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In Today’s Impatient Care Environment, the Nurse Call Light Falls Short

nurse call light illustration

U.S. nurses have relied on the same technology, the nurse call light, to care for a growing, aging, more demanding patient population

It’s time for a more interactive patient room

The truth is that the call light technology used in thousands of patient rooms is rarely updated and increasingly deficient in detecting and alerting staff to life-threatening scenarios.

Amazing advancements like virtual visits, patient portals and remote patient monitoring for disease management are improving communication and quality of care. But how about technology that optimizes inpatient and caregiver safety against violence and “sentinel”[1] or patient safety events?

It’s time to overhaul the call light.

As AI, virtual care, and telehealth take center stage in healthcare delivery, there is an opportunity to embrace a more interactive patient room where:

  • Patients are protected from self-harm and adverse events in real time
  • Clinicians and caregivers can safely and effectively interact with patients before events escalate
  • The spread of viruses like COVID-19 is mitigated
  • The care team is reserved for the highest, most effective level of bedside care

Call lights, unsecured mobile devices (think baby monitors), and the questionable practice of using 1:1 sitters placed with patients presenting infectious disease or violent tendencies are neither safe nor sustainable ways to improve patient safety, experience or outcomes. As healthcare workers sometimes feel compelled to adapt unsecure workarounds to monitor potentially dangerous scenarios, it is imperative that health systems consider secure technology for optimal care and safety for every patient and every caregiver.

Thankfully, this is not a futurist mindset. A solution – remote inpatient video monitoring – does exist in most major hospitals around the country. Has it made its way into your holistic telehealth strategy?

What exactly is remote safety monitoring?

Remote safety monitoring technology provides a continuous live feed from a patient’s room, allowing hospital staff to monitor a patient while reducing exposure risks to infectious disease or violence. It improves communication, provides peace of mind and reduces stress among caregivers, patients and families. It allows healthcare workers to keep an eye on patients who are at risk or in isolation and enables clinicians to communicate with their patients any time, remotely, from a monitor at the nursing station.

Remote video monitoring, in conjunction with other safety measures, can:

  • Help monitoring staff prevent falls, self-harm attempts, and manage other adverse events, such as elopement or wandering and interfering with medical devices.
  • Alert nursing staff to potentially abusive visitors
  • Help staff immediately identify clinical deterioration and notify nurses
  • Protect bedside staff from potentially violent patients
  • Enable remote monitoring staff to calm the most vulnerable patients

In addition, a paper[2] published in the Journal of Nursing Measurement shared a more personal benefit of the technology, in which a dying, nonverbal patient began humming along with a TeleSitter monitor who initiated humming the song the patient’s daughter hummed every time she visited, pre-COVID. This touching gesture created calm and familiarity in this patient’s final days.

A Holistic Telehealth Strategy Can Address Staffing Shortages, Hospital Falls, and Isolation

Even before the COVID-19 pandemic, nursing shortages, patient falls and patient violence were trending concerns in healthcare. Healthcare workers are four times more likely to suffer violence than workers in other industries.[3] These issues have been exacerbated in healthcare environments where staffing is limited, infectious disease management is critical, and at-risk inpatients continue to be isolated due to tighter visitor restrictions. AvaSure’s TeleSitter® Solution has been deployed in 75 percent of major health systems in 48 states. The secured audiovisual monitoring technology allows one tech to monitor up to 16 patients at a time. In an over-burdened health system – the implications of the COVID-19 pandemic notwithstanding – we must consider telehealth technology that protects the patient and the caregiver in today’s precarious healthcare environment. And technology that allows a nurse to serve at their highest calling can only elevate the nursing profession, improve staff engagement and, ultimately, optimize each patient’s recovery.

As chief clinical innovation officer of AvaSure, Lisbeth Votruba, MSN, RN, demonstrates her vision for innovative inpatient telehealth care delivery through her compassionate leadership, activism for the nursing profession, and advocacy for the dignity, safety and quality of care for patients, families and healthcare professionals. As a third-generation nurse, she understands how important it is to keep patients and frontline medical workers safe in clinical environments.

[1] Joint Commission /20200101 [2] Remote Visual Monitoring During a Pandemic by Keeling, Eva, MSN, RN, NE-BC | Cudjoe, Joycelyn, PhD, RN | Hawksworth, Lisa, MSN, RN, NEA-BC | Drake, Jennifer, DNP, RN, NPD-BC, ONC |Davis, Theresa, PhD, RN, NE-BC, FAAN Journal of Nursing Measurement, Vol 28 Issue 3, DOI: 10.1891/JNM-D-20-00100 [3] https://pubmed.ncbi.nlm.nih.gov/32433143/

AvaSure Virtual Classroom Series: Virtual Nursing 101

nurse writing in notebook

Are you thinking about implementing virtual nursing but are not sure where to start? Or have you tried out things that don’t quite meet your objectives? You aren’t alone!

Join AvaSure’s Chief Clinical Officer, Lisbeth Votruba, MSN, RN as she navigates you through your program and how to get started in a 6-part educational series. Lisbeth is a pioneering nurse executive committed to continuous improvement of healthcare and the diffusion of new technologies to drive patient and staff safety. She was selected as a participant at the recent Medical Surgical Nursing Certification Board task force meeting to develop a certification for the virtual nursing position and for nearly 15 years, she has worked extensively with over 1,100 hospitals in standing up their virtual care platforms to help optimize labor forces, improve the quality of patient care and drive staff satisfaction & retention.

This free, six-part series features Lisbeth along with special guests and experts who will cover key topics and lessons learned from ongoing programs.


Session 1: The Role of the Virtual Nurse

Featuring Terri Hinkley, EdD, MBA, BScN, RN, CAE, CEO of Academy of Medical-Surgical Nurses

  1. Learn about the role of the virtual nurse and what was involved in the creation of the MSNCB Role Certification from two task force members.
  2. Understanding competencies to look for when hiring a virtual nurse and how to recruit for this role without taking away from bedside staff or further exacerbating staffing challenges.

Session 2: Introducing the Clinical Resource TeleNurse™ Model – What is it and How Can it Help?

Featuring Wayde Batt, MSN, NEA-BC, BC-RN, Patient Services Manager, NSICU / Virtual Nursing, UNC Health Rex & Laura Gartner DNP, MS, RN, RN-BC, NEA-BC , Director Clinical Informatics, Jefferson Health

  1. This model of virtual nursing focuses on offloading documentation and administrative burden from bedside teams, helping to optimize your labor force and deliver elevated patient care
  2. In this session, learn what’s driving the need for this nursing model, areas of focus and hear best practices from those who’ve already piloted
  3. Discover early outcomes from those already using this model to help reduce discharge time, increase patient & staff satisfaction and optimize outcomes

Session 3: Building a Virtual Nursing Business Case

  1. Learn how to partner clinical and IT resources to build a business case for virtual nursing
  2. Identify key metrics to use as goals & benchmarks for your program
  3. Get best practices for setting up an initial pilot & how to sell your leadership team on starting a program

Watch On-Demand


Session 4: Introducing The Expert Oversight TeleNurse™ Model: What Is It & How Can It Help?

  1. This model of virtual nursing focuses on retaining an experienced nurse to oversee a cohort of complex patients, monitoring for early signs of adverse patient events, mentoring novice nurses and providing support to bedside care teams
  2. In this session, learn what’s driving the need for this nursing model, areas of focus and hear best practices from those who’ve already piloted
  3. Discover early outcomes from those already using this model to help detect adverse events sooner and drive satisfaction in nursing staff, especially novice team members

Watch On-Demand


Session 5: Selecting The Right Technology Partner For Virtual Nursing

  1. Once you’ve sold your teams on virtual nursing, picking the right partner is essential
  2. Learn criteria to use to select the right partner for program success & what requirements should guide your decision
  3. Understand how technology will impact your program and details around emerging trends towards AI/Machine Learning, Camera-in-every-room and more

Watch On-Demand


Session 6: Starting & Scaling Your Virtual Nurse Program

  1. Once you’ve decided to kickoff, learn best practices around developing your initial pilot and kickstarting your program
  2. Learn how to scale and grow your program over time

Watch On-Demand


Discover everything you need to know to start your virtual nursing program, no matter what stage you’re at. To learn more, check out our 7 step roadmap to developing a virtual nursing program.

Want to learn more about our virtual nursing solutions? Explore here.

The Importance of Centralized Monitoring in a Health System’s Patient Safety Program

illustration of patient being monitored by virtual staff

Key insights and takeaways from successful patient safety programs.

Two Virtual Safety Attendants sitting at computers & monitoring patients

Historically, health systems and hospitals have used ‘patient-sitters’ to provide direct and one-on-one monitoring support to their patients. But this method is expensive and inefficient. Many healthcare systems have identified the importance of a centralized patient safety program for labor optimization and providing value-based care and  have scaled to hub and spoke model systems, increasing their coverage through a centralized monitoring model. Read on to learn more on how hub and spoke models are becoming the norm for virtual care. 

Streamlining patient care with a hub and spoke model 

  • When an administrator at Baptist Health Medicine spotted a sitter in full PPE in a room when doing rounds on a COVID floor, she came up with the idea to introduce the TeleSitter® solution. She got the parties from all six campuses as well as the leaders in the fields of executive, nursing, financial leadership, social work, and case management. Within 18 months, the project went from piloting with 16 cameras to centralized, off-site operation covering multiple facilities. Implementation of the centralized system involved 100 team members!
  • To make sure that a workforce would be available, Loyola Medicine looked at the location of the hub while monitoring all four time zones. Cost of sitters, fall rates, and present-day costs associated with falls were examined. The estimated number of patients requiring monitoring at each facility was used to decide how many cameras per hospital to install.
  • A best practice for budgeting hub & spoke – each facility receiving monitoring in the hub & spoke model pays for 60% of the program. This budget then supports virtual safety attendants (VSAs), regardless of utilization. It’s important to keep the FTE level of virtual safety attendant staff adequate so you can monitor the requested number of patients at any given time. Cox Health uses a similar model to support their patient safety program. In year 1, they reduced the requirement for 30 FTE sitters, saving $1.3M. Since remote hospitals lack sitter reserves, cameras have been helpful in preventing staff from being called away from the floor.

Data collections across health systems

  • Many healthcare systems run extremely differently from one another (even when part of the same IDN) and efforts to harmonize data collecting are still a work in progress at many systems. At Baptist Health Medicine, falls have been identified as a core metric to measure results of the TeleSitter system. The system’s fall committee tracks “falls” and “falls with injury” using an incident reporting system. YoY comparisons are made to ensure that as they reduce sitter counts, they see reduction in falls as well. Prior to AvaSure, there was no reliable statistic for tracking sitter impact.
  • Sharing data throughout the system can help to garner buy in for your patient safety program. Once a month, Loyola Medicine holds a hub & spoke meeting where data is presented at the hub level, but also broken down by each spoke so that everyone can see their individual results. This makes it easier to benchmark each facilities effectiveness by looking at important indicators such as stat alarm reduction time & utilization. Asking leaders to bring information to the meeting such as falls data (not collected in ORNA®) can help make it a productive time to share other results as well. The dashboard in ORNA helps them be accountable to how VSAs are performing and quantify the value they’re bringing to the hospital. This meeting helps collect results to hold staff accountable and demonstrate program effectiveness to leadership.

Building support: How to get your patient safety programs off the ground

  • Facilities have different approaches on staff background required to become a virtual monitor team member; some require entry-level staff to have a general understanding of healthcare. PCTs or CNAs are also great candidates as they have all worked and gained hospital experience. Given medical expertise, the learning curve is lowered, and this can help to build a team of more experienced VSAs to balance out anyone who may be new to the industry.
  • To give virtual safety attendants a perspective for what RNs are dealing with, Loyola Medicine implemented “reverse shadowing” with new hires helping to overcome the obstacle of how each side views “what you truly do all day.” Cox Health has specific qualifications they look for in a VSA, including a positive attitude and demeanor to help foster positive interactions with patients. They are hired as an in-person sitter first, and then after 30 days may permanently place them in a VSA role depending on their understanding of the healthcare space intimately and their technological abilities.
  • Cox Health prioritizes education for both groups. To keep personnel accountable, discuss the necessity for vocal intervention. If calling the nurse, verbally intervene first to ensure it’s documented. Also, make sure that bedside staff knows when monitors are and are not monitoring the patient to ensure no moment is missed. Education and communication are key to bridging the gap between the two groups and will be a continual work in progress.
  • For VSAs to recognize the importance of their position, they must feel connected with patients, family members, and team members in the hospital. A best practice at some facilities is to have a nurse manager or ANM from one of the spokes round at the departments they’re monitoring to help foster relationships with the bedside. Virtual safety attendants are more likely to find success when they have these relationships with the bedside teams they’re supporting. Presenting at nurse leadership meetings across the spoke facilities help identify new and emerging problems and pain points, helping to continue to optimize the focus of your patient safety program.

 Build a strong team – Hire, train & retain staff

  • Maintaining a strong team is another key to long-term patient safety program success. Having a house-wide partnership council where all nursing staff are welcome to participate to enhance processes can help with this. This council allows participation from virtual monitors, connecting them to the bedside staff and allowing them to develop process changes, introduce initiatives to the whole company, and bounce ideas off different roles. Each unit has a council that any staff member may join as a subset.
  • Loyola Medicine has struggled with retention, so they try to get creative and create more flexibility beyond 12-hour shifts when it comes to scheduling, trying to ensure that they get enough rest and adequate breaks but also considering work/life balance expectations of people interested in this role. When hiring, consider their chances for advancement and where they want to go next; many who start as VSAs are then interested in opportunities to apply to CNA programs, etc., providing a talent pipeline for your organization. At Loyola Medicine, this is so common that they are developing a virtual monitor attendant/CNA program so they can perform both roles in a more flexible program.
  • Creating a fun and interactive environment has helped multiple facilities keep staff satisfied and retain them long term. Office items such as sit-to-stand desk or stationary exercise equipment can help to break up the day for workers pulling long shifts. Some offices take it further with “fun Friday” including activities like potlucks, PJ parties, karaoke, or a hot chocolate bar. Because the office is not on site at the hospital, their office setting is more accommodating to these types of work activities. It has created such a great culture at Loyola Medicine that there is a waiting list for VSA roles when many other departments are struggling for staff.
  • Having a lead virtual safety attendant who isn’t assigned to specific patients can also help when centralized monitoring increases the number of patients being monitored. What is the lead’s role?
    • Be the resource relief for team
    • Relieve them for breaks & be a second pair of eyes
    • Lead the majority of communication with hospital – troubleshooting, tracking down numbers, etc.
    • Do all the admissions & discharges into the TeleSitter system so they can focus on patient care
    • Balance workloads, manage patient assignments, and manage VSA’s patient mix between “busy” and “less busy” patients, optimizing their efficiency
    • Ensure that the virtual safety attendants are doing their work properly by conducting accountability tracking
  • The importance of recognition:
    • Emailing virtual safety teams and bedside workers with great catches and highlighting the work of the combined teams every few weeks can help to boost moral of the teams and generate buy-in.
    • Use team or staff meetings, orientation, or any time in front of facility staff as an opportunity to highlight the work of the patient safety programs/teams.
    • Encourage the use of “kudos” in HR systems to celebrate great catches, but overall, make sure both VSAs and nurses see the good they’re doing in keeping patients safe and make them feel like invaluable assets of the team.

Insights and takeaways to get you started

  • When getting started, involve more stakeholders than less. Think about departments likes security, biomed, and all nursing units – ensure everyone who may have a hand in the patient safety program has a voice.
  • Consider a steering committee to develop and implement required policies and procedures. This steering committee can also help to guide the program, facilitating communication between departments and driving growth over time. Especially when working with pediatrics, behavior health, or higher risk patients, it’s important to collaborate and communicate regularly to keep the patient safety program running smoothly.
  • Don’t stop at falls! Many say they started their patient safety programs focusing only on falls, but over time saw value with a number of other use cases and many wish they had expanded sooner to things like:
  • Establish bonds with your spokes, including facility leadership and bedside staff. The ones where leaders are engaged with and have a relationship with the TeleSitter teams have better performance than other units.
  • Help your staff recognize the delicate balance between keeping an eye on patient safety vs. being big brother. It’s not their focus to judge nursing jobs, i.e., document “not rounding enough” or commenting on nurse performance. This can help drive trust between nursing and VSAs.
  • Early involvement in system falls teams, committees, etc. is important. If you don’t make yourself top of mind, people may forget you are there. Getting involved early is key.

Centralized monitoring is a great way for a patient safety program to create efficiency while delivering improved patient outcomes. Virtual safety teams bridge the gap between patients and nurses, being a true part of the team helping to ensure patient safety and improved outcomes. With the staffing shortage continuing to increase, it is more difficult than ever to find patient sitters without further exacerbating staffing challenges. Virtual sitting is proven to be a safe and reliable way to monitor a variety of patients, while reducing labor costs, driving improved patient safety, and quality outcomes. At AvaSure, we have a best-in-class team that helps establish the goals of your health system while maintaining high-reliability, expertise, quality, and safety. To learn more about how we can help you streamline and increase quality patient care, contact us and get a free complimentary on-site assessment.

Watch the recorded session with Loyola Medicine, Baptist Health Medicine, and Cox Health or download the guide for more best practices.

Tips, Tricks, and Tales from Monitor Staff Superstars

speaker headshots

Many conversations surrounding AvaSure TeleSitter® or TeleNurse® programs focus on the burden removed from the bedside care team & the benefits to patient.

Transforming the Industry: Avasure Virtual Symposium Recap

Many conversations surrounding AvaSure TeleSitter® or TeleNurse® programs focus on the burden removed from the bedside care team & the benefits to patient outcomes, but the forgotten superstar is often the care provider on the other side of the device. In this session, we had the opportunity to speak with two phenomenal monitor staff managers who lead effective teams that work tirelessly to keep patients & staff safe. As Juliet said, “it’s not just about the patient alone – it’s also about protecting staff while they work tirelessly to provide care.” Read on to learn more about their tips, best practices & experiences as monitor staff, program leaders & facilitators of great patient care.

Panelists:
Kearston Winder, Ascension Via Christi
Juliet Aninye, LVN, VA North Texas Health Care System

Q: What Was It Like Verbally Redirecting Patients For The First Time?

  • Kearston was excited to be able to help the floor staff & help in managing the patient. She felt apart of the care team and during her first intervention, was trying to get a patient to keep their oxygen on. She felt great when the floor staff immediately recognized her work reaching out to say thank you & share their gratitude, she was watching their patient. This acknowledgment went a long way in her feeling valued in her role.

Q: Were You Skeptical When You First Heard About The Avasure Telesitter Program?

  • Juliet had a strong interest coming from a long term care environment. The VA already had a program in place when she joined, but when she was trained by current monitor staff & rounding with the bedside staff, she got a new perspective on the work. She was excited by the challenge of getting the program on the right track to work in partnership with the bedside team & help to expand the program further.

Q:  What Best Practices Are There For Developing Relationships With Patients & Does That Help With Redirecting Them?

  • It’s all about communication. Acknowledgement that their need is heard goes a long way – let them know you’re going to get their nurse, come back on after making the call to say someone is coming and check in after that everything is okay. Providing verbal feedback goes a long way.
  • Introductions can help to ensure they understand the why & view the camera as a helper. Build some rapport by having a conversation with them so you build confidence that this tool is to keep them safe, not some sort of “big brother.”
  • When verballing queuing, make sure it comes across in the tone of, “how can I help you?”
  • If possible, having a manager round in person to introduce the device and program and verbally prompting the introduction of the monitor staff can go a long way to build confidence – especially if the family is in the room. This usually opens a dialogue for questions and ends with a positive view of the monitor’s role.
  • Best Practice: in a VA setting, patients are at high risk of having some form of PTSD. In these situations, when doing introductions walk them through what a verbal intervention & stat alarm will sound like. This can help ensure they aren’t startled, especially when sleeping, potentially causing a trigger.

Q: What Are Some Best Practices For Handoff?

  • You need to ensure you consider both types of handoff – handoff from one monitor staff to another about a patient, but also handoff from one bedside nurse to another for the monitor staff. It all comes down to communication! A best practice from one panelist is a handoff report sheet where they document any key events, patient/nurse preferences or interventions during the 8 hour shift. That sheet is then passed to the next staff member & so on. This allows for a record for the particular patient that can be referenced at any time.
  • When it comes to the bedside nurses, ensure you always check in at the beginning of a new nurses shift to see if there are changes to be aware of. Different nurses may have different preferences for what you watch for, communication, etc. so reset expectations with every shift.
  • Monitor staff can provide valuable information to the bedside staff during report outs on things to watch for, the patient condition over the past days & if they’ve been “busy.”
  • If you’re in a hub & spoke model, ensure there is a standard procedure across all facilities to ensure ease of compliance for your monitor team
  • Constant, easy communication between the monitor staff & front-line staff is the key to a successful program – at all times, not just at shift change or handoff.

Q: Monitor Staff Sometimes Witness Upsetting Events They May Not Be Used To If They Didn’t Come From A Clinical Environment. How Do Leaders Support Staff During These Events?

  • Staff without previous hospital experience may be overcome by events like a patient passing away and can be unsure how to move past such an event. Ensure they feel comfortable being able to reach out to their manager whenever such an event may occur. Listen to them openly and continuously follow up/check in on them over the coming days or weeks. It can be helpful to use the data & reporting available to show that they fulfilled their role to the best of their abilities and that there wasn’t anything they could do. Bedside staff are typically supportive in these situations as well, especially if an adverse event like a fall occurred, assuring the monitor staff that they followed all procedure correctly. This can help to alleviate guilt they may feel.
  • If your facility has employee assistance program for clinical staff dealing with these situations, extend it to monitor staff so they can have a support network.
  • Use any adverse event as a learning opportunity for the team to review what happened, what interventions occurred, and discuss if there were any further actions that could be taken in the future.
  • Be supportive, understanding and transparent with your team – this goes a long way!

A great catch from Juliet: “We had just admitted a new patient to the AvaSure TeleSitter program and within a few minutes, the monitor staff could tell something didn’t look quite right. The monitor staff called the nurse right away and discovered the patient was unconscious. A rapid response was called and the patient was then transferred to the ICU. This could have been an adverse event without the camera, as it would’ve been a while for the patient to be checked on. The bedside staff called the monitor staff later that day to thank them for alerting staff in item to catch this.”

Monitor staff are key members of the care team who build relationships with the patients & provide essential care. Sometimes, these team members are monitoring patients for weeks, months or longer – so it’s important to realize the impact they are making. A best-in-class TeleSitter program has communication, camaraderie, and respect between the on-site and off-site teams that fosters an environment of elevated patient care. At AvaSure, we have a best-in-class education team that helps to share best practices for building, staffing, and running your monitor team.

Keeping Suicidal Patients Safe, Virtually

illustration of AI in virtual monitoring

In this post-pandemic world, we are seeing an uptick in behavioral health patients across the u.s., especially in our vulnerable pediatric population. When we pair this with a shortage of mental health professionals, there is a risk in our ability to adequately care for this important demographic. One particular challenge is handling suicide ideation (si) patients in acute care facilities, as they require a one-to-one sitter for their health and safety.

With our current staffing situation, providing this sitter often means pulling a much-needed member of the care staff off the floor. This can exacerbate already strained staffing, which is why telesitter solutions are so important for low and moderate risk si patients and why AvaSure pulled together this panel for our annual symposium. There is a perception that telesitter solutions aren’t allowed or suitable for these patients – in reality,  policies may have to be adjusted, but most governing bodies allow for the virtual monitoring of si patients that are assessed to be low or moderate risk. Using a telesitter program for these patients can help reduce placing additional staffing constraints on your system while keeping patients safe.

Read below for key highlights from our panel discussion on this underutilized but important use case of the telesitter solution:

Q: Why did you first implement a TeleSitter program? Did you consider using it for SI patients at that time?

  • HCA Methodist & St Peter’s Health both were primarily focused on falls prevention when first building out their programs and the inclusion of use on SI patients came down the road. Both saw challenges increasing where CNAs, RNs, and even administrators were being pulled to sit with patients exacerbating the need for another solution.
  • Ascension Michigan started the program with SI in mind, but offsetting sitting costs related to patient falls were the driving factor

Q: Was there a perception that TeleSitter solutions couldn’t be used for SI patients & how did you overcome this challenge?

  • Most hospitals have a policy in place that needs to be addressed & reviewed. In some instances, depending on state legislation, it may be important to include your regulatory/compliance managers as well. Ensure that you have an adequate screening tool in place – most customers on the panel utilized the Columbia suicide screening tool to assess for low/moderate/high risk. This will be important in case of an potential JCO visits that staff is aware that screening does take place before placing a patient on virtual vs. in-person sitting.
  • As the program gets started, be sure to share good catches with hospital leadership, nurse managers, and front-line staff. This is key to building good will around the program and gaining support.
  • Once the team understood that the devices do not record & are fully HIPPA compliant, there was no longer a concern about it potentially violating JCO regulations to utilize virtual monitoring

Q: Were there any specific challenges with getting physicians on board?

  • Some physicians were hesitant at first, especially pediatrics. To help build confidence, multiple facilities conducted a pilot where a video monitor was used in combination with an in-person sitter who sat outside the room. This allowed for a safety net while they proved out the efficacy of the system.
  • One panelist noted that less than a year into the program, providers don’t hesitate to rely on the TeleSitter staff for monitoring these patients
  • However, all systems noted you’ll have to stay on top of educating new providers & residents as they join the system – so continue to share great catches even after initial implementation

Q: Are the monitor staff for SI patients required to be clinical or specially trained in any way differently from those monitoring for falls, elopement, etc.?

  • All the systems on the panel utilize the same monitor staff which can be clinical but are not required to be when monitoring all patients – including SI
  • The training modules on monitoring Suicide Ideation Patients from AvaSure were viewed by all as an essential tool in training staff to properly monitor this patient population
  • One panelist recommended the best practice of rotating “on-site” 1:1 sitters and virtual monitors so they have an appreciation for both versions of the program helping to build consistency
  • Another best practice is that if monitor techs aren’t yet at their maximum number of patients being monitored, consider having multiple monitor techs viewing a SI patient for an extra set of eyes on these patients
  • In addition to training monitor staff, it’s essential to train bedside staff. Most aren’t adequately educated on the details of their hospital policy regarding sitting & sharing stories of what could happen when things go wrong can help to drive the need for compliance.

Q: What advice do you have for customers just thinking about rolling out a TeleSitter program for monitoring SI patients?

  • Consider your use cases when selecting devices. Not all TeleSitting devices are ligature free, so if you’re thinking about monitoring SI patients from the onset or down the road, share this with your vendor to ensure you purchase the correct devices
  • Hold a roundtable with various departments allowing for open conversation between leaders prior to rollout. This can help to identify any areas of concern that you can then be laser focused on addressing.
  • Don’t underestimate the number of cameras you’ll need – Kim Beckett from Ascension said the program would be easier to manage with a camera in every patient room!
  • “It’s possible, efficient & effective. The camera prevents harm,” said one panelist while another noted, “don’t hesitate. Education is how you overcome any potential pushback. The results will speak for themselves.”

The team was able to share several great catches, all noting they have not yet had a successful attempt on a patient being monitored by their TeleSitter program. In addition to more typical catches, such as a patient attempting to strangle themselves with heart monitors, they also caught things like a patient who was able to smuggle in materials from the outside & an incident where an on-staff security guard entered a pediatric patient room and was overly aggressive with the patient. Events like this have caused the facilities to think outside the box on future potential use cases for their TeleSitter programs – such as watching infants for potential abduction, monitoring eating disorder patients & keeping an eye on family members in the room for potential staff or patient injury & medication theft. With a well supported program, the use cases truly are endless. If you’d like to learn more about potential use cases, we’d be happy to complete a complimentary on-site assessment and make recommendations.

​​Watch the recorded session

Panelists:

  • Debbie Cronin, RN, Director of Patient Care Services, St.Peter’s Health
  • Kim Beckett, RN Manager – Clinical Surveillance, Ascension Michigan
  • Wesley Wingate, Director Cardiac Telemetry, HCA Methodist

Virtual nursing: it’s a thing, but where to start?

nurse smiling

Program overview:

  • 1 virtual nurse per 100 M/S beds that assists with 55-60% of patients
  • At admission complete the questionnaire & can scribe physical assessment of onsite nurse, work on care plans, virtual patient education, core measures, make follow up appointments and lead discharge process including compiling all discharge information, ensure follow up appointments are lined up & medication reconciliation

Early Outcomes:

  • On average, virtual nursing saves 12 minutes per admission and 15-29 minutes per discharge, giving time back to bedside teams for patient care
  • During first 6 months, 107 catches in discharge errors that could have been significant patient harm. The panelist noted, “while bedside nurses may have caught these errors prior to discharge, the virtual nurse can be laser focused on these specific tasks without the distractions of a typical floor nurse.”
    • Patient who was about to be discharged on 2 blood thinners
    • Diabetic patient being discharged without Insulin education
    • New CHF patient without proper medication prescription at discharge
  • Discharges completed by the virtual nurse currently have lower rates of readmission – this is an early trend; they’re waiting to see more results over time to consider it correlated
  • Increases in HCAHPS:
    • 7.6% increase in patient understanding of purpose of taking medication
    • 2.04% increase in top box score for transition of care
  • Qualitative feedback from patients that they enjoy seeing a nurse without a mask on, can smile & interact more genuinely and can assist with hearing impaired patients who read lips.

UCHealth: expert ICU nurse helping monitor high risk critical patients for sepsis, deterioration, and other adverse outcomes

Program Overview:

  • 3-4 virtual nurses monitor up to 1,800 patients within the system
  • Provide surveillance and early detection support aimed primarily at sepsis
  • Partner with novice bedside nurses providing help due to high turnover & lack of bedside experience
  • Work with other technologies that scan EHR and physiological monitors for triggers helping to identify patients in need of extra care
  • Monitor patients post rapid response to help detect rebounds

Early Outcomes:

  • Reduction in non-present on admission sepsis mortality & have seen compliance go up
  • Increase in rapid response calls
  • Unprecedented 25-70% code blue reduction in acute care areas, in combination with program on deterioration education
  • Bedside nurses have praised the program in making them feel more supported & secure in their roles

Great Catch: A post seizure patient was being monitored remotely and the virtual nurse (VN) could tell the patient was going to throw up. The expert VN was able to walk the bedside nurse through the steps to handle the situation – including fetching suction and calling the doctor. The doctor was able to help prevent the patient from aspirating. This gave peace of mind to the bedside nurse who was dealing with this situation for the first time.

Tips for getting started with virtual nursing

Our panelists shared a number of best practices when it comes to building out your own virtual nursing program – but their biggest advice was to, “just do it!” While starting a program can be daunting, they both feel that the benefits have outweighed the work.

Some of their tips are:

  • Whatever process you’re designing for needs to make sense and solve a bedside need. It needs to make life easier for the end user and be integrated in a way that makes sense in building a team effort approach for care.
  • Be sure to clarify for the team what virtual nursing is – but more importantly what it is not to all team members involved
  • Building a virtual nursing program is an iterative process – be willing to adapt as you get feedback from the front-line teams
  • When staffing your virtual team, look for nurses with multiple years of experience who can bring a level of wisdom to the role and can take a wide-angle lens on the patient population allowing them to catch things the bedside team may not. In addition to experience, soft skills are key. Look for collaborators who love to teach, have high emotional intelligence, and want to mentor other nurses
  • Have courage to try! Start a program, build some buzz around it. There’s a lot of work in this, but it’s good work, so give it a shot.

What’s next for virtual nursing

So, as early innovators in this space, where do they see their programs going in the future? Unity Point is focused on scale and standardization. They’re currently focused on creating a standardized, sustainable structure across their enterprise when it comes to technology, job descriptions, and everything else operational that goes with virtual nursing including creating a centralized leadership structure for the program. UCHealth is looking at expanding use cases of the program including virtual specialist care for areas such as wound care and respiratory therapy where they currently lack adequate staff across the system. They’re also exploring how a virtual nurse could assist with dual sign off activities such as checking blood & verifying high risk medications. Their ideal future state is one where an expert nurse is always a “call away” for a novice nurse who, for instance, is working night shift and has never placed an NG tube before, creating a culture of support and mentorship in all care settings.

Interested in your own virtual nursing program but not sure where to start? Our AvaSure RN’s can complete a free, on-site assessment of your facility and help in creating a business case based on your individual use cases. Request an assessment here and we will be in touch. We look forward to helping you transition to this exciting new model of supporting nurses through virtual care.

Watch the recorded session.

Transforming the Industry: Day 2 of the AvaSure Virtual Symposium 2022

AvaSure Symposium ft. Lisbeth Votruba

After an energizing first day, we’re back with another afternoon of fantastic content to share with you. As Gerry Lewis said during our closing fireside chat, in today’s environment clinicians and IT teams have a responsibility to work together to, “Create an end-to-end ecosystem that leverages enhanced clinical process and integrations, so we aren’t overburdening our clinical staff from a cognitive and burnout standpoint – otherwise, we are going to be challenged to take care of those in need in our communities.” Our role in helping to provide elevated patient care while liberating the bedside nurse has never been more important than in the midst of current staffing crisis.  

Today, we focused on Change Agents: Creating Awareness, Confidence and Excitement when rolling out a new care model inclusive of AvaSure TeleSitter and TeleNurse programs. We discussed obstacles to overcome, best practices for implementation and keys ways to share results with leadership. Then, we spoke with systems that have scaled to hub and spoke model systems – increasing their coverage through a centralized monitoring model. Ending the day, AvaSure CEO Adam McMullin sat down with Gerry Lewis, former CIO/EVP of Ascension to discuss the role of technology in the future of healthcare – exploring how to drive change at a health system, advice for expanding your virtual care program and how clinical leaders can best partner with their IT teams.   

Let’s look at some of the key findings from today: 

Change Agents: Creating Awareness, Confidence and Excitement

Presenters:

  • Shannon Robertson, BSN, RN, Unit Director, Virtual Care Operations, Carilion Clinic Park View
  • Jason Crouch, Virtual Care Operations Manager, Carilion Clinic Park View
  • Meg Alexander-Patton, RN, BSN, Carilion Clinic Park View
    • No one is going to be a bigger advocate for your program than you are! You need to sell the value of your program – to leadership, to staff – for it to be successful. Meet with teams at all levels, explain the service and benefits to drive utilization. 
    • Change doesn’t end – it’s constant. If you don’t keep yourself on the front of people’s mind, they may forget you. Keep pushing to find new and innovative ways for devices to be used to continue pushing value of the program higher. 
    • Trust is the biggest key to success. Leadership and bedside staff need to trust that the monitor staff isn’t just “watching a camera” but adding value. You can demonstrate this with great catches, with shadowing programs and with communication.  
    • Listen to your staff – try to understand potential pain points, make them feel heard and important. Also make sure stakeholders have skin in the game, including these stakeholders in the process helps drive the best outcomes ensuring they have reasons to help drive the program forward. 
    • Best practice: do shadowing as part of interview process so that monitor techs can truly get a feel for what their job will be like before accepting the role, this helps them grasp the reality of the role and drive retention 

Centralized Monitoring: Optimizing Labor Across an Entire Health System 

Presenters:

  • Mark Quirin, MSN, RN, Regional Manager for Virtual Monitoring Loyola Medicine
  • Katherine Mitchell, BS, BSN, RN, CMU/VMU Nurse Manager, Baptist Health Medicine
  • Kahlia King, CARE, Assistant Nurse Manager, Cox Health
    • Think about time zones being served and having an adequate hiring pool when picking a hub location.
    • As best you can, standardize data collection and routines across spokes being served by your hub to ensure consistency 
    • Involve more stakeholders up front – think beyond just clinical teams when starting your program and include case management, social work, security, financial leadership and more 
    • Consider a steering committee to help drive policy and procedure implementation but also to have people not in the “day to day” provide a wide-angle lens on your program 

Best practices for creating an engaged and effective monitor staff: 

  • Consider flexibility in scheduling – 12-hour shifts may make sense for nursing but not for monitor techs sitting at a desk, consider breaking them down or allowing for regular breaks to ensure they’re engaged when monitoring 
  • Use sit-to-stand desks to give monitors a way to change up their workspace. Want to take it one step further? One panelist has treadmill desks, stationary bikes and more! 
  • If you’re in an office environment, consider ‘theme days’ – like potlucks, pajama days, karaoke parties and more! 
  • Focus on recognition: use a ‘wow wall’, kudos system, newsletters, or emails to share great catches and recognize your monitor staff 

Fireside Chat with Gerry Lewis, Former CIO/EVP of Ascension and Adam McMullin, CEO AvaSure: How Technology Plays a Role in the Future of Healthcare 

  • Three things to consider when trying to drive change at a health system (if you can meet 2-3 of these, we should be taking next steps in how we operationalize this):
    • Does this differentiate the patient or clinical experience? 
    • Does this help us improve the value of the services we provide? Can we provide better services and be more efficient in how we deploy them? 
    • Is there an opportunity to bend the cost curve? 
  • The key to project success: clinically led but technically enabled – if that partnership isn’t there it’s very difficult
    • When working together with clinicians and IT teams – the more we create relationship and trust, break big complex processes down and continuously iterate we will be more successful. We like to go after these big bang projects where we expect everything to be perfect instead of starting with the first 20% and iterating until we feel like we’ve met all the clinical needs
  • We are at an inflection point; skilled care labor shortages have put us there. We need to look at how we apply labor and technology differently. We need to look at models, processes, technology and people in a very different way because the fundamentals are going to be challenged. 

Thank you to all who joined us for an exciting two days of sharing stories, learnings and experiences together.  

Transforming the Industry: Day 1 of the AvaSure Virtual Symposium 2022

AvaSure Symposium ft. Adam McMullin

We had a fantastic first day of the AvaSure Virtual Symposium focused on Transforming the Industry. “This year, our customers are focused on protecting their patients, making things easier on their care teams and reducing cost”, per Adam McMullin, CEO of AvaSure. That’s why the theme of this year’s event is Transforming the Industry. We know that customers need to make changes to their care delivery model in light of macro factors and we are here to help.  

Day one’s discussion were focused on various aspects of this care model transition – starting with Virtual Nursing: It’s a Thing, But Where to Start? We then spoke with a customer panel on using the TeleSitter solution to monitor for suicidal patients – an important and underutilized form of virtual monitoring. We ended the day highlighting the superstars of monitor staff programs sharing their best practices on staffing a program.   

Let’s look at some of the key learnings from today: 

Virtual Nursing: It’s a Thing, but Where to Start?

Presenters:

  • Sarah Brown MSN, RN, Chief Nursing Officer, UnityPoint Health
  • Amy Hassell MSN, RN, Director of Patient Services, UCHealth Virtual Health Center 
    • 89% of hospital and nurse leaders are moderately to extremely interested in virtual nursing, but most are still in planning phases. From our customers on the panel who have implemented, they all say, “just do it”. As our one panelist said, “have courage to try something – create some buzz around it. There’s a lot of work in this, but it’s good work so give it a shot.”  

Early results from virtual nursing pilot panelists:

  • Time savings for bedside staff using a TeleNurse for admission and discharge – reduce admission time by 12 minutes and discharge by 15-29 minutes 
  • Saw increase in patient experience scores on HCAHPS – 7.6% increase in patient understanding of purpose of taking medication and 2.04% increase in top box score for transition in care 
  • Critical care expert TeleNurse helped drive increase in rapid response calls and an unprecedented 25-70% reduction in code blues in combination with deterioration education 

Lesson learned for starting a virtual nursing program:

  • Whatever process you’re designing needs to make sense for and solve a need at the bedside. It needs to be easy for the end user, needs to be seamlessly integrated and make sense in building a team effort.  
  • Clarify what virtual nursing is – and importantly what it is not – to all team members 
  • Need senior leadership buy in but nurse managers and front-line staff buy in is essential – start conversations on the issues they’re having and key pain points to address 
  • Just jump in and be willing to iterate – you need to be flexible and be willing to adapt as you gain feedback. The hardest thing to do is just say go and start. 

Keeping Suicidal Patients Safe, Virtually

Panelists:

  • Debbie Cronin, RN, Director of Patient Care Services, St.Peter’s Health 
  • Kim Beckett, RN Manager – Clinical Surveillance, Ascension Michigan 
  • Wesley Wingate, Director Cardiac Telemetry, HCA Methodist
    • You may have to address your hospital policy, but virtual monitoring of low and moderate risk suicide ideation patients is accepted by most governing bodies 
    • If you’re struggling to gain buy in or are skeptical, consider a pilot where a physical sitter is outside the room with a virtual monitor. This will allow a safety net while you gather outcomes of how verbal interventions help prevent adverse events. This can be presented, in addition to research and testimonials, to leadership in order to drive program acceptance. 
    • Device selection is key based on your anticipated use cases. When purchasing devices, if you anticipate using on SI patients make sure you consider ligature risks and buy appropriately, or this can be a challenge down the road. 
    • Training and education of monitor staff here is key – AvaSure provides a great module focused specifically on suicidal patients that can help educate both monitor and front-line staff 
    • Best practice: don’t think about limiting just SI patients in a ratio for your monitor techs, instead make sure they take note of all “busy” patients (could be falls risks, elopement risks, SI or other risk) and ensure they don’t have more than 2 per monitor tech 

Tips, Tricks & Tales from Monitor Staff Superstars

Panelists:

  • Kearston Winder, Ascension Via Christi 
  • Juliet Aninye, LVN, VA North Texas Health Care System
    • It’s all about communication – communication with the patient and communication with the bedside staff. Ensure you properly introduce yourself and your role to the patient to put them at ease but also ensure there is easy, routine communication between monitor staff and the bedside team for an effective TeleSitting program. 
    • Develop a handoff process – some panelists used a document where monitor techs would note any key interventions or patient/nurse preferences that could be given to the next tech, but whatever your process ensure information can flow from nurse shift to nurse shift and monitor tech to monitor tech 
    • Best practice for veteran facilities: Many of these patients may suffer from PTSD. Ensure your staff when introducing themselves coaches on what a verbal intervention and stat alarm will sound like so they are not startled – especially when sleeping 
    • Best practice: have an escalation pathway on both sides – so that monitor staff know who to escalate to when they can’t reach the nurse and so nurses know who to escalate to when they have feedback for the monitor staff. It all comes down to transparency and good communication. 
    • Build rapport with the patient through conversation, this will help them to respond more positively during intervention periods  

For those who joined us – we hope you enjoyed the first day as much as we did. If you missed it, all of the recorded sessions will be available for viewing next week. Make sure you tune in tomorrow as we have another great day of content including:  

  • Change Agents: Creating Awareness, Confidence & Excitement! 
  • Centralized Monitoring: Optimizing Labor Across and Entire Health System 
  • Fireside Chat with Gerry Lewis

See you tomorrow! – AvaSure Team 

How Trinity Health Drove $23M in Labor Cost Savings Through Virtual Monitoring

AvaSure logo

A new on-demand webinar is now available on Becker’s Hospital Review.

During this webinar, Gay Landstrom, PhD, RN, senior vice president and chief nursing officer of Livonia, Mich.-based Trinity Health will share her experience on improving the safety of at-risk patients while optimizing labor costs using centralized virtual monitoring.

Ms. Landstorm will discuss the speed of implementing the “hub and spoke” approach across the health system. This approach has improved patient safety, saved $23 million in labor costs and opened up possible career paths for patient safety assistants.

Key Learnings:

  • Why Trinity Health made video monitoring a top priority for labor cost savings
  • How the organization scaled the program across the enterprise
  • How Trinity Health reduced labor costs while increasing patient safety

Presenters:

  • Gay L. Landstrom, Senior Vice President & Chief Nursing Officer for Trinity Health
  • Lisbeth Votruba, MSN, RN, AvaSure Chief Clinical Innovation Officer

Did you know? AvaSure Integration with Epic Enhances Clinical Workflows

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AvaSure’s software has the capability of seamless integration with Epic and other electronic health records systems, becoming a natural part of caregivers’ workflow and an easy way to connect with patients.

AvaSure’s two-way, secure, HIPAA-compliant video communications can be launched from within Epic with a simple mouse click, enabling physicians and other clinicians to have instant telehealth check-ins with patients and their families, even if they don’t have a video app or MyChart account.

This is far from the only way that AvaSure helps improve patient safety and reduces workforce burden across your enterprise. Our platform can easily be integrated with nurse call, clinical communications systems, and more. Together, these systems help staff keep closer, more informed track of a patient’s status.

If you would like to learn more or add AvaSure to your Epic ecosystem, reach out to your AvaSure contact, who will facilitate your introduction to our dedicated expert integration team.