How Holzer improved care while progressing from virtual sitting to virtual nursing

By Lisbeth Votruba, MSN, RN, Chief Clinical Officer

The Goal:
• Improve patient safety
• Reduce fall risk
• Increase access to specialty care
• Free up CNA and bedside nurses for other activities

The Results:
1. Success of the virtual sitting program:
• Saved costs
• Improved patient and staff satisfaction
2. Progression into virtual nursing:
• Utilization of the same technology
• Further cost savings
• Enhanced patient and staff satisfaction

Nursing shortages and associated costs are not going away. While RN turnover has dropped from 22.5% in 2022 to 18.4% in 2023, the turnover rate for nursing assistants increased from 33.7% to 41.8% in the same period. And the ongoing costs as nurses continue to leave the profession are high. Each RN that leaves costs an average hospital $56,350, totaling roughly $4M – $6M per year, according to the 2024 NSI National Health Care Retention and RN Staffing Report. Bottom line: nurses need sustained support or the profession will continue to decline in well-being and in numbers.

These challenges hit particularly hard in smaller, community-based organizations. Holzer Health System is a not-for-profit, multi-disciplinary regional health system that provides the full continuum of care for its communities with locations throughout southeastern Ohio and western West Virginia. The system includes two hospital locations, including a rural critical access hospital, as well as multiple clinical locations, long-term care entities, and more than 180 providers in more than 30 medical specialties.

Matthew L. Hemphill MSN, RN, CNML, Director of Acute Care Nursing at Holzer Health System, described the problem: “We want to keep as many of our patients here rather than transferring them out to the nearest tertiary center two hours away. While we did have a small pool of one-to-one sitters, staffing was a challenge. Many needs were going unmet. There were numerous patients who required more monitoring than we could offer.”

Improving care, beginning with virtual sitting

The COVID-19 pandemic made matters worse, so Holzer had to come up with a workable plan that would allow it to augment its existing staff while keeping a larger volume of patients safe. 

Holzer undertook a major initiative to improve patient safety, reduce fall risk and increase access to specialty care by securing a grant through the FCC COVID-19 Telehealth Program to implement an inpatient virtual sitting solution.

With the aid of the grant, Holzer implemented AvaSure’s virtual care technology to support virtual sitters, who watch over patients via video-and-audio connections to enhance patient safety, such as reducing patient falls and elopement. The health system implemented 16 devices, including four ceiling-mounted devices, 12 mobile devices and a centralized monitoring station. The primary goal was to enable and expand the use of virtual sitters, freeing up CNAs and bedside nurses for other care activities.

After seeing the virtual sitting program’s success in saving costs, as well as improving patient and staff satisfaction, the health system progressed into virtual nursing using the same technology platform. AvaSure’s intelligent virtual care platform enables virtual sitting, virtual nursing and specialty medical consults.

Progressing to inpatient virtual nursing and realizing multiple improvements

When Holzer progressed from virtual sitting to virtual nursing, one key principle it followed was to structure the use of virtual sitters and nurses so that all nurses work at the top of their licenses. This enables a care model where RNs, CNAs, and VRNs perform the most-appropriate patient care activities based on their skills and experience.

Using the AvaSure platform, scarce specialists in neurology, nephrology, diabetes education and wound care can serve more patients in both facilities, the main Gallipolis Hospital and the rural critical access Jackson Hospital.  

For example, Holzer has one certified wound and ostomy nurse (CWON) serving both facilities, located 30 miles apart. Natalie Gardner BSN, RN, CWON, CFCS, described the benefits: “This has provided a way for me to do video consults with the Jackson facility which saves precious time as well as mileage. The staff take the device to the patient’s room, remove their dressings, and position the patient so that I can see the wound. This leaves me more time to spend with all patients by eliminating the time it would take to drive to Jackson and back.” Giving patients easier access to specialists improves care and facilitates early intervention to prevent transfers from the critical access hospital to the main facility.

Continuing to hone the virtual nursing program

For community health systems, the strain on resources will continue for the foreseeable future. Progressing on a path from virtual sitting to virtual nursing extends precious resources to enable high quality patient care, while allowing all nursing staff to work at the top of their skills and licenses. Holzer is continuing its path to expand its virtual nursing program to encompass more activities across more inpatient care units. At every stage, Holzer is delivering better patient outcomes while enabling a care model that gives nurses more time for their most satisfying work – spending time on direct patient care.