expeditiously. If it was something more clinical in nature, the non-nursing staff would contact a member of the care team. Just-in-time training was incorporated for nursing and other hospital staff such as IT and Patient Experience. Under this new process, calls were answered timelier and patients were happier. As it turned out, the scores for Responsiveness improved and continue in an upward trajectory.

Leadership is essential to help move the needle on many of the processes in a healthcare facility. More importantly, an open environment for communication among the staff is critical.  Sharing ideas on improvement, not only with each other but also with the leadership, will help a unit, department, service, and organization gain momentum when it comes to addressing important issues like helping patients in need.

Robert Rahal is currently the Veterans Patient Experience Officer at the VA Central California Healthcare System in Fresno, CA.  He started his career in service as a hospital corpsman in the United States Navy. As a Veteran, he has a connection with the Veterans that come to the VA Medical Center at Fresno. He enjoys helping Veterans, their families and caregivers to navigate the sometimes-challenging processes at the VA.