Topic: Nurse Leadership

AvaSure’s fourth annual National Symposium has closed its virtual doors following an inspiring and informative Day 2 on October 7th. Once again, the theme of connection and the growing role of telehealth took center stage as keynote speakers, panelists and presenters shared their insights.

Keynote – John O’Leary

John O’Leary, author and activist, kicked off the day with a moving and motivational talk about thriving in the face of adversity. After 20 months of COVID-19, O’Leary encouraged attendees that the best of the journey to better healthcare is to come.

Throughout his keynote, O’Leary prompted attendees to remind their colleagues at all levels that their work matters. At an early age, O’Leary was burned on 100% of his body in an accident, and he spent much of his childhood in the hospital. Throughout his time there, his doctors empowered everyone from custodians to nurses to be a part of his journey.

Today, O’Leary is grateful for the opportunity to speak to the public at events like the AvaSure Symposium. He thanked the hardworking frontline workers, administrators and staff for all that they do, and reminded everyone that gratitude can create the largest impact, reduce stress and help find joy.

Lunch Time Knowledge Bites

After the keynote presentation, attendees had the choice of two Lunch Time Knowledge Bites sessions:

• Common Challenges & Misconceptions
• Working with Organized Labor & Your TeleSitter® Program

This wide range of topics was perfect for any organization that wants to take a deep dive into their AvaSure TeleSitter^® solution and equip staff with what they need to thrive.

Common Challenges & Misconceptions provided both new and existing AvaSure users with insights into how to optimize among both monitor staff and program leaders. Presenter Wendy Popma-Breen, BSN, BS, RN, Clinical Implementation Services Manager at AvaSure, said that transparency and the sharing of information needs to be a key consideration for hospitals and healthcare systems. In many situations, monitor staff are not aware of the conditions or history of the patients they are monitoring. In order to keep patients safe, monitor staff need to be equipped with as much information as possible. Processes can help alleviate this strain, as well as robust onboarding and continuous learning for all staff.

Panel 1 – Keeping Suicidal Patients Safe, Virtually

After lunch, attendees attended the Keeping Suicidal Patients Safe, Virtually, presented by UC Davis and Benefis Health. Amid the ongoing mental health crisis, healthcare systems are seeing an influx of patients who are struggling with suicidal ideation, especially among adolescents.

Both teams worked closely with AvaSure to implement TeleSitter solutions that can monitor patients and mitigate risk. One of the biggest benefits of the program is the ability for monitor staff to observe patients 24/7, whereas nurses may not see signs of escalation unless they are in the room. In some case uses, the one-on-one option for the TeleSitter provided an opportunity to form a connection with patients who are in crisis, helping them on the road to recovery.

With no end to the crisis in sight, AvaSure continues its commitment to providing tools and resources to help healthcare systems best serve their patients.

Breakout Sessions

The afternoon breakout sessions included:

• Tales from the Front: Early Wins Beget Long-term Success
• Fostering New Use Cases for Virtual Care
• Standing Up to the Surge: Virtual Nurses Help a Health System Manage COVID

In the face of the COVID-19 pandemic, staffing shortages and a deep freeze that wreaked havoc on much of Texas, Memorial Hermann Health System and its implementation of the TeleSitter program are a case study that all telehealth professionals need to hear.

In July 2020, Memorial Hermann went from initial contact with AvaSure to fully operational coverage of COVID-19 patients in 15 days. Today, Memorial Hermann has over 100 cameras across 12 care facilities in the Houston metro area. The program even allows monitor staff to work from home, when necessary. Their IT team put together workstation kits that included everything an employee would need to work from home alongside their on-site colleagues. When much of the area was hit by an ice storm earlier this year, Memorial Hermann was able to scale its program to continue to provide patients with the safety and monitoring that they needed.

The Memorial Hermann team shared many of the lessons that they learned along the way. For them, staff buy-in was essential, and they made sure that nurses knew that the program was not a critique of their work, but instead, a resource designed to support them. Additional key takeaways included the value of communication, identifying areas of concern, creating an escalation process and developing a pipeline for staffing support.

Panel 2 – Case Closed: Remote Video Monitoring Increases Staff Safety

The final panel of the AvaSure Symposium covered workplace violence. Christina Case, MSN, RN-BC, Clinical Nurse Manager at Providence St. Peter Hospital, presented alongside Lisbeth Votruba, MSN, RN, Chief Clinical Innovation Officer at AvaSure. The duo shared peer-reviewed research, ORNA data and anecdotal evidence on workplace violence and how AvaSure solutions can help prevent it. In fact, ORNA data shows that 17,077 abusive events were prevented at 195 hospitals from July 2017 to July 2021.

Once the TeleSitter was implemented at Providence St. Peter, Case and her team found success in the creation of an educational toolkit. These toolkits improved her staff’s feeling of the program, increased reporting and encouraged engagement. When asked if staff safety was more important than patient safety, Votruba and Case shared that while patient safety is extremely important, it cannot come at the cost of staff safety.

AvaSure sends a sincere thank you to all keynote speakers, moderators, panelists and participants who made the fourth annual AvaSure Symposium a success. Registered attendees will receive a link to the recordings for keynotes, panels and sessions next week.

A recent trip to UCHealth’s Virtual Health Center in Aurora, CO, gave me and a colleague a breathtaking view of AvaSure as an indispensable part of healthcare delivery. From a central observation facility, this multi-hospital system is keeping patients safe at the bedside, validating telemetry alarms and supporting ICU teams in delivering critical care. In the early stages of COVID, its Virtual Health Center collected and disseminated the latest evidence-based treatment options to frontline staff who barely had time to sleep, much less review clinical research.

We at AvaSure have been planning for these new use cases, but to see them in full flight was inspiring for me and my colleague, Crystal Harding. We could see some of the seams in what the system was doing, but it was real, bringing home the potential of AvaSure to support critical care nurses and technicians as they seek to improve quality, make the highest use of staff resources and take some of the feelings of isolation out of isolation care.

We have names for these new services, but what we are doing is essentially extending the same proven technology that for a decade has been preventing bedside disasters such as falls to provide new layers of virtual care.

Here is some of what we saw on our trip:

• The Virtual Health Center has three rooms. In one, five monitor techs were each watching a dozen med-surg patients for the “traditional” risks such as falling, eloping and pulling at lines and tubes. Staff were part of a research protocol on patient selection for remote monitoring. The room was mostly quiet while I was there, though I did witness an intervention to stop a traumatic brain injury patient from trying to go to the bathroom without staff help.
• The telemetry room was quite a contrast. It was monitoring 500 patients from multiple workstations. Audible alarms were a constant. As I walked through the room, I imagined the staff hearing those alarms in their sleep.
• The front room is the Virtual ICU, where three critical care nurses were using our technology, known as Verify, to watch over patients in all of this system’s hospitals. During night shifts, when physicians at the hospitals may not be as readily accessible, an intensivist physician joins the expert nurses in monitoring care. Verify uses AvaSure’s technology, but instead of a dozen patient rooms on screen, there are 38. Using a variety of physiologic monitors, the team can respond to the most at-risk patients based on bedside nurses’ concern or electronic trigger tools such as sepsis alerts and early warning scores, as well as visually rounding on the ICU patients.
• Sepsis is a great example of the success of this approach. The health system has implemented a state-of-the-art sepsis care bundle. Changes in lactic acid levels, blood pressure and heart rate trigger an intervention, as sepsis treatment is so time sensitive. I was told of a novice nurse in one of the system’s smaller facilities who was not administering antibiotics in a timely manner to a patient in danger of slipping into septic shock. The patient had pulled out the IV and the new nurse had not been able to re-insert it. The virtual nurse found the resource needed to get the IV back in and antibiotics delivered quickly.
• One of the nurses told me a story of how she witnessed a patient being coded for full cardiac arrest. She noticed that no one in the room was recording the medications given, so she took on the role of virtual recorder. There is an Advanced Cardiac Life Support algorithm that should be followed during a code. She was able to help make sure the team stayed on track. She told me: “I called into the room and reminded everyone, ‘It’s been two minutes since we last gave epinephrine; let’s give another dose now.’”

My colleague and I left our visit so inspired by the work this UCHealth is doing to keep patients safe. When the nurse told me this story, I had a lightbulb moment. While our TeleSitter® application helps keep patients physically safe, Verify is a wonderful tool for clinical safety.

All of this reminded me of a conference presentation I attended pre-COVID about virtual ICUs and the need for faster responses to “triggers,” or changes in physiologic conditions that are most closely tied to the danger of a life-threatening event. The presenters discussed how a bedside nurse has to open the electronic health record to receive one of these triggers, which might not happen if the nurse is occupied talking to a patient’s family or changing a dressing. With a virtual care team in place, the trigger generates an instant response.

The broader role we have envisioned for AvaSure is being actualized on the frontlines of care. We developed the tools, but nurses, doctors and monitoring staff are inspiring us by using them to improve the quality as well as the safety of care.

On September 24, AvaSure held the second day of its virtual National Symposium. Health care experts from across the United States gathered again to network and learn from each other on their experiences with continuous remote safety monitoring. The symposium topics on day two were mindful of this year’s theme, Leading Through Change, and made way for caregivers to collaborate and present best practices when utilizing the telehealth platform and providing the best care for their patients.

Panel 4 – Lessons Learned Monitoring the Monitors
The first panel of the day, Lessons Learned Monitoring the Monitors, brought together the AvaSure TeleSitter program managers from Covenant Health, Ascension St. Joseph Hospital, VA North Texas Health Care System and Oregon Health & Science University. The discussion was moderated by Wendy Popma-Breen, RN, BS, BSN AvaSure Clinical Program Specialist.

The TeleSitter program managers shared insights on best practices, tips for enculturation, utilization of the technology and more. Experts provided meaningful advice as learned from hands-on experience in leading monitoring staff teams, including insight on a wide range of use cases such as with patients who have COVID-19, are suicidal or at-risk of falling. Additionally, extensive insight was provided as it pertains to the staff who are in charge of monitoring the patients, such as ensuring they are appropriately trained, collaborate in teams with helpful feedback and take ample breaks so they are in a good headspace.

We learned that not only do these hospital systems utilize AvaSure’s technology for day-to-day monitoring of patients that qualify for inpatient TeleSitters, they spend time as teams to review the ORNA data the platform provides. By reviewing the data, the networks are able to accurately make decisions when expanding the application of continuous remote safety monitoring, how its use saves the hospital systems on operational costs, output the value with specified metrics, and more.

Panel 5 – Preventing Self-Harm, Remotely
The second panel of the day was moderated by AvaSure’s Vice President of Clinical Quality & Innovation Lisbeth Votruba, MSN, RN. The topic was Preventing Self-Harm, Remotely. Participants included hospital staff from, The University of Kansas Health System, Spectrum Health and Helen DeVos Children’s Hospital.

A Q&A discussion prompted the experts on how using the TeleSitter keeps patients with suicide ideation and other behavioral health patients safe from self-harm via the ability to remotely monitor them 24/7. All care networks that utilize continuous  remote safey monitoring to supervise patients who could harm themselves are handled on a case-by-case basis. For example, an inpatient that is a low to moderate risk of self-harm might be a great fit for a TeleSitter, while high risk patients would be better suited for a 1:1 sitter that is always present in the hospital room. AvaSure consistently works alongside its customers to train monitoring staff and management departments to appropriately prepare the caregivers to make these decisions.

Panel representatives also discussed the topic of suicide from a general perspective, reiterating the need to continue normalizing discussions surrounding behavioral health. It’s important to understand the stigmas surrounding suicide so health care organizations and their providers can continue to educate and improve the notions of silence.

The discussion wrapped with timely comments regarding the recent Centers for Disease Control and Prevention (CDC)-issued warning and predictions on the potential increase on the horizon for behavioral health issues, considering the difficult year 2020 has been. The hospital representatives expressed they are starting to see suicidal patients increase, especially in younger adults who are autistic.

Panel 6 – Making Sure the Kids are All Right
A new panel at this year’s symposium was Making Sure the Kids are All Right, which was moderated by Stacey Overholt, MBA, BSN, RN, AvaSure Clinical Director. Panel experts included staff from Anne Arundel Hospital and Methodist Children’s Hospital San Antonio. The participants outlined the benefits and challenges of utilizing continuous remote safety monitoring for those in pediatric care.

Anne Arundel Hospital staff stated they have utilized AvaSure’s TeleSitter platform for more than 8,400 monitoring hours over the past year just in the pediatric department location, which also resulted in an operational cost savings of $200,000 in that sector alone for that time period. Not only does the hospital network see the cost reduction benefit, but they said it allows them to better care for their young patients who are struggling with behavioral health while undergoing inpatient care.

A specific topic that was discussed extensively during the session was the importance of communication between the care staff who are utilizing remote monitoring methods in a pediatric hospital room with the patient’s parent or guardian. We learned that communicating from the beginning on why the patient is being monitored, the fact that the cameras aren’t recording the room and the benefits it provides greatly increased the parent’s comfort when having their dependent in the hospital’s care.

Following the conclusion of the second day panels, AvaSure was incredibly excited to honor the 2020 AvaPrize recipients:

• Hub & Spoke Award – WakeMed Health & Hospitals
• Path-to-Zero Award – The Miriam Hospital
• Safety Net Award – Riverside University Health System Medical Center
• Superstar Monitor Staff Member – Megan Fitzsimmons, Oregon Health & Science University Hospital

Keynote – Dr. Kelly Posner Gerstenhaber
The symposium ended on an extremely honorable note. Dr. Kelly Posner presented the final keynote presentation. Dr. Posner is the Professor of Psychiatry at Columbia University and world-renowned expert on the risk of suicide among patients. She spoke about her work in developing the Colombia Protocol, and the importance of shining a light on suicide as a worldwide public health crisis.

The Columbia Protocol, also known as the Columbia-Suicide Severity Rating Scale (C-SSRS), supports suicide risk assessment through a series of simple, plain-language questions that anyone can ask. The answers help users identify whether someone is at risk for suicide, assess the severity and immediacy of that risk, and gauge the level of support that the person needs. In 2011, the CDC adopted the protocol’s definitions for suicidal behavior and recommended the use of the Columbia Protocol for data collection. In 2012, the Food and Drug Administration declared the Columbia Protocol the standard for measuring suicidal ideation and behavior in clinical trials. Today, the Columbia Protocol is used in clinical trials, public settings, and everyday situations, such as in schools, faith communities, hospitals, and the military, to identify who needs help – saving lives in 45 nations on six continents.

Dr. Posner expressed this protocol works because people care and want to engage. Engagement and asking the right questions can quite literally be medicine for someone who is contemplating self-harm or suicide. Suicide is a shared problem of humanity, but it’s the one preventable cause of death. Everyone across the world has in some way been affected by suicide and when you break down barriers by asking tough questions and paying attention, you save lives.

AvaSure is so appreciative of those who made our third National Symposium on Leading Through Change a success. In case you missed any of the presentations and would like to learn more, a recording of the symposium sessions will be available after the event.

We also encourage you to check out the other resources on our website and social media channels. You can find us on Twitter @AvaPrize and on our Symposium Facebook page www.facebook.com/groups/avasurecommunity.

On September 23, AvaSure kicked off its third National Symposium in a virtual format as a result of COVID-19. These events bring together senior leaders, frontline staff and health policy experts to share best practices and new uses for continuous remote patient care. The symposium theme this year is Leading Through Change, which hospital systems and care networks have especially demonstrated throughout the continued challenges of the pandemic.

Brad Playford, AvaSure’s CEO, opened up the day by providing attendees with the latest news about the company and its role in the future of telehealth – which has been proven to be a critical, now more important than ever, force multiplier for healthcare providers and the patients we serve.

Keynote – Wes Moore
Following the opening remarks, attendees enjoyed an incredibly motivational discussion with first day’s keynote speaker, Wes Moore. Wes is currently the CEO of Robin Hood, one of the largest anti-poverty forces in the nation. As a bestselling author, a combat veteran, and social entrepreneur, his insight set the tone for an inspirational day.

Wes provided listeners with an abundance of experiences and examples on how to be a good leader during a time of change, resonating with the force who has been on the frontline of caring for patients who have COVID-19. Not only have health care systems and workers had to adapt to new environments and processes, they are consistently seeking innovative methods of care to keep everyone safe in today’s and future care applications.

Panel 1 – In Isolation BUT Not Alone
After the keynote presentation from Wes, our first panel of experts took the virtual stage. The panel topic, In Isolation BUT Not Alone, was moderated by Cathy Rick and included panelists from Mount Sinai Morningside, Sinai Health and Moanalua Medical.

This topic specifically covered the viewpoint from the respective hospitals and networks alike who are continuing to care for patients with COVID-19. AvaSure’s telehealth technology and remote monitoring system allows caregivers to isolate patients who have the virus, but also ensure an effective secure way to attend to them without risking potential spread and saving valuable resources like PPE.

Panelists expressed they continue to use AvaSure in COVID-19 settings as some unfortunately are experiencing increased case numbers. For example, when licensed teaching hospital Sinai Health had to prevent students from coming in for hands-on learning due to virus risks, they were still able to participate with AvaSure’s monitoring technology – similar to a live teaching simulation. A representative from Mount Sinai Morningside said their hospital used the audiovisual monitoring technology to allow infected patients to communicate with their families who were unable to visit them.

There continue to be new applications the TeleSitter can be used for, many of which have become an invaluable use during COVID-19.

Panel 2 – Preventing Disruptions
The second panel, Preventing Disruptions, was moderated by AvaSure’s Vice President of Clinical Quality & Innovation Lisbeth Votruba MSN, RN, and included participants from Elliot Health System and Piedmont Athens Regional Medical Center. These healthcare leaders discussed the oftentimes overlooked but incredibly important topic of keeping health care workers safe and preventing workplace violence. Special guest Adrien Bardes, Manager of Public Safety, Piedmont Athens Regional also sat in on the panel to provide his expertise.

The experts walked through examples of remote interventions and the application of AvaSure’s telehealth system in keeping staff, patients, and families safe amid the continuing epidemic of illicit substance abuse and issues in behavioral health settings.

Audiovisual monitoring allows hospital staff to continuously monitor patients who might be suicidal, are experiencing drug and alcohol withdraws, could be at-risk of following and much more. This option keeps the patient in a secure and safe environment, alongside protecting the caregivers who interact with them.

Panel 3 – Tales from the Frontline
The final panel on symposium day one was brought back by popular demand! Moderator Pat Quigley, PhD spoke with the hands-on TeleSitter users at systems including Covenant Health, Providence St. Joseph Orange and Abington Hospital Jefferson Health.

The monitor staff revealed best practices, lessons learned and views from behind the camera on time spent watching at-risk patients. If there was one theme consistently expressed throughout this discussion, it was that the day-to-day application of the unique telehealth resource has proven to be a force multiplier in health care – both for patients, staff and their families.

Aside for COVID-19, the TeleSitter allows hospital staff to better connect with their patients and provide a safe and meaningful experience.

AvaSure sends a sincere thank you to our keynote, moderators, panelists and all participants who made the first day of our virtual symposium a success. In case you missed any of the presentations and would like to learn more, a recording of the symposium sessions will be available after the event.

We encourage you to join us today, September 24 from 11 a.m. to 3:30 p.m. EST, as we continue the meaningful presentations and discussions on Leading Through Change. We will hear from experts on best practices is utilizing AvaSure’s technology, how the TeleSitter is used to keep suicidal patients and their caregivers safe, benefits of using our applications in pediatric care units, wrapped up with a presentation from keynote Dr. Kelly Posner Gerstenhaber. AvaSure is also looking forward to honoring the 2020 AvaPrize recipients on day two. Participants can follow along and engage with us on Twitter @AvaSure or our Symposium Facebook page www.facebook.com/groups/avasurecommunity.