Technology is increasing human interaction and safety in patient care
A self-described cranky patient at Community Hospital of the Monterey Peninsula was unhappy when he learned his discharge instructions would be provided by a nurse appearing on a computer screen, rather than at his bedside.
“I need to know why you’re not here, standing next to me right now,” he demanded of Desiree Franklin as she materialized on an iPad in front of him.
Franklin patiently explained her role as a “virtual discharge nurse” and asked the man to give her a chance. He did, and, over the course of a 45-minute discussion, she won him over.
“I’m just a cranky old man,” he said. “This is change for me. But this is really good. You’ve answered all my questions and I’ve got the information in front of me so I can see everything that we went over.”
Though it seems counterintuitive, technology is being used in healthcare to increase interactions between care providers and their patients and to support patient safety. Virtual discharge nursing is one of the latest such initiatives at Community Hospital, joining others, such as “telesitters” who remotely help patients who have dementia or other issues that can benefit from closer supervision.
“We’re looking at innovative ways to support the nursing staff so we can decrease the burdens on them that take them away from direct patient care,” says Debbie Sober, Vice President and Chief Nursing Officer at Montage Health.
I’m just a cranky old man. This is change for me. But this is really good. You’ve answered all my questions and I’ve got the information in front of me so I can see everything that we went over.
— Patient
Sober proposed a virtual discharge nursing pilot project after reviewing some at other hospitals. With a nurse handling much of the discharge process virtually, the in-person nurse can spend more time providing hands-on care to other patients, Sober says. Virtual discharge nursing can also give patients who are going home uninterrupted one-to-one time with the nurse guiding their discharge, who is free from interruptions from other patients. This can streamline the discharge process for patients and families and free beds sooner for new patients.
At first, nurses were skeptical: No one else should be discharging “their” patients, Sober says. But they were open to trying. Working together, Sober, the nurses, and staff from the Health Information Technology department and elsewhere, developed a pilot. It began in September in the nursing unit where most orthopedic patients go after surgery; those patients are usually discharged after a day or two, so there is high turnover.
Since then, the pilot has evolved and expanded. One virtual discharge nurse works four days per week and Sober anticipates expanding soon to seven days per week.
Franklin, a nurse at Community Hospital since 2001, starts her day by reviewing the files of patients being considered for virtual discharge. They must meet several criteria, including being able to communicate over an iPad, and they must be going home rather than to another care facility.
Franklin reviews each patient’s medical history, hospital stay, and their doctor’s plan for post-hospital care. She works with discharge planners to ensure arrangements for assistive devices or at-home care. Before virtually meeting with a patient, Franklin sends their specific discharge instructions to a printer in the patient’s nursing unit, then the patient’s nurse takes those instructions and an iPad mounted on a pole into the patient’s room. The nurse helps the patient start the session on the iPad, introduces them to Franklin, and the virtual discharge conversation begins.
“I let them know that we’re going through discharge instructions from their doctor and that I’ve reviewed them and know all about them,” Franklin says. “I tell them to stop me with any questions and reassure them that if they think of something after the call has ended, they can push the call button for their nurse for follow-up.”
Franklin and the patient go over dos and don’ts, medications, dressing changes, and other issues that might arise at home. Family members or other caregivers can join the conversation or have a separate call with Franklin.
We’re looking at innovative ways to support the nursing staff so we can decrease the burdens on them that take them away from direct patient care.
— Debbie Sober, Vice President and Chief Nursing Officer at Montage Health
Patients have responded favorably, Franklin says, and nurses are finding that having much of the discharge process handled by another nurse gives them more time for their other patients.
A “virtual nursing hub” was created inside the hospital and is home to the on-duty virtual discharge nurse as well as telesitter staff members. While the discharge nurse focuses one-on-one, telesitter staff members each work with up to 10 patients at a time.
Telesitters, officially called “safety observational specialists,” monitor and communicate with patients to help keep them safe throughout their hospitalization. For example, a patient who is prone to falls may frequently try to get out of bed without assistance. Or a patient with dementia or drug or alcohol addiction may try to pull out IVs or remove wound dressings. The telesitter talks with the patient over a two-way video system, trying to redirect them. If necessary, the telesitter contacts the patient’s nurse for a swift, in-person response.
For years, hospitals have had actual “sitters” — staff assigned to sit in the rooms of patients who need constant monitoring for safety. Community Hospital still has up to six in-person sitters each day, but changes in patient populations — and not as many family members at the bedside — have increased the need, says Christine Payne, Administrative Director of Nursing.
“Using a video system allows us to ensure the safety of many more people than we could if we needed one-to-one sitters,” Payne says.
Telesitters are trained in what to watch for and ways to respond. Often, a conversation with the patient will end the potentially harmful behavior; other times, the telesitter will offer patients outlets for attention and energy, like “fidget” devices or coloring books.
One telesitter was caring for an elderly woman with dementia who was restless and pulling out her IV lines,” Payne says. “The telesitter offered to bring her a doll. Once she did, all the patient’s energy went into caring for the doll. She was rocking it, changing it. She had purpose.”
The telesitters are not nurses, but, using technology, they support nurses and patients.
“It’s our team on the other side of the monitor, their ownership of the service, and their connection with the patients that make this program successful,” Payne says.
