The integration of virtual care and artificial intelligence (AI) into the standard care delivery model is permanently reshaping nursing practice. This leads to the pivotal question: How do we best prepare the next generation of nurses to thrive in this environment?
Let’s discuss how innovative technologies are being integrated into nursing curricula, the transition from education to clinical practice, and leadership strategies to foster resilience and innovation within nursing teams.
How to integrate innovative technologies into nursing criteria
It’s no longer optional for Academic institutions to adapt to the rise of virtual care, it’s a necessity. Universities such as Chamberlain University, the nation’s largest nursing school, have implemented virtual nursing courses and certifications to better prepare students for the new care delivery model they’ll see in practice. President of Chamberlain University, Dr. Karen Cox, confirms that the traditional nursing education model needs to evolve rapidly to incorporate digital competencies, ensuring that new graduates are proficient in virtual patient care technologies.
What should nursing education institutions do today?
Shift nursing curricula to include AI and virtual care competencies
Provide opportunities for students to gain hands-on experience with telehealth platforms and remote monitoring
Be flexible and responsive to technological advancements
“Chamberlain’s approach allows us to be more nimble compared to traditional academic settings, ensuring students are prepared for real-world challenges.” – Dr. Karen Cox
The importance of supporting new nurses in the transition to practice
The transition from school to practice is a critical time for new nurses, and health care organizations like Community Health Systems (CHS) are integrating virtual care into their onboarding programs. Karen Henson, Corporate Vice President of Nursing Operations at CHS, suggests that facilities build virtual care competencies from day one. Workforce challenges today differ significantly from those a decade ago and organizations need to be adaptable to survive.
Key tips for healthcare institutions:
Embed virtual care training into new nurse onboarding
Prioritize nurse retention by implementing strategies that better support early-career nurses.
Add virtual care programs, presenting an opportunity to bridge workforce gaps and enhance patient safety
“The challenges facing new grads today—like adapting to technology-driven care models—were not issues 5-10 years ago. We have to ensure they feel supported and competent in this new environment.” – Karen Henson
The Role of Nurse Leaders in Driving Change
As virtual care adoption grows, nurse leaders play a pivotal role in shaping policy, accreditation, and workplace culture. Cole Edmonson, CEO of the Nurses on Boards Coalition, emphasizes the importance of leadership advocacy in removing barriers to virtual care implementation. From influencing accreditation standards to creating supportive environments for new nurses, nurse leaders must actively participate in shaping the future of nursing.
Tips for nurse leaders:
Advocate for policy changes that support virtual care transitions
Work to develop a strong culture of mentorship and support, this is crucial for the success of new nurses. Using virtual technology can help overcome the resource gap preventing the same level of preceptorship from pre-pandemic times
Foster collaboration between academia and healthcare organizations to ensure smoother transitions from education to practice.
“Accreditation standards must evolve alongside nursing practice. Leaders have a responsibility to push for policies that facilitate, rather than hinder, virtual care adoption.” – Cole Edmonson
Shaping the Future of Nursing
Nursing leaders, educators and healthcare organizations must collaborate in preparing the next generation of nurses for an AI-driven, virtual care-centric future. As healthcare continues to evolve, fostering a tech-savvy, adaptable nursing workforce will be essential for ensuring high-quality patient care.
Institutions must integrate virtual care and AI into nursing education
Healthcare organizations should support new nurses with robust transition programs
Nurse leaders must play a key role in driving policy changes and cultural shifts in healthcare
AvaSure is committed to keeping this important conversation going, that’s why we create a community of virtual care leaders and bring them together to discuss the pressing issues of healthcare transformation. Join us at the Annual AvaSure Symposium to be a part of the discussion and work with us on bridging the gap between nursing education and practice in the era of virtual care.
As hospitals and healthcare providers face increasing pressures to do more with less, nurses are feeling burnt out. A more novice nurse workforce, in addition to inadequate education and training, higher patient acuity, and rising nurse-to-patient ratios are amplifying this, ultimately leading to nurse staffing shortages. These problems not only affect the well-being of nurses but also impact the quality of patient care.
To address these ongoing issues, hospital systems are reevaluating their workflows and looking at technology solutions to help support their staff. For example, many hospitals are adopting virtual care platforms and AI-enabled tools to help relieve administrative burden. However, before making decisions on solutions, it’s important to really understand the root causes of nurse staffing issues.
Top Reasons for Nursing Shortages:
Nurse Burnout
Nurse burnout is a common consequence of the overwhelming responsibility and pressure placed on nursing staff in hospital systems. Reduced resources and support lead to some nurses deciding to leave the healthcare industry all together. Nurses play a vital role in ensuring that patients’ well-being remains a priority. RNs aren’t the only ones affected; when it comes to Patient Care Technicians (PCTs) and Certified Nursing Assistants (CNAs), health systems are seeing turnover rates in excess of 30%. So, what happens when nurses experience burnout and leave the profession? The remaining nurses within the hospital are stretched too thin with the number of patients they must care for. Job satisfaction begins to decrease, and turnover rates rise, leading to more resources and funds spent to replace and train new staff. As a result, trust in the hospital system starts to fade.
Higher Patient Acuity and Reduced Resources
Another key contributor to the nurse shortage is higher patient acuity and limited training and resources. Patient acuity refers to the level of care or monitoring a patient requires from hospital staff, particularly nurses. The higher the patient’s acuity, the more attention the patient needs. As the patient-to-nurse ratio increases, less attention is given to patients with less demanding issues and health concerns. This leads to diminished patient care, as nurses are unable to provide the attention each patient deserves. Inadequate resources and training leave nurses feeling overwhelmed, making it challenging to provide proper care for all their patients. More experienced nurses are retiring early, leaving junior nurses with a larger workload and less mentorship. This results in stressful situations and higher risk of incidents under the care of the hospital.
Solutions to the Nurse Staffing Shortage
One solution to this issue is to hire additional staff and nurses at the bedside. However, the high cost of hiring travel nurses makes it challenging for hospitals to support their existing nursing staff while meeting the demand for additional help. This is where virtual care can play a key role in providing support, helping optimize the staffing they have. It is crucial for hospital systems to address nurse staffing problems. By providing a better work environment for nurses and offering education and support to nurses’ journeys, hospitals can help the 52% of the nursing workforce who have considered leaving the bedside.
Virtual Care: a Solution to Help the Staffing Crisis
Virtual care is a resource used by healthcare providers and hospital systems to connect patients with doctors, nurses, specialists, and virtual sitting staff remotely. This includes use-cases such as virtual sitting, virtual nursing, and virtual visits. This approach increases efficiency in managing workloads and can help patients receive care more quickly. Virtual care is becoming a prominent resource to help solve staffing issues. It allows nurses to return to the bedside and focus on direct patient care, working at the top of their license. Studies have proven that virtual care, specifically virtual sitting, reduces burnout and improves nurse well-being. A recent survey of 74 nurses from Renton, Washington-based Providence found virtual sitting improved their “emotional labor” and “emotional exhaustion” over in-person sitting. The survey illustrated that virtual sitting improves the well-being of nurses and helps maintain patient safety. Emily Anderson, MSN, RN, PCCN-K, nurse manager at Providence Medical Center in Anchorage, AK said, “Having insightful research into virtual sitting helps us alleviate burnout among our nursing staff and optimize the usage of all our resources to get the right care to the right patient at the right time.” As healthcare systems are evaluating ways to reduce nursing shortages, aid their teams, and deliver the best care possible, solutions like virtual sitting, virtual nursing, and AI need to be considered to support staff and ease the workload and pressure that has been causing the drop in workforce.
What is Virtual Sitting?
Virtual sitting, also referred to as virtual monitoring, is a resource for nurses at the bedside, reducing the need for one-to-one in-person sitting and helping to prevent adverse events for patients. Virtual sitting equips trained safety attendants to use video and audio connections to watch over multiple patients and improve overall safety. Virtual sitting has been used for preventing a variety of adverse events, such as falls, elopement, possible self-harm, suicide ideation, and staff abuse. By using this technology, events that once required 1:1 sitting can now be monitored by a virtual safety attendant, who can safely observe up to 36 patients at a time. This helps reduce the workload of nurses, allowing them to work at the top of their license and focus on higher-acuity patients.
One hospital that successfully implemented virtual sitting amid nurse staffing shortages is St. Luke’s Duluth, a Minnesota-based health system. Like many health systems, St. Luke’s faced challenges such as a tightening labor market, increasing competition for experienced healthcare workers, and rising costs. To provide additional resources and support to their current patient care staff, St. Luke’s implemented a virtual sitting program. They utilize a two-person model: one staff member provides rounding services for patients and staff, while the other staff member observes patients via video monitors. Nursing leaders have found that this approach enhances patient and staff safety and helps support monitoring staff by providing adequate breaks to avoid monitor fatigue.
Another way virtual care has emerged as a solution to nurse staffing problems is through virtual nursing. The American Nursing Association describes virtual nursing as a resource that “support(s) the team at the bedside to alleviate the workload and provide greater satisfaction for both the patients and the nursing staff.”1 Through virtual platforms, nurses and care managers can support teams at the bedside to educate patients, complete admissions and discharge paperwork, automate documentation, and mentor more novice nurses. This allows virtual nurses to have direct, uninterrupted time with patients, leading to less errors or gaps in documentation and freeing up floor nurses to care for their patients at the bedside. It enables a care model where RNs, CNAs, and VRNs (virtual nurses) perform the most appropriate patient care activities based on their skills and experience.
Virtual nursing tools also connect hospital staff with external care providers in real time, ensuring smooth transitions and avoiding delays in securing post-discharge services. Holzer Health System is a recent example of this use case. Using the AvaSure virtual care platform, scarce specialists in neurology, nephrology, diabetes education, and wound care were able to serve patients in two facilities, located 30 miles apart. Natalie Gardner, BSN, RN, CWON, CFCS, describes 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.”
Additionally, virtual nurses can provide real-time mentorship, feedback, and confidence to recent graduates and novice bedside nurses, nurturing a nursing workforce for the future.
What is Computer Vision and AI?
While AI is advancing and gaining attention in the healthcare industry, hospital leaders must remember to use applications that can be easily used by their staff, enhance patient safety, and improve the overall hospital experience, all while ensuring that workflow is not disrupted.
There are multiple types of AI currently being used in healthcare settings. Computer vision is a subset of AI that can vastly improve the way hospitals provide care without requiring care providers to compromise on safety and control. One application of computer vision is to help to prevent falls, elopement, and workplace violence by being able to detect factors that are potential warning signs. Following the detection, computer vision alerts a worker to address the issue that may be at hand. The technology is used to augment virtual sitting, helping care team members monitor patients more efficiently, identify patients in need, and make fast, informed decisions that keep them safe.
To know you are using computer vision and AI correctly, keep an eye out for three positive indicators:
Data is used both to prevent immediate incidents and to drive proactive interventions based on insights over time
Real-time alerts are targeted enough to inform the right staff of risk without contributing to alarm fatigue
The program is scalable; AI isn’t just another expense but a way to reduce operational costs and drive savings that fund additional technology investments.
AI in healthcare systems can be a tool but be sure to use the correct collaborative platforms, and track ROI from the start of the AI journey.
A new example of AI in the healthcare space is AvaSure’s virtual care assistant, designed to bridge gaps in communication, prioritize urgent patient needs, and support healthcare teams in delivering timely, high-quality care. The Virtual Care Assistant appears as an avatar, helping triage requests, questions, or needs and assist within the nursing workflow. Requests are categorized into clinical and operational groups, and the assistant, named Vicky, ensures they are directed to the appropriate human personnel or team, helping healthcare systems integrate a reliable, trustworthy, and supportive system for healthcare workers.
Implementing Virtual Care
While there are many virtual care tools and technologies to help reduce the burden on nurses, what does implementation look like in practice? There are multiple phases of the virtual care journey; while it may feel like other hospitals are ahead of the curve, 29% of healthcare leaders established that they have no virtual care solutions, and 39% of hospitals are still in early exploration with virtual nursing. The 5-stage maturity model, developed with the input of 1,100 hospitals and 15+ clinical and hospital IT executives, represents a blueprint for care model redesign led by change-management oriented, outcome-focused leaders. By making virtual care workflows a standard part of care delivery, facilities can meet the evolving needs of both patients and healthcare providers. It can help by expanding access to care, improving patient experience, reducing caregiver workload, and increasing the efficiency and scalability of staffing.
Nurse staffing shortages are a real challenge in hospitals and create a chain reaction that impacts everything, from quality of patient care to the health and well-being of nurses. This issue contributes to burnout and stress, ultimately affecting the care that patients receive. It’s crucial that hospitals find solutions that support nurses and improve the entire healthcare system.
AvaSure’s virtual care platform deploys AI-powered virtual sitting and virtual nursing solutions, meets the highest enterprise IT standards, and drives measurable outcomes with support from care experts. By offering our virtual care platform to monitor and support staff and patients, AvaSure can help reduce the burden on nurses, improve patient outcomes, and assist healthcare systems to better improve staff workflow and patient care.
Resources
1Ball, J. (2022, July 1). Virtual nursing: What is it?. Innovation Site. https://www.nursingworld.org/practice-policy/innovation/blog/virtual-nursing-what-is-it/
These were some takeaways from our most popular session at Symposium 2024! The live session highlighted Regina Foley, EVP and Chief Nurse Executive at Hackensack Meridian Health, and Dr. Nick Patel, CEO of Stealth Consulting, highlighting how clinical & IT teams can partner together.
Virtual care is rapidly changing the healthcare landscape, offering innovative solutions to age-old challenges. But successful implementation requires a strong partnership between IT and clinical leaders.
Two healthcare leaders who exemplify the gold standard of this partnership are Regina Foley, EVP and Chief Nurse Executive at Hackensack Meridian Health, and Dr. Nick Patel, CEO of Stealth Consulting.
Here are five of their recommended best practices for seamless collaboration:
1. Start with the Clinical Need, Not the Technology:
Define the problem: What are you trying to solve? Is it nurse burnout, patient satisfaction, or access to care?
Focus on solutions: How can virtual care programs improve workflows, reduce administrative burdens, and enhance patient care?
Avoid the “shiny object” syndrome: Don’t get distracted by the latest gadgets. Choose technology that truly addresses your needs.
2. Foster a Culture of Collaboration and Trust:
Leave egos at the door: Encourage open communication and mutual respect between IT and clinical teams.
Build a shared virtual care vision: Ensure both teams understand the goals and are working towards the same outcomes.
Involve clinicians in the process: Ensure their input is valued and incorporated into decision-making for implementation of virtual care programs.
4. Prioritize Training and Education:
Provide comprehensive training: Ensure both IT and clinical staff are comfortable using and supporting new technologies.
Offer ongoing support: Address questions, concerns, and challenges that arise during implementation.
Foster a culture of continuous learning: Encourage both teams to stay up-to-date on the latest advancements in virtual care.
5. Embrace AI Cautiously and Strategically:
Focus on data quality: Ensure your data is accurate, complete, and unbiased before implementing AI solutions.
Start with specific use cases: Prioritize areas where AI can have the greatest impact, such as clinical documentation and decision support.
Involve clinicians in AI development: Ensure their expertise is incorporated into the design and implementation of AI algorithms.
Bonus Tip: Don’t be afraid to learn from others! Network with colleagues, attend conferences, and share best practices to accelerate your virtual care program.
By following these guidelines, IT and clinical leaders can forge a powerful partnership that drives innovation, improves patient outcomes, and transforms the future of healthcare.
Interested in more content like this? Save the date for AvaSure Symposium 2025! Registration isn’t open yet, but stay tuned & take a look at our 2024 recap video from attendees.
Falls among VA hospitalized patients are a serious concern and can lead to injuries and increased healthcare costs, often requiring additional treatment and prolonged hospital stays. A recent 8-hospital analysis of over 10,000 patients falls cited by JAMA showed that a fall with any injury is associated with a cost increase of $36,776 and doubles the length of stay.
In VA hospitals, where patients often have more chronic conditions that contribute to a greater falls risk, prevention is critical. Staffing shortages, particularly among Patient Care Technicians and Certified Nursing Assistants, have exacerbated patient safety concerns, with patient falls rising 253% from 2020 to 2022.1 In response, the Veterans Health Administration introduced the SAFE STEPS for Veterans Act in 2024, creating an Office of Falls Prevention.
Addressing Patient Safety Challenges
Facing labor shortages and escalating costs, VA hospitals across the country have turned to virtual sitting, a replacement for traditional one-to-one sitting. Virtual sitting reduces the need for 1:1 sitting by 75% or more, freeing up clinician’s time and headspace for other valuable work.
With AvaSure’s virtual care platform for virtual sitting, a Virtual Safety Attendant (VSA) can oversee up to 16 veterans at once, using an intelligent, AI-enabled platform to identify patients at risk of a fall and verbally redirect them back to safety. If necessary, the VSA can issue a stat alarm, a loud, in-room alarm that draws nearby caregivers to the room in an emergency with an average response time of 20 seconds2. Freeing up CNAs and nurses from one-to-one sitting allows them to move back to the bedside for more direct patient care activities.
An important aspect of virtual sitting is assessing patients individually to determine whether virtual sitting will meet their needs. Conditions typically monitored by virtual sitters include general safety concerns, such as high fall risk, drug or alcohol withdrawal, confusion, agitation, and elopement risk, and failure to follow safety instructions, such as leaving the unit without notifying staff.
Success Stories in Virtual Sitting Implementation for VA Fall Prevention
AvaSure’s virtual care platform is implemented in 45 VA hospitals across the country. For more success stories, check out the whitepaper on VA Fall Prevention.
Fayetteville VA Hospitals
Fayetteville VA hospitals were recently recognized with the 2024 VA Excellence Award when their virtual care program soared to 80% utilization in just six months, highlighting their strong leadership, organization, and commitment to success. Their journey serves as an inspiring model for other VA facilities, proving that with the right strategies and dedication, significant progress can be achieved in a short time.
VA North Texas
Facing labor shortages and escalating costs, VA North Texas implemented a virtual sitting program. At the heart of the program is a centralized monitoring hub, allowing 4 virtual safety attendants to oversee a total of 48 patients to reduce falls.
Since implementing the program, VA North Texas freed up bedside care teams for direct patient care and decreased 1:1 sitter usage, saving the program an average of 83 full-time equivalents per month – an annual savings of $3.4 million. The efficiency gains are substantial, with costs per virtual sitting hour reduced to $3.05 compared to $26 for one-to-one sitters. VA fall rates plummeted by nearly 20%, well below national averages. Learn more about VA North Texas Program
For health systems, one-to-one sitters represent a costly drain on resources that do little to improve patient safety. With virtual sitting, health systems such as VA’s have prioritized fall prevention and created better patient outcomes while delivering staff cost savings that can be invested back into direct patient care.
AvaSure’s Intelligent Virtual Care Platform is deployed in 45 VA hospitals across the country, helping make significant strides in VA fall prevention and patient safety. By leveraging technology and data-driven insights, these hospitals are creating a safer environment for veterans and their caregivers.
In recent memory, no technology has so quickly penetrated the cultural zeitgeist as artificial intelligence (AI). At an ever-increasing pace, AI is being hailed as the hero capable of fixing everything from world hunger to climate change. Companies across the globe are racing to utilize AI to automate, simplify, and rationalize manual tasks across every industry, including healthcare.
At the same time, healthcare has been grappling with tremendous cost pressure & staffing shortages for years. Over the past decade, hospitals have focused on utilizing technology to help drive significant change through:
Digitization of documentation and communication tools
Consolidation of health systems in search of economies of scale
Virtualization of traditional care models to include remote caregivers and stakeholders
In 2020, the COVID-19 pandemic poured gasoline over the fire of those pressures; and hospitals quickly implemented changes to adapt. In many cases, integrated tools are not delivering the simplicity needed; shared data is not delivering the actionable insights that caregivers need; and automation is not allowing care teams to scale that care to an increasing number of patients.
Clearly, there’s no “silver bullet” to remedy all the chaos and pressure. Many key plays need to be run, integrations must deepen, technology needs to be more open to 3rd party access, and virtual experience needs to seamlessly merge with care workflows.
How can AI in healthcare help?
As an industry, we seem to latch on to the hope of the next big thing. Waves of opportunity have come our way with Meaningful Use, Actionable Insights, multi-use case infrastructure like Real-Time Location Systems (RTLS), and more. What does that mean for AI? How can we focus our efforts to soak up as much of the wave as it rolls in?
There are a few key questions we need to answer in determining if utilizing AI in healthcare will truly be the savior it needs, or if it’s just another passing technology fad that won’t deliver on its promises:
What is AI? What use case examples of AI in healthcare are primed for change? What risks need to be top of mind when implementing AI in healthcare settings? How can those risks be mitigated?
What is AI?
Let’s tackle what that term, “artificial intelligence,” means. Promising examples of AI in healthcare settings include references to the following technologies:
Natural Language Processing (NLP) – helps take data from unstructured to structured
Conversational Bots – virtual agents that manage conversations with patients via text, IM, etc.
Predictive analytics – mines data to plug into algorithms that project things like patient risk
Ambient Listening – listens to live audio to turn conversations into notes or identify risks
Computer Vision – watches live video to identify patterns or risks
Remote Patient Monitoring – uses data from medical devices to anticipate risks or care needs
What use case examples of AI in healthcare are primed for change?
Despite AI’s newfound popularity, some technologies on the list above have been around in healthcare for years. NLP is being used to turn dictated notes into actionable work, like orders, and Predictive Analytics are employed by Populational Health technologies to help target specific populations for focused care based on their risk.
So, if AI in healthcare isn’t anything new, why is it so prevalent in today’s industry discussions? For one, the underlying technology has changed and improved very quickly, making it a more powerful tool. For another, the volume of data needed to improve AI models is becoming more manageable to achieve. As a perfect example, ChatGPT-4 took social media by storm as people began asking for AI to produce legal contracts, bedtime stories for their kids, and essays for homework assignments. Mere weeks later, new forms of this AI were appearing as Chrome extensions that were already better, faster, and stronger than the ones before. The more AI is used, the more valuable it will become because every use provides meaningful learning.
All this progress makes the potential for AI in healthcare more optimistic. Experts agree that, among other things, AI will be key in supporting the push towards more impactful virtual care models. More specifically, this will be achieved through the use of predictive analytics, computer vision, and ambient listening.
During the time that AI entered the conversation, two other important advancements also happened:
Technology continued to get faster, stronger, and cheaper. Cameras, microphones, speakers, and other equipment necessary to facilitate virtual interactions are now available in more patient rooms than ever before.
The COVID-19 pandemic opened patients’ and caregivers’ eyes to virtual care, making these interactions more trusted and commonplace.
AI can help turn heavily user dependent devices into seamlessly integrated, clinical workflow-enabling devices. We are entering a moment where the true potential of virtual care is being unlocked, facilitated by the growing prospect of the availability of an AI-enabled virtual care device in every hospital room.
What risks need to be top of mind when implementing AI in healthcare settings?
While one may not be worried about what’s at stake when using AI to help write a bedtime story, the stakes of healthcare are much higher. AI-enabled devices in every hospital room could bring virtual care to life, but there are important questions to consider.
Are cameras and speakers now the equivalent of a door to the patient room?
Who decides when the door should be open or closed?
How do patients, staff, and visitors know that the doors are open, and what does that mean?
What happens if multiple virtual care team members try to open that door and walk in at the same time?
Which patients do, or do not, qualify for virtual care models and participation?
The list goes on….
So, is AI just a short-lived buzzword, or are there clinically relevant use cases that you can take advantage of? Industry experience tells us to avoid getting our hopes up, else our belief in a healthy future might be dashed. We now know that failure is not an option. If we can all see the challenges for what they are and take a mindful approach to what and how we implement, then AI in healthcare may be the ‘silver bullet’ we’ve been promised for years.
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.
Explore their journey of virtual patient monitoring from evaluation to implementation to outcomes, including a significant reduction in falls, zero patient falls with injuries in 2022, and improved staffing efficiencies.
Challenge: Reducing patient falls
CHS, one of the largest provider organizations in the United States, operates across 43 distinct markets in 15 states. Their decade-long commitment to high reliability, safety, and harm reduction aligned perfectly with the need to reduce falls during the pandemic in 2021. Hospitals across the nation have been grappling with staffing shortages, leading to nurse burnout and a rise in adverse patient events. As the personnel issue worsened, many healthcare systems asked: How can hospitals create a care system that reduces the need for 1:1 patient sitters while allowing nurses to focus on critical patient care?
Evaluating solutions: Evidence and scalability
In their quest for the right solution, CHS employs a rigorous evaluation process. Their primary criteria encompass two crucial elements: evidence-based effectiveness and scalability. First and foremost, CHS seeks evidence-backed solutions, emphasizing clinical outcomes and operational impacts. This commitment to data-driven decision-making ensures that any chosen solution delivers tangible benefits across both patient care and operational efficiency.
The second key criterion is scalability. Given CHS’s size, the ability to initially implement a solution at a few select hospitals and then scale it elsewhere across the organization is paramount. In this regard, AvaSure’s TeleSitter solution met these criteria for virtual patient monitoring, making it a natural choice to address their needs.
Phase 1 deployment: Keys to success
CHS’s journey with the AvaSure TeleSitter solution commenced with a pilot deployment at three hospitals and then scaled to 17. This pivotal phase yielded notable success, attributed to several critical factors:
Intentionality: The deployment of virtual patient monitoring was marked by a deliberate and well-thought-out strategy. Every step was carefully considered, from initial planning to execution, ensuring a seamless integration of the TeleSitter solution into their healthcare ecosystem.
Metrics that matter: A key driver of success was CHS’s dedication to data-driven decision-making. They recognized the importance of collecting precise and relevant data to assess the impact of the TeleSitter solution accurately. This commitment to meaningful metrics allowed them to track progress, identify areas for improvement, and ultimately optimize patient care outcomes.
Leadership and oversight: Strong leadership and dedicated oversight were pivotal throughout the deployment process. Key leaders within CHS played a central role in driving the virtual patient monitoring initiative forward. Their unwavering commitment and guidance ensured that the program remained aligned with the organization’s broader goals and objectives.
Buy-in and Teamwork: CHS understood that achieving the desired results required a collaborative effort. Encouraging buy-in and utilization among staff was essential. Through effective communication, collaboration, and trust, the healthcare team worked together to maximize the benefits of the TeleSitter solution. It became a team effort, with everyone playing a crucial role in its success.
Strategic Patient Selection: CHS recognized the importance of strategic patient selection in applying the technology where it would be most effective. Careful consideration was given to identifying patients who would benefit most from the TeleSitter solution, further optimizing its impact on patient safety and care quality.
This comprehensive approach to the Phase 1 deployment set the stage for CHS’s journey implementing virtual patient monitoring, paving the way for positive clinical and operational results.
Outcomes: Reduction in falls and positive operational and financial impact
Following the completion of the pilot program, CHS embarked on a thorough analysis, which unveiled some significant outcomes.
A Meaningful decrease in falls: While CHS has worked effectively to reduce falls for years, implementation of the TeleSitter solution led to an even greater reduction in falls, including a 76% reduction in one hospital.
Zero patient falls with injuries in 2022: In 2022, CHS reported zero patient falls with injuries at facilities using virtual patient monitoring. This milestone reflects a profound commitment to patient safety.
Savings through injury avoidance: The solution translated into meaningful savings through the avoidance of costs related to patient injuries. In an environment where litigation looms, AvaSure can help mitigate potential liability claims when it comes to falls with injury.
Staffing dfficiencies of 16 to 1: The introduction of virtual sitters had a strong effect on staffing efficiency. With each virtual sitter capable of monitoring up to 16 patients simultaneously, CHS achieved staffing efficiencies of 16 to 1. This efficiency not only optimized staffing allocation but also enabled caregivers in CHS hospitals to work at the top of their licenses and provide more attentive care to a broader patient population.
These outcomes are a testament to CHS’s commitment to excellence, safety, and innovation. AvaSure delivered quantifiable operational benefit and helped reinforce the high standard of patient care and safety across CHS.
Quality and patient care lead to next steps
Today, CHS is poised to expand virtual patient monitoring services. With 87 devices currently in place, CHS plans to add78 more across 12 more hospitals by the end of 2023.
CHS’s innovative approach helps ensure that more patients are kept safe, more healthcare professionals are supported, and the future of healthcare is brighter than ever.
Watch the webinar replay to hear firsthand from CHS about how they expanded their virtual patient monitoring program to enhance patient safety and optimize resource utilization.
Today, CHS is poised to expand virtual patient monitoring services. With 87 devices currently in place, CHS plans to add 78 more across 12 more hospitals by the end of 2023.
Gaylord Specialty Healthcare reveals inspiring results with the TeleSitter® solution
During AvaSure’s Digital Summit, Henry C. Hrdlicka, PhD, Director of Research, Milne Institute for Healthcare Innovation presented recent findings from Gaylord Specialty Healthcare’s TeleSitter® program. Watch here.
Inpatient falls are a universal safety concern in healthcare facilities, and their consequences can be devastating. This is especially a concern in the LTACH setting where individual risk is increased by anticipated longer lengths of stay & early and frequent encouragement of patient mobility. Up until now, 1:1 patient sitters have been the primary option for ensuring patient safety, however, staffing 1:1 sitters is a costly solution that can pull much needed hands from the bedside.
“Often the demand for 1:1 sitters outpaces staff availability. This accrues a massive financial burden on any institution. These factors have been further exacerbated due to ongoing national staffing shortages as well as the COVID-19 pandemic. This led us to the conclusion that an alternative needed to be found.”
Henry C. Hrdlicka, PhD, Director of Research, Milne Institute for Healthcare Innovation
Gaylord Specialty Healthcare, a rehabilitation-focused nonprofit healthcare system, embarked on a study to assess the impact of continuous virtual monitoring on inpatient falls and 1:1 sitter usage. In partnership with the Milne Institute for Healthcare Innovation, the study was carried out at Gaylord Hospital, a 137-bed Long-Term Acute Care Hospital (LTACH), in Connecticut. The results of this research not only demonstrated a profound impact on patient safety but also revealed a promising opportunity for significant cost savings that can benefit healthcare facilities across the board.
The ins and outs of behavioral health monitoring, including regulatory standards, device selection, patient consent, and evaluation tools in utilizing virtual monitoring for patients at risk of suicide.
Mental health conditions are on the rise in all age groups, affecting millions of Americans. Providing safe care for patients with behavioral health needs can be especially difficult when they are in emergency departments or acute-care settings that are not designed for their needs. Too often, hospitals resort to using costly 1:1 sitters to monitor patients with low-to-moderate suicide risk, and providing this sitter often means pulling a much-needed care staff member from the floor. In a world where hospitals are pressed to “do more with less” this can exacerbate already stretched staffing levels, which is why hospitals are looking for more scalable ways to keep their at-risk patients safe. There is a perception that virtual sitting solutions aren’t allowed or suitable for these patients – in reality, while policies may have to be adjusted, most governing bodies allow for the virtual monitoring of patients that are assessed to be at low and moderate risk of suicide. Using a TeleSitter® program for these behavioral health monitoring can help reduce placing additional staffing constraints on your system while empowering patients on their journey to well-being.
What are the regulatory standards for behavioral health monitoring?
With virtual sitting proven as a reliable solution for preventing falls, the question has naturally risen whether it is a suitable method for monitoring other vulnerable patients, including those at risk of suicide. Research led by David Kroll, MD, of Brigham and Women’s Hospital in Boston, showed that having a 1:1 sitter in the room of a suicidal risk patient is unproven in preventing self-harm. By contrast, use of the TeleSitter® solution on suicide risk patients resulted in zero adverse events.1 This study paved the way for the Joint Commission to deem the use of video monitoring for patients who are not at high risk for suicide up to the discretion of the organization in 2019.
Hospitals in 45 states across the U.S. are using AvaSure to virtually monitor over 75,000 patients for low-to-moderate risk of suicide.2
Do patients need to complete an informed consent form before they can be monitored?
Patient consent is not necessary for non-recorded video monitoring when it is solely employed for the purpose of ensuring patient safety, allowing healthcare providers to promptly implement essential monitoring systems that prioritize patient welfare, and fostering a safer and more secure healthcare environment. AvaSure’s platform does not record videos of patients.
What devices are best for behavioral health monitoring?
Selecting the right device is key to ensuring patient safety. You will need a robust device that offers 360-degree pan/tilt/zoom functionality for a comprehensive view of the surroundings. The device should feature infrared viewing to ensure visibility during both the day and night. High-resolution capability is essential to enable effective risk assessment, such as identifying potential hazards like trash bags, lines, or hidden items.
Two-way communication capabilities are a must for verbal redirection, especially in situations where a patient may attempt to go into the bathroom alone. And finally, any alerts from the device must be loud so staff can quickly respond to potential safety concerns.
AvaSure offers robust device options suited to meet the needs of behavioral health monitoring, such as patients at risk of suicide, including ligature-free ceiling options.
What tools are used to evaluate patients for suicide risk?
It is up to the discretion of the care team to determine if a patient is appropriate for virtual monitoring based on the hospital’s protocols and clinical judgment.
It’s critical to have an adequate, evidence-based screening tool in place to conduct suicide risk assessments. The Columbia Suicide Severity Risk Scale (C-SSRS) is the most commonly used tool to assess suicide risk, and we highly recommend it. However, if you’re interested in exploring other options, The Suicide Prevention Resource Center provides a variety of resources for different risk stratification tools.
To keep everyone on the same page, it’s important to review and address any existing hospital policies around suicide risk assessments. Depending on the state and other regulatory factors, there may be additional compliance considerations to keep in mind.
At the end of the day, our goal is to work collaboratively with hospitals and providers to ensure that every patient receives the appropriate level of monitoring to keep them safe and healthy. AvaSure’s Customer Success team will advise and help your team develop policies and risk stratification that work best for your hospital and patient population.
How do you overcome adoption challenges in behavioral health monitoring?
Change management is key. It’s common for staff to initially feel hesitant to use a virtual monitoring solution in place of a 1:1 sitter. First and foremost, ensure your staff understands the inclusion and exclusion criteria for patients and the screening process. You’ll want to keep everyone in the loop so they can feel confident about the new system. To make everyone feel even more comfortable, many facilities run pilots where a virtual monitor is used alongside an in-person sitter, who is just outside of the room. This safety net not only eases minds but also proves the efficacy of the system.
And don’t forget to celebrate the good catches! Sharing your successes with hospital leadership, nurse managers, and front-line staff is crucial to building goodwill around your new behavioral health monitoring program and gaining support. AvaSure provides a toolkit for our customers to easily share the good news with their hospital.
Are the staff monitoring for suicide risk required to be clinical or specially trained in any way differently from those monitoring for falls, elopement, etc.?
While there are no formal requirements for specialized training, we highly encourage you to invest in additional training to ensure your staff is fully prepared for their role. We recommend annual education and competency validation for Virtual Safety Attendants (VSAs) along with education on the risk of suicide to ensure that your team’s skills remain sharp while monitoring this vulnerable patient population.
But it doesn’t stop there – it’s equally important to train your bedside staff. By sharing stories and experiences that highlight the potential consequences when things go wrong, you can drive home the need for compliance and create a sense of urgency around proper training.
At AvaSure, we provide specialized training and competency evaluation resources that equip your VSAs with the knowledge and skills needed to effectively monitor patients at risk of suicide. From screening the room for potential safety risks to redirecting patients who may attempt to use the bathroom alone, our training ensures that your VSAs are well-prepared for any situation.
By investing in comprehensive training for your virtual safety attendants and bedside staff, you can enhance the overall safety and well-being of your patients. Together, we can ensure that everyone is equipped with the necessary knowledge and skills to provide the highest level of care.
AvaSure’s Customer Success team is comprised of nurses and change management experts who are ready to guide you through best practices and provide clarity, policy templates, training, and resources about using behavioral health monitoring to keep patients safe. Schedule a discovery session with our team today.
Kroll, D. S. et al., (2020). Virtual monitoring of suicide risk in the general hospital and emergency department. General hospital psychiatry, 63, 33-38. https://doi.org/10.1016/j.genhosppsych.2019.01.002
Insights from AvaSure’s national database on virtual monitoring (ORNA®)
Last week AvaSure hosted our 1st Annual Digital Summit: Start, Scale & Succeed with Virtual Sitting. During this one-day educational event, we featured over 10 current AvaSure customers to share their best practices & learnings from deploying virtual sitting programs. Read on to hear how they were able to improve outcomes, optimize their labor force and protect staff all while helping to reduce costs.
There were so many exceptional discussions centered around today’s challenges – staffing being front and center. We know that hospitals across the U.S. are struggling to find enough nurses and support staff to run efficiently, so technology is helping to bridge the gap. With the AvaSure TeleSitter® Solution, hospitals are replacing the need for traditional 1:1 sitters by using Virtual Safety Attendants (VSAs) to monitor up to 12 patients remotely while reducing adverse events. Seem too good to be true? The results just may be.
How Valley Health Reduced the Use of 1:1 Sitters While Decreasing Falls
Valley Health System shared their story of starting a TeleSitter program four years ago that has gone on to help:
Reduce falls with injury by 50%
Save over $1 million dollars from combined fall reduction and sitter cost reduction
Achieve an 80% device utilization across the system
When discussing why they chose to work with AvaSure, they said, “We wanted to work with the experts to show us how this has worked at other organizations. Other organizations have made mistakes, had those mistakes corrected and so we are the beneficiaries of that. We wanted to focus on what we are good at. What we aren’t good at is setting up our own sitter program. But, what we are good at is knowing our needs, selecting the best partner out there and picking someone who could address our needs today & help us go beyond that in the future.” AvaSure has helped over 1,000 customers just like Valley Health start their programs and we have the clinical expertise to help make it as turnkey as possible for your staff.
Use Cases for TeleSitter solutions extend beyond just falls
Success of virtual sitting extends beyond just the acute care setting, Gaylord Specialty Healthcare gave a sneak preview of yet-to-be published results of how AvaSure helped optimize their LTACH program.
While virtual sitting programs may be best known for helping reduce falls, their use extends far beyond that one use case. We heard from Rachel Krajnovich, MSN, RN-BC, Director of Clinical Operations atHCA Kingwood on utilizing virtual monitoring for suicide risk & behavioral health patients.
Suicide is the 12th leading cause of death in the U.S. across all age groups and the number of patients requiring suicide monitoring in acute care has increased 165% since 2019
45% of hospitals that utilize AvaSure have monitored over 75,000 suicide risk patients across 45 states
This lesser-known use case can be extremely effective in helping to monitor low and moderate suicide risk patients, and is proven to be equally effective to in-person sitters for this population(1). These customers shared best practices regarding how they evaluate patients to be placed in the program, how they helped to get physicians and staff on board with utilizing virtual monitoring for this high-risk population and how it has helped them extend access of needed yet scarce mental health resources in ERs today.
Expanding to other use cases is just one example of scaling your program, you can also help to extend the reach of your program across various facilities in your system, helping you to achieve greater scale and efficiency. Providence Oregon Region shared how they built a ‘hub and spoke’ model – which involves having devices across multiple facilities with monitor staff at one, centralized hub watching patients across the system. This can help create a highly effective staff that is able to protect patients across the system and optimize your device utilization. Hear how they were able to achieve an average stat alarm response time of 12-15 seconds, well below the national average of 17 seconds.
Virtual Safety Attendants are Key to Program Success
As always, one of our most popular sessions was best practices from Virtual Safety Attendants – sharing how they’ve built teams of heroes that work 24/7 to connect with patients, keep them safe, keep them calm & help assist them on their recovery journey. We heard from a VSA, Tom Dezell from Froedtert, who shared when thinking back on advice he’d give himself on his first day:
“That I cannot let my fear of something happening to the patient interfere with my taking care of the patient. In other words, I can’t respond out of fear, I have to respond out of patient advocacy and confidence.”
His demonstrated commitment to his patients brought emotions to all who listened as he spoke so passionately and eloquently about the time he spends helping patients.
What Does the Future of Virtual Care Look Like?
We closed the day with Claire Zangerle, DNP, MBA, RN, NEA-BC, FAONL, FAAN, Nurse Executive with CMZ Strategies, LLC discussing the future of virtual care with AvaSure Chief Clinical Officer, Lisbeth Votruba, MSN, RN. In discussing her hopes for the future of nursing in this new virtual care environment she said,
“It’s our time as nurses to step up and make sure we’re listened to. We have to tell people how great it is to be a nurse and what it means to be a nurse. We’re in danger of people saying that the job is too hard to do. Everyone wants to work remote now, you can’t be hands on and work remote. You have to promote the value of human interaction, it’s so important. We know we don’t have enough staff and enough people to do human interaction whether it’s in a hospital, ASC, community health center, we know we don’t have enough people. We need to meet patients where they are, and we need to think of new ways to meet patients. We aren’t thinking about this because we don’t have enough staff, it’s also because that’s what patients want. We are looking at ways to make sure they get what they want.”
Nursing has always been and will always be an essential and noble profession that relies on hands-on patient care, clinical expertise & empathizers who care deeply about the lives of their patients. AvaSure believes that nurses should always be central to care, which is why we featured nurses throughout our summit – as moderators, hosts & panelists to demonstrate the vital role they play in the shifting care model moving forward.
We look forward to sharing more insights, recaps and full session replays of Digital Summit for those who have missed it.
1 Kroll, D. S. et al., (2020). Virtual monitoring of suicide risk in the general hospital and emergency department. General hospital psychiatry, 63, 33–38. https://doi.org/10.1016/j.genhosppsych.2019.01.002
