Category: Case Study
Johns Hopkins’ Virtual Nursing ‘Delivers Sustainable Value’
The health system’s use of telemedicine has saved more than 3,000 hours of bedside nurse time, supported by more than 16,000 virtual nursing sessions. The CNIO discusses this and other successes.
Johns Hopkins Health System recognized an opportunity to evolve how nursing care was delivered in response to mounting clinical and operational complexity – and without compromising quality or patient experience. Evolving workforce dynamics required ongoing attention to staffing consistency at the bedside, while patient acuity, regulatory requirements and documentation demands continued to rise.
THE CHALLENGE
In today’s healthcare environment, nurses often manage admissions, discharges, patient education, quality monitoring and hands-on care simultaneously – which can limit the flexibility to engage as deeply as desired in relationship‑based patient care.
“As part of our ongoing commitment to operational excellence, we continually evaluate opportunities to further streamline admission and discharge workflows,” said April Saathoff, DNP, RN, vice president and chief nursing information officer at the Johns Hopkins Health System and an adjunct faculty member at the University of Maryland School of Nursing. “Enhancing these processes supports smooth patient flow across the health system, improves care transitions, and helps ensure patients are well prepared to manage their healthcare decisions after leaving the hospital.
“At the same time, performance expectations around readmissions, patient experience and hospital‑acquired conditions remain high, requiring careful attention to education, coordination and compliance across every shift,” she continued. “We recognized that the inherent pace and demands of bedside nursing can contribute to interruptions during care delivery.”
Staff wanted to create a more intentional, less rushed model of care – one that allows experienced nurses to engage more fully with patients, address questions, reinforce education and support informed decision-making.
“As we looked ahead, we saw value in reimagining how nursing work is structured to proactively support staff wellbeing, reinforce consistent best practices and enable long‑term success across quality, experience and efficiency,” she added.
PROPOSAL
Virtual nursing was proposed as a care delivery redesign focused on strengthening – not replacing – the bedside nurse role. The model offered a way to redistribute time‑intensive and cognitively demanding tasks such as admission assessments, discharge education, care coordination, quality monitoring and mentoring to experienced nurses working remotely – allowing bedside nurses to focus more fully on physical assessment, interventions and other forms of direct patient care, Saathoff said.
“Technology‑enabled virtual nursing platforms made it possible for virtual nurses to engage patients in real time through secure audio‑visual connections while remaining fully integrated with the care team,” she explained.
“The intent was to create a continuous, visible nursing presence that could reliably support patients, families and staff during high‑impact moments of care such as admissions, discharges and education – factors strongly tied to outcomes like readmissions, patient satisfaction and safety,” she continued.
Staff saw virtual nursing as a scalable system that aligned workforce sustainability with patient‑centered care. It offered flexibility to retain highly experienced nurses, reinforce standardized workflows, improve throughput, and ensure consistent delivery of education and quality practices – all while preserving the human connection that is central to nursing, she added.
MEETING THE CHALLENGE
Virtual nursing was implemented as a collaborative model embedded directly into nursing workflows across multiple medical‑surgical units. Virtual nurses have taken on the roles of performing admission assessments, discharge planning and teaching, patient and family education, care plan updates, quality and regulatory monitoring, dual medication verification, and mentoring. Meanwhile, bedside nurses retain full responsibility for physical assessments, medication administration and hands‑on care.
“Virtual nurses work from dedicated on‑site hubs and interact with patients through Caregility cameras, speakers and monitors installed in patient rooms,” Saathoff explained. “Patients are introduced to virtual nurses as members of their care team, and sessions include education, safety checks, interpreter‑supported visits, and family/caregiver participation, as needed. Bedside nurses can easily request virtual support, creating real‑time relief during peak workload periods.
“Virtual nursing is tightly integrated into the electronic health record,” she continued. “Virtual nurses document directly in the EHR, use dashboards to prioritize work, communicate with bedside nurses via secure messaging applications, and leverage eligibility screening tools embedded into admission and discharge workflows.”
This integration ensures shared situational awareness, minimizes duplication, and reinforces virtual nursing as a seamless extension of bedside care rather than an add‑on, she added.
RESULTS
Throughput and efficiency: Virtual nursing drove measurable improvements in patient flow. Over this period, Johns Hopkins Health System saw measurable improvements in both admission readiness and discharge workflows, resulting in more timely patient movement and smoother care transitions across the health system, Saathoff reported.
“By handling admissions and discharges remotely, virtual nurses were able to complete these processes more quickly – yet still thoroughly – without the interruptions that routinely challenge bedside nurses, making these gains possible and helping to reduce average length of stay,” she said.
Quality and safety outcomes: The model contributed to meaningful improvements in patient safety and regulatory compliance, particularly in the areas of fall prevention and pressure injury reduction. Staff also observed improvements in regulatory documentation compliance, as virtual nurses consistently monitored, documented and reinforced quality practices – helping reduce variation and support bedside staff during busy shifts, she noted.
“In addition, virtual nurses routinely review care delivery to ensure quality bundle compliance and appropriate interventions are in place, while assuming administrative and documentation tasks that free bedside nurses to spend more time delivering direct, high‑quality and safety‑focused care with patients,” she added.
Patient and nurse experience: From the outset, nursing staff worked closely with their colleague Patient and Family Advisors, Patient Education and Patient Experience teams to co‑design a virtual nursing program that directly addressed patients’ needs, preferences and concerns.
“Many nursing‑related HCAHPS domains improved following implementation, specifically in categories like likelihood to recommend, nurse communication and discharge information,” Saathoff explained. “From a workforce perspective, virtual nurses rate their shift workload and satisfaction highly.”
Financial and workforce impact: Virtual nursing promoted nursing wellness by offloading cognitively intense and administrative tasks from the bedside nurse. The initiative allowed for greater workforce stability, with decreased dependence on premium labor and improved nursing vacancy rates, she reported.
“Since go‑live, virtual nurses have saved more than 3,000 hours of bedside nurse time, supported by more than 16,000 virtual nursing sessions,” she concluded. “These results demonstrate that virtual nursing is not only a technology investment, but a workforce and care delivery strategy that delivers sustainable value.”
This article was originally published by Bill Siwicki, Managing Editor, Healthcare IT News.
HIMSS26: Baptist Health’s Keys to Success with Virtual Nursing
How Baptist Health aligned clinical and IT teams to scale virtual nursing, strengthen staff adoption, and return valuable time to bedside care.
In a recent session at the HIMSS conference, Kevin Ehemann, Telehealth Account Manager at Baptist Health, Danny Kennedy, Corporate Director of Care Innovation at Baptist Health, Arkansas, and Angela Wilgus, Manager, Virtual Nursing at Baptist Health, Arkansas, shared more about their journey to bring multi-site virtual nursing from Caregility to their organization. In the session they shared some of their learnings and how they had to align clinical and IT to make it a success.
Below you’ll find some of the keys to success that we captured during the session along with some additional commentary.
One of the common threads I’ve been hearing from CIOs lately is that there are no projects that are IT projects anymore. Every project a CIO is leading requires involvement from the clinical team along with IT. This aligns with Baptist Health’s experience with virtual nursing and the need to bring both teams together to make it a success.
This is a great takeaway from their experience. I think we all like convenience and dragging a cart around is not convenient. I did see a humanoid robot that could do telehealth at HIMSS, so maybe that will be the future. Until that fully arrives, it seems like pulling around a cart for telehealth is friction a nurse doesn’t need.
It makes a lot of sense why you’d want a seasoned nurse to be doing your virtual nursing. They’ve likely seen most of the situations that you’ll encounter and so they can be helpful across a wide variety of situations. I’ve also heard a number of nurses say that virtual nursing extended their career a number of years. Their bodies couldn’t handle the rigors of walking around like they used to do. Virtual nursing provided them an alternative that leveraged their skills without the same physical rigor of being on the floor.
Like most change, it takes time to build trust in something. Having the virtual nurse call the units each day was a creative way to build trust and consistency. Building those relationships really is key. Otherwise, the nurses on the floor won’t trust the virtual nurses.
Fascinating to see that the initial virtual nursing efforts led to a full Virtual Care Center. I imagine building a full Virtual Care Center showed the staff that the organization was committed to virtual nursing. The move to consistent hours likely helped to build trust in the process as well. I’d like to learn more about how they’re integrating the virtual observation and virtual nursing efforts. I imagine it’s a bit like a call center where it’s nice to have people who can float between different areas. Having nurses who can do virtual observation and virtual nursing likely provides some staffing flexibility as demand for these services changes day by day.
I’ve heard a lot of people talk about the value of in-room cameras. My guess is that this will become pretty standard in most hospital exam rooms. Partially because the cost to put a camera in a room has gotten much cheaper, but also because being able to connect with the patient almost instantly is valuable for nurses, doctors, allied staff, and even the patients’ loved ones.
In this case, having the in-room camera is great for the virtual nurse who can easily connect with the patient and do the admission or discharge without help from the nurses on the floor.
The proof is always in the pudding as they say. Amazing to see that the virtual care center was able to provide 60 hours back to nursing per day. It’s interesting to hear that the documentation improved which likely has really nice downstream effects on things like revenue cycle management. Plus, they had lower vacancy rates. Harder to measure is the reduced administrative burden on the nursing staff that frees them up to focus more on patient care.
It’s amazing to see that Baptist Health was able to grow their patient encounters so quickly. Normally a shift like this would take more time, but credit goes to their leadership for creating a great workflow that worked and for getting buy-in from staff for the effort.
Like often happens with successful IT projects, they were able to expand to many different departments. I call it department jealousy. It’s a powerful thing when one department sees another one use technology successfully, then they want to do it as well. Seems like this is what happened with the virtual care programs at Baptist Health.
We’ve been seeing this trend happen over a number of years. While TVs are great for entertainment in a hospital, the TVs are now connected and can be used for a wide variety of things beyond entertainment. It’s nice to see them using the TVs as part of their virtual nursing effort including admission and discharge.
This is a great lesson learned. Often we’re trying to fit technology into old buildings that weren’t designed for this technology. There’s a lot to think about when doing so and may require some construction to do it right. These little nuances really matter and often aren’t discovered until you start to implement the technology in the rooms.
This case study is a great example of the benefits of virtual nursing solutions from Caregility implemented at Baptist Health. What I love about this project is that it continued to evolve and improve over time. They applied the lessons learned and improved their approach as things progressed. Now they have a full virtual care center they can build off of as they build even more virtual care functions into the future.
This article was originally published by John Lynn, Founder and Chief Editor, Healthcare IT Today.
Salem Health Virtual Nursing Case Study
See how Salem Health modernized nursing operations through a scalable Virtual Nursing program powered by Caregility’s Connected Care™ Platform.
Lee Health Virtual Nursing Case Study
Virtual Nursing: An Inside Look at Central Maine Healthcare
Kris Chaisson RN, BSN, MS, CCRN-K, NEA-BC, is the Chief Nursing Officer at Central Maine Healthcare where she oversees nursing and patient care services on behalf of Central Maine Medical Center, Bridgton Hospital, Rumford Hospital, and the health system’s ambulatory care locations.
Chaisson and the Central Maine Healthcare team recently launched a Virtual Nursing Program on the healthcare organization’s three hospital campuses. In a recent panel discussion co-hosted by nursing leaders from Caregility, Hicuity Health, and Blue Cirrus Consulting, Chaisson shared insight into her team’s experience with the new nursing model.
Access the recording: Virtual Nursing: From Concept to Impact
You recently launched a virtual nursing program at Central Maine Healthcare. Can you walk us through the impetus for going the route of virtual nursing, which workflows you selected for the initial program, and why?
I think everybody can appreciate this nursing shortage and needing to find ways to help the bedside nurse, especially when 35% of our nurses have three years of experience or less. We were finding that they needed a little bit more support from experienced nurses so we decided to look at this route.
We initially engaged Hicuity Health in looking at this right at the height of the pandemic when we were taking care of critical care patients outside of the critical care area. We were having critical care patients in our ED, our critical care units were full, our PACUs were full, and we were wondering how we were going to do this with the expertise we needed. Once the pandemic sort of leveled out a little bit, we really shifted our focus and decided to look at how we could support the bedside nurse.
Most of the workflows we’ve used are really helping us with admission histories, medical histories in terms of medications, looking at discharge teaching, discharge education, and education throughout the patient’s stay. We recently started talking about using the virtual nurse to document for codes. That’s the next workflow we are going to look for, especially in our critical access hospitals.
You have a lot of novice nurses due to some of the turnover. How are you seeing this program assist the novice nurse?
I think they’re more comfortable with the technology and they haven’t had this established practice that they have to do everything by themselves. So, they’ve actually adopted it a little bit more readily than a more tenured nurse.
When a patient is boarding in the ED for a little bit and comes up to the floor and all their admission history and medication history is done, it’s a sense of relief that now they can spend time just meeting the patient, talking to them, doing their physical assessment, and developing that relationship instead of worrying about the tasks that need to happen. So, they’ve embraced it.
How did you work to establish trust between the staff on the floor and the nurses that are supporting them virtually?
We really worked at that. The implementation team did a little team building and orientation with the virtual nurses, just to get to know them a little bit and really be inspired by how much experience they have to bring to the bedside. And then we really worked hard on the handoff, sort of scripting an introduction of the virtual nurse to the patient. So, there was trying to manage learning who they are, what they can do, and then have [bedside staff] really treat [virtual nurses] as an extension of our team. And I think that really helped the nurses see that they were really helping and not something to fear.
We eased into this with the virtual nurse. We were comfortable with the camera because we do have a virtual patient safety assistant program. They were kind of used to the traveling video camera, going from room to room to help care for patients in that way. So that was less of a hurdle for us because we had that foundation.
Getting folks engaged really early on was really important. We also launched a survey to the nurses before we started, asking them what would help them. What do they find takes the most time out of their day? And then we wanted to make sure we didn’t just put a cookie-cutter sort of solution on top of a problem we thought we were fixing, but really didn’t need to. So that was really helpful.
What are best practices around insourcing versus outsourcing the virtual nursing staff?
What was most helpful working with Hicuity is we asked to talk to a few clients who had already been there, done that, and got to learn from them and ask, “If you had to do it all over again – what wouldn’t you do?” That way, we wouldn’t step in those potholes that they did. That was very helpful.
We did entertain whether or not this was something we could take on ourselves and we quickly came to the decision that we don’t have the nursing supply here in Maine. We rely heavily on purchased labor. This was cheaper than purchased labor, so we were excited about that.
Now I would be lying if I didn’t admit I thought, “Wouldn’t this be awesome in the future as the nurses here age and can’t be at the bedside anymore? Is this an opportunity for us to build in some retention for our tenured nurses to be able to do this remotely at home?” And that’s crossed our minds, of course, because I do need to have a long-term strategy for that game.
What are some of the things that you’re going to measure for success in your program?
We’re going to resurvey the team. We’re also looking at our nurse-sensitive indicators to see if they’ve helped. We have a dashboard on our portal page where we track all the assignments that the virtual nurse has done through Cerner. So, we have a tally of how productive we are in that realm.
We’re also looking at our quality metrics and then any event that they sort of head off at the pass. So, if they notice somebody that’s not doing very well and they cue in the nurse and we save a code from happening or, say, help with a rapid call, we’re going to track that too on our risk-tracking system.
If there was one thing about the perceptions of virtual tools and virtual nursing at your organization that you could change, what would it be?
I would try to take the fear out that we are replacing nurses with this. I think there was a fear there when we first started talking about it because our scope was big – like adding maybe a virtual nurse on every floor and maybe we could downsize a nurse but add more CNAs. And then we quickly learned that wasn’t going to be right for our organization or culture. We had to really shift gears and think, “How do we support them?” It’s supportive and it’s not replacing a nurse. And I think that went a long way.
We also started very small. We have 24 hours of nursing care coverage by a virtual nurse. We have a nurse coming in at 7:00 in the morning and leaving at 7:00 at night and one coming in from 11:00 AM to 11:00 PM. That’s 24 hours of care. We picked those hours because that’s when you ramp up in your admissions throughout the day. We’re going to start there, and we want to see how that goes and whether we need to expand or cut back or adjust hours a little bit. But we started slow and small to get people used to it and it is going really well.
What advice would you give anyone who is trying to implement a virtual nursing program?
I wish I had somebody to tell me how to do it. You really need to know your data. You need to know your nurse turnover. You need to know the experience of your nurses. You need to know what the skills and the pain points are for them.
And then you need to put that proposal together and get real support from your executive team because there is a financial investment you have to put in upfront. There is some technology. We had to sign a service agreement with the company to get the nurses. And we had to say, “Okay, if we do this, we’ll get this.” So, we put together a very robust business proposal to get buy-in from them. That was really the first step.
I had already kind of circulated it through the nursing leadership team… but getting the senior team to really buy in as being a partner with nursing to support this [was vital]. I needed every member from finance to HR to understand. Because, as you can imagine, HR was going to get questions like, “What’s going to happen with my job? Do I still have a job?” Those sorts of things. So, getting support from those stakeholders was really key.
And then really engaging your key stakeholders. We had a plethora of different services from patient experience to infection prevention, transport, and environmental services all engaged in this process to make sure that we went through all the steps you need to in change management. IT had their own project manager. We had Kaitlyn Smith, who helped manage the project from the nursing clinical side. So that was a great partnership. And then we had both Caregility and Hicuity Health facilitating those meetings as well and it was a great partnership to get this launched.
Considering Virtual Nursing for your healthcare organization? Schedule a call with our experienced team of clinical program managers and virtual care implementation experts today.
Lee Health Virtual Patient Observation Program Earns Innovation Award
HIMSS South Florida chapter members gathered recently for the 11th annual Integrate Conference, where Caregility partner Lee Health was announced as the recipient of the 2022 Digital Transformation Innovation Award.
The award recognizes leading-edge ideas, research, products, and services that are empowering healthcare. Lee Health Advanced Application Analyst Kimberly Gault, RN, and System Director of Virtual Health and Telemedicine Jonathan Witenko were awarded the recognition based on the success of the health system’s virtual patient observation program.
The Problem: Limited Staff to Support Rising Demand for Patient Observation
Lee Health’s virtual patient observation program was developed to address a prevalent issue in healthcare: optimizing patient safety in the midst of clinical workforce shortages.
“We decided to pursue this initiative as we were experiencing staffing shortages with our bedside safety technicians,” explains Gault. As demand for observation of fall-risk and at-risk behavioral health patients rose within the health system, “we were having many patients go unwatched or having to pull clinical staff to accommodate requests.”
Patient fall scores were elevated and care teams were stretched thin as a result. That prompted Lee Health to look for a smarter way forward.
The Solution: Virtual Workflow Innovation
Lee Health turned to virtual observation as an alternative to its in-person sitter model. Using newly procured technology, including Caregility’s iObserver tele-sitting application and telehealth endpoint solutions, the team began developing innovative new workflows to create a sustainable solution that redefined how high-risk patients are monitored.
Running on the same platform the health system uses to support additional telemedicine initiatives, the new program enables two-way audio/video communication between virtual safety technicians, observation patients, family, interpreters, and clinical staff. Lee Health acquired 70 telehealth carts to support virtual observation at patient bedsides across the health system. A PRN-to-FTE model is used to staff the virtual safety technician role.
To implement the program, Lee Health made investments in:
- Staff training
- Technology (telehealth endpoints, workstation monitors, cameras, and headsets)
- Software licensing
- Wage increases to migrate virtual observation staff from PRN to FTE status
Internal clinical stakeholders collaborated with technical teams to build workflow and documentation processes. Educators from internal nursing units supported intervention and escalation process training for virtual safety technicians.
The Results: Quantifying the Impact of Digital Transformation
Prior to implementing virtual patient observation, Lee Health relied on baby monitors to support 1:4 observer-to-patient ratios. Under the new model, the health system was able to reach a 1:6 ratio, with plans to scale operations to support 1:8 observation.
“With this program, we are able to watch more patients per safety technician at a time,” says Gault. “We have expanded virtual patient observation to all of our acute care facilities and emergency departments and are now working on our Skilled Nursing and Rehab facilities.”
Minus implementation investments, the team reported a six-month program ROI of $280,260. That number is expected to blossom to $1,705,260 in the years ahead. The new approach allows the health system to leverage virtual staff resources instead of drawing from limited bedside staff.
Lessons Learned: Virtual Patient Observation Essentials
Gault points to securing CNO executive sponsorship, up-front funding and project approvals, and comprehensive pilot program and go-live support as crucial elements of program success.
Pushback from nursing staff and lack of communication with ancillary departments created some friction during Lee Health’s initial pilot program. To address these issues, the team amplified training and communication efforts to build stronger staff awareness and education prior to implementing virtual patient observation at additional facilities.
Lee Health executives view virtual patient observation as something health systems of any size can benefit from but encourage healthcare organizations to adopt flexible solutions that are easy to use and easily scale depending on program needs.
Caregility congratulates the Lee Health team on their well-deserved SFLHIMSS Innovation Award win! The health system’s virtual patient observation program is a shining example of how hybrid care innovation is enhancing and empowering bedside care.
UMass Virtual Patient Observation Case Study
UMass Memorial Health improved patient safety and reduced labor costs by enabling virtual patient observation across the enterprise.
SCL Health Virtual Patient Observation Case Study
OhioHealth Virtual Sitter Case Study
With iObserver, OhioHealth scaled its virtual sitter program to expand workflows and meet growing demand at multiple clinical sites.