PTT as comms tool in hospital emergency departments

A Saudi Arabian study found a quicker and safer method to inform all hospital staff during the pandemic.

A study was recently conducted during the COVID-19 pandemic to assess the effects of using a smartphone-based push-to-talk (PTT) application on communication, safety and clinical performance of emergency department (ED) workers during the COVID-19 outbreak.

Titled ‘A Push-to-Talk Application as an Inter-Professional Communication Tool in an Emergency Department During the COVID-19 Pandemic’, the resulting paper was published by Dove Press. The authors were: Osama Kentab, Khaled Soliman, Ahmad AAl Ibrahim, Abdulaziz Alresseeni, Khalid Aljohani and Muna Aljahany. The first five worked at the emergency department of King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia. The last author is at Clinical Sciences Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia. The paper was accepted in April 2022.

Following is an approved summary of the paper approved by the publisher Dove Press.

Study design

An observational, cross-sectional study was conducted at an emergency department (ED) in an academic medical centre. All ED staff members, including physicians such as consultants, specialists, residents, and interns, plus nurses, emergency medical services staff, technicians (X-ray) and administration employees, were involved.

Because of distinct and unique challenges in EDs, where overcrowding in unrestricted-access areas is evident on a 24-hour basis, it is crucial to implement an effective inter-professional communication and take infection control measures. Communicative disruption in EDs may become more significant with the opening of new isolation areas, which are remote from EDs.

As such, there was a need to improve communication via instant messaging among ED staff to take the relevant precautionary infection control measures upon receiving a suspected patient. An efficient alarm system relies on rapid, secure and non-disruptive tools. Instant messaging through mobile phone applications may provide promising solutions for healthcare professionals.

Instant voice messages sent via push-to-talk (PTT) applications installed on smartphones offer network-based rapid alarm systems that facilitate communication. PTT applications provide instant connectivity as there is no need to dial specific numbers to contact others. They also provide real-time group contact and most of them are affordable: free of charge or cheap.

For these purposes, the use of a voice messaging PTT application on smartphones was mandated at King Abdullah bin Abdulaziz University Hospital (KAAUH), Riyadh, Saudi Arabia, during the COVID-19 outbreak. KAAUH belongs to the Princess Norah bint Abdulrahman University campus.

Participants were invited to fill out an online questionnaire 30 days after using a PTT application for sharing instant voice messages during the COVID-19 outbreak. Ultimately, there were 128 eligible participants.

The use of the PTT application at the ED

The PTT application (Zello 4.96.3 PTT Walkie Talkie, Zello Inc.) was used to create a specific channel as a radio platform for information sharing and communication among ED staff. Instant voice messages sent via the PTT application installed on smartphones offered rapid alarm systems that facilitated direct and clear communications.

All doctors and nurses were added to the channel and they were trained to use the application without sharing personal data, such as patients’ names and medical record numbers. The personal smartphones were packed in specimen bags in a clean area before entering the respiratory zone to limit their contamination.

All staff were instructed to share notifications and emergency information about the patients upon presentation, such as the triage category and the respiratory severity score. Registration officers were also added to the same channel to register patients’ data into the ED system after receiving information over their smartphones. All hospital staff subscribed to the PTT channel were regularly notified about patients referred for admission in internal wards or intensive care units, such that they could get prepared and equipped with PPE.

Effects on communication, infection control measures and job-related stress

After 30 days of using the PTT application, ED staff reported general improvements in all domains of communication and taking precautionary measures during the epidemic within the department.

The highest levels of agreement regarding the impact of the PTT on the performance at the ED was concerning the improvements in preparedness, followed by patient assessment time, and the effects on the overall performance. In total, 94 of the 128 participants recommend the use of the PTT application in other non-COVID-19 areas.

Significant low proportions of the participants agreed that they received fake alerts, voice messages were annoying or they experienced delays in real-time notifications.

Principal findings

The intradepartmental, inter-professional use of a PTT smartphone application for one month led to significant improvements in communication as perceived by approximately three-quarters of the participants. Additionally, the safety of the staff and the time required to implement preventive measures improved after exchanging the instant voice alarms through the application. These were reflected in both clinical performance and preparedness.

The novel system ensures quick communication among the staff in the isolation area and those working in the ED in a single press of a button without the need to make phone calls, emails, etc. The results of our analysis can widen the applicability of the alarming system to other isolation areas and the concerned hospital departments, such as infectious disease departments, internal medicine, microbiology and intensive care units.

With the use of the PTT application, our recent findings during the COVID-19 outbreak indicate that various aspects of communication have improved, which include the efforts needed to communicate, improved access to other medical and nonmedical HCWs and improved responses to notifications. Since patient transfer to the isolation area would take approximately three to five minutes, the notified nurses and physicians would have enough time to get prepared and wear PPE. Furthermore, administrative issues would have been resolved since the employees on the same PTT channel would be notified (even while being at home) to intervene immediately, especially when there are no available beds for admission.

Conclusion

In conclusion, the use of a PTT application in the ED, KAAUH, Saudi Arabia, was associated with self-reported improvements in all aspects of intradepartmental communication regarding instant notifications of receiving suspected patients with COVID-19. This included reduced efforts to communicate, improved staff responses and improved access to other staff members. This was reflected in the safety of staff members via reducing the time required to implement infection control protective measures and giving sufficient time to HCWs to wear PPE before the arrival of the suspected patient.

In addition, the clinical performance improved owing to improved preparedness and reduced patient assessment time. Future large-sized, multidepartmental studies are needed to corroborate the applicability and usability of the promising PTT system.

The assessed PTT application can be generalised to other departments and hospitals dealing with patients with COVID-19 to optimise staff safety and institutional preparedness.

‘Open Access Emergency Medicine 2021 13 189-199’ Originally published by and used with permission from Dove Medical Press Ltd.

Image credit: ©stock.adobe.com/au/Tyler Olson