Topic: Patient and Nurse Satisfaction

Virtual Nursing Emerged as Solution to Workforce Shortage in Texas During Pandemic Surges

On July 30th, 2020, as hospitalizations from COVID-19 were hitting new peaks across the country, Memorial Hermann Health System initiated a pilot virtual nursing program at 3 of its hospitals in Texas during its COVID-19 hospitalization surge.

ICUs at Memorial Hermann have large windows that allow nurses to monitor and check-in on patients without physically entering the room. As patients filled hospital beds outside these ICU locations, nurses had to physically enter rooms in full personal protective equipment (PPE) to periodically check in on the critically ill.

The program utilized mobile monitoring devices in rooms so nurses could monitor patients virtually, and soon the virtual program covered 14 ICUs during the summer surge through September. The program was designed to maximize shift efficiency, protect staff and patients from COVID exposure, and centralize protocols based on nursing qualifications.

As the COVID-19 delta variant spread, experienced critical care nurses were sent to a central video monitoring station that managed the health system’s 100 mobile monitoring devices, which allowed communication between less experienced staff to effectively monitor and care for COVID patients in the 2 subsequent surges that followed.

The system also allowed nurses at Memorial Hermann to safely and effectively monitor up to 8 patients from remote (at-home) locations if needed.

Memorial Hermann’s protocols included revamping its staff and nurse practices to accommodate for the high demand created by COVID-19 hospitalization surges and ongoing workforce shortages.

“We also in the future could use [the virtual program] for nurses who may not be physically able to work more than 3 shifts,” said Director of Hospital Information Systems at Memorial Hermann Scott Shaver, MSN and registered nurse. “I have full disclosure, I guarantee you if I was a nurse on the floor right now, I would do 3 shifts and that would be it. I am too old to do more than that.

My body doesn’t work that way [anymore]. But I can guarantee you that I can do 3 shifts in the ER and then do a shift at home using this. I could definitely do that. And so we actually have that availability as well not just for COVID but for really anything in the future. This can be applied to really anything that we can think of in the future where we can use virtual nursing to take care of patients.”

The company AvaSure provided the virtual nursing platform used by Memorial Hermann. The company sells evidence-based virtual care solutions, an innovative set of software and hardware aimed at inpatient telehealth care and utilized in nearly 1,000 hospitals across North America.

Juliet Aninye, a VA North Texas Health Care System nurse and LVN Lead for AvaSure’s TeleSitter® Program, was the winner of the Department of Veterans Affairs (VA) 2022 Secretary’s Award for Excellence in Nursing and Advancement of Nursing Programs.

The AvaSure TeleSitter® solution allows one trained hospital employee to monitor up to 16 patients simultaneously, preventing not only falls but elopement, violence against caregivers, and other adverse events.

“The bedside nurse will select which patients are most at risk for some kind of adverse events,” said Lisbeth Votruba, Chief Clinical Innovation Officer at AvaSure and herself a registered nurse. “[Falling] is a very common one. A frail elderly person who’s disoriented in a hospital setting—if they fall it can be really catastrophic. Those types of patients or a traumatic brain injury patient who’s impulsive and aggressive … or a patient who is in isolation with COVID, is delirious, their oxygen level is dropping, they’ve got to keep a mask on and they keep pulling it off. [It is important] to have the ability to monitor those higher risk patients, which is about 10% of the [in-patient] setting.”

Votruba said the virtual nursing models that have emerged improve efficiencies in patient admission and discharge, virtual preceptor mentoring, and critical care support that leverages nursing expertise across a health system in a centralized manner.

AvaSure’s video platforms that enable physicians and other clinicians to have instant telehealth check-ins with patients and their families are part of a $12 billion global telehealth market that exploded in growth during the pandemic.

Texas plans to invest $600 million over the next several years to expand broadband statewide and improve telehealth access for the 2nd largest rural population in the US. Nearly 2.8 million Texas households, or 7 million people, lack broadband access, according to the US Census Bureau.

According to the Texas Rural Health Association and Rural Health Hub, there are 64 counties in the state without a hospital, 25 counties without a physician, and 75% of counties are designated as Health Professional Shortage Areas (HPSA).

Virtual nursing advocates say the shortage of trained health care professionals in rural areas was an existing problem that was exacerbated by the pandemic and highlighted the state’s current health care system’s inability to reach these vulnerable communities.

The University of Texas Medical Branch (UTMB) School of Nursing will be launching a nursing certificate program in January of 2023 that aims to improve care for patients in rural areas where there are not enough professionals to care for these communities.

“For telehealth to be a widely adopted solution across Texas, providers need resources, education, and support to eliminate barriers and successfully implement telehealth tools into modern health care practice,” said Dr. Kristen Starnes-Ott, Vice Dean for Academic Affairs and Professor at UTMB School of Nursing.

She pointed out that many health care institutions shifted to a telehealth model as an emergency measure when the pandemic began, but much of it was done without adequate training.

With proper preparation, training, and implementation, she said that telehealth has great potential to help Texans receive needed care in areas with a shortage of providers.

Source: Boram, K (August 1, 2022). “Virtual nurse emerged as solution workforce shortage in Texas during pandemic surges”. State of Reform Texas

Here’s to Nurses: May You Stay Healthy, Happy and on the Job

Dear Colleagues:

Providers are under stress. Kaufman Hall reports that through February, the average hospital operating margin had fallen 42.4% in the first two years of the pandemic, to a negative 3.5%. Widespread staff shortages – mainly but not exclusively nurses – and pandemic-related supply chain challenges drove expenses up 32% in the same two years. There are 3% fewer staff on hand, but those who remain cost far more.

More alarmingly, a survey by the American Nurses Foundation revealed that more than half of all RNs were considering leaving their organizations this year.

Last September, the CDC reported that because of these stresses, adverse events were on the rise. Infections, central-line and catheter-associated, as well as MRSA, increased exponentially. COVID made close observation of patients harder and delayed responses as RNs and techs needed to don PPE before entering the room. This is why more than 400 hospitals took us up on our offer of free software licenses for using AvaSure’s TeleSitter® solution to monitor COVID patients.

Social isolation and other stressors from the pandemic have also led to an explosion of behavioral health problems, including drug overdoses, suicidality, eating disorders and violence against caregivers.

CMH Uses TeleSitter® Solution and Remote Monitoring To Enhance Patient and Staff Safety

Thanks to technology, nurses and other caregivers at Community Memorial Hospital (CMH) in Ventura have a new way to monitor and communicate with COVID-19 and other high-risk patients. Now, with help from remote “TeleSitters,” physicians and staff at CMH can observe and care for such patients effectively while also minimizing close staff-patient interactions.

Read the full news release to learn more.

Happy Nurses Week

Our salute to two RNs and those they have chosen to assist

Today is National Nurses Day, which typically kicks off a weeklong celebration, culminating with the anniversary of Florence Nightingale’s birthday. This year, the American Nurses Association extended the event into a into a month-long celebration to “expand opportunities to elevate and celebrate nursing.” Little did they know how appropriate and deserving such a move would prove to be.

Two of our own – AvaSure Board Member Cathy Rick and Clinical Program Specialist Sarah Quiring – have rejoined the ranks of nurses after years away from direct patient care to do whatever is needed.

AvaTalk caught up with them to talk about how their mission to contribute is going.

AvaTalk: When did you decide to actually return to active duty nursing and what was it about the pandemic that drove you to do this?

Rick: I had no plans to go back to work after retiring as CNO of the Veterans Health Administration in 2014. I have enjoyed being engaged in mentoring roles and periodic consulting work for healthcare organizations in addition to my commitment as an AvaSure board member. But then came COVID-19. I know full well how challenging it is to deal with day-to-day operations across a large system like the VHA while, at the same time, fulfilling the needs during a national crisis. So in early April I reached out to longtime colleagues at the VA just to say that I was thinking of them. I offered my support in any way that they thought appropriate, and lo and behold, they immediately took me up on it.

Quiring: Early on in my career as a nurse, I was given a thank-you card by a patient that in paraphrase said: “You were called to this place, at this time, for a purpose.” I have often reflected on that sentiment. By going back to the hospital during the COVID-19 pandemic, I have joined multitudes of others who were willing to show up with their skills when they were needed, whether that was suddenly home schooling their children, providing janitorial services or making masks.

AvaTalk: What is your assignment?

Rick: I was asked what I’d like to do, and said I’ll do whatever you want. I started my virtual assignment to assist with national nurse staffing strategies on April 9th.

Quiring: I am currently working as a staff RN, in an eICU, providing coaching to regional nurses who may have limited critical care experience.

AvaTalk: So what is the nature of the work and how much time is involved?

Rick: I am assigned to support an Office of Nursing Services Workgroup to offer my expertise as a former VHA senior executive. This workgroup has been charged to develop innovative options for meeting staffing needs during surge capacity requirements in this (and future) national emergencies. It’s been a daily whirlwind, working 8-11 hours a day, seven days per week, including Easter Sunday, quite an adjustment from retirement!

Quiring: I currently work full time on the weekdays as a Clinical Program Specialist for AvaSure and work between one and two 12-hour shifts on the weekend in the eICU. I am very fortunate that AvaSure and my local hospital have been both flexible and supportive with this unique arrangement.

AvaTalk: How long do plan on contributing?

Rick: As long as I’m needed. Although the work hours are intense at this time, I would anticipate that will change to a slower pace as newly designed innovative approaches become standard operating procedures.

Quiring: I plan on contributing through the projected census surge time until the hospital resumes serving at typical capacity.

AvaTalk: How does it feel to contribute again on the frontlines?

Rick: It is an honor and a privilege. I am reminded again and again of how nurses are the backbone of global healthcare. It is a very special feeling to be a VA nurse again. My colleagues there are talented, dedicated, forward-thinking federal employees, and the VHA nursing workforce is among the best of that workforce.

Quiring: As a bedside nurse, you have the unique and humbling position to walk alongside people during some of the most difficult times of their lives. This pandemic has taught us that we are all connected, perhaps more than many of us realized. I have the rare opportunity to directly help patients in dire need while also working for AvaSure, whose business is making the jobs of the same frontline staff easier and more productive.

Bill of Health: TeleSitters® Are Entering Hospital Rooms. How Will They Change Patient Care?

In many medical circumstances, clinicians and caregivers may choose to not leave a patient alone. For example, a patient may present a fall risk, experience confusion and agitation, or be at risk of self-harm. In these circumstances, they are in need of 24/7 monitoring. The TeleSitter® is a critical patient supervision tool, particularly for hospitals that are understaffed or cannot afford the number of sitters that their patient load requires. They also present clear and remarkable improvements to hospital operations: they reduce costs, improve staffing allocation, and help the hospital focus costs on improving and scaling access to care.

Read more here.

Midland Health: TeleSitter® Program Offers Increased Patient Safety, Peace of Mind

Being able to protect our patients and offer quality care are of the utmost importance at Midland Health. In always looking at innovative ways to enhance patient safety, we created the TeleSitter® Program, a video monitoring system that gives our patients extra attention and further promotes their safety. The primary staff responsible for monitoring patients with this technology are our behavioral health assistants who are experts in this area.

Read the full article to learn more.

Henry Mayo Newhall Hospital Unveils New Technology for the Betterment of Patients

AvaSure’s TeleSitter® Technology is a system that is designed to connect caregivers more closely with patients and families while improving the quality of care delivered, according to Henry Mayo officials.

This new technology is part of Henry Mayo’s “Fall Prevention Program,” which is intended to keep patients safe and allow Henry Mayo patient care associates (PCAs) to spend more time caring for patients.

“We have specific patients that meet certain criteria that don’t need a physical body present, but can use the robot services from the AvaSure product,” said Jennifer Castaldo, Henry Mayo vice president and chief nursing officer. “The TeleSitter® devices will give our nurses and PCAs more time to spend with patients, while at the same time keeping our high-risk patients safer.”

Castaldo mentioned how the need for their PCAs to be bedside with patients is becoming more of a necessity.

Read the full story here.