Emergency Call Systems
A Quality Indicator?

Southern California Renal Disease Council, Inc.
ESRD Network 18

AUTHORS:    Vickie Peters, RN, MSN, MAEd, CPHQ, Q. I. Director, NW 18
                       Cecilia Torres, RN, BSN, Patient Services Coordinator, NW 18

NETWORK 18

DESCRIPTION/BACKGROUND: During 1998 and 1999, several patient complaints were received by the Network regarding lack of emergency/nurse call lights at each dialysis patient’s treatment chair.  Recent remodeling of the facilities, or opening of new facilities, resulted in call systems not being installed at each patient station.  The cases were presented at the Patient Advisory Committee and the Medical Review Board, who felt that the issue was important enough to warrant preliminary study.  (There is currently no Federal or California state requirement for nurse call lights at each patient treatment station.)

PURPOSE & GOALS: The initial purpose was to investigate the prevalence of bedside emergency call systems in the hemodialysis facilities in Network 18.  A secondary goal, based on initial results, was to examine if there was any correlation between a specific patient outcome measure and whether a call system was present in a particular facility.

METHODOLOGY: Initially, a brief survey form was sent out to facilities, asking basic questions: is there a nurse call button at each treatment station, is the button audible, does it light up and turn off at the patient station, and does it light up at the nurses station?  Although the survey was anonymous, most facilities faxed the one-page survey form back to the Network office, with either written comments (pro or con) included, or their facility fax cover sheet containing information.  After the survey forms were returned, the Medical Review Board could not make any conclusions or recommendations, and asked for additional information.  A suggestion was made to try to identify as many facilities participating as possible, examine the facility’s most recent Standardized Mortality Rate (SMR), and group the facilities into two groups: one with bedside call systems (the YES group), and one without (the NO group).  The same was done with another patient outcome measure, the Standardized Hospitalization Rate (SHR).  Other than for the purpose of forming the groups, no other facility-specific profiling was done.

SUMMARY OF FINDINGS: There were 153 (out of 212) survey forms returned.  Of those 153, 82 facilities responded that they had a nurse call button at each station, while 71 facilities did not.  These results were surprising to the MRB, since there was an expectation that there were more emergency call lights available than the returned forms suggested.  Of the 153 forms returned, 114 were identifiable.  Among this subgroup, 63 had call buttons, and comprised the YES group, while 51 did not (the NO group).  In the YES group, the 1998 SMR was .90; in the NO group, the 1998 SMR was 1.17.  A similar pattern developed for the SHR:  the YES group had a SHR of .92, the NO group was 1.04.

The two groups were also ranked in terms of how many facilities had SMR/SHR lower (better) than the national and Network average, and how many had a higher than average SMR/SHR (worse).  Among the YES group, 16 facilities (29%) had better SMR and 4 (7%) had poorer SMR, while the reverse was true for the NO group (11,or 24%, having poorer SMR, and 5, or 11%, having better SMR).  Once again, the same pattern emerged for the SHR: the YES group had 33 facilities (or 62%) with good SHR and 16 facilities (30%) with a poor SHR, while the NO group had 13 (34%) facilities with good SHR and 20 facilities (53%) with a poor SHR.   

RECOMMENDATIONS:  There are no direct cause/effect conclusions possible from this limited pilot study.  This was not a rigorous scientific study, and it has many limitations.  Specifically, not all facilities participated (or were identifiable), they were not randomly selected, and not all respondents had correlating SMR/SHR data available.  There is, however, an interesting pattern of results, with the patient outcome indicators inversely proportional to the presence of emergency call systems.  This issue may warrant further investigation, since the results appear consistent with a theory that patients who cannot notify care staff in a timely manner during dialysis have a greater risk of physiological problems that could possibly result in greater morbidity/mortality.