Hybrid Care: Making the Case for Telehealth in Every Patient Room
During the pandemic, many health systems adopted telehealth to meet one specific objective: to ensure access to care for patients isolated at home. Telehealth and virtual care delivered on that and more. Homebound patients maintained ties to their providers, and hospital-based care teams used telehealth resources to reduce COVID-19 exposure and keep families connected during visitation restrictions.
As isolation issues abate, new challenges are driving health systems to explore ways telehealth can further support care delivery within inpatient settings. Clinical workforce shortages, patient safety concerns, and increased competition are all taking a toll on hospitals.
Here we look at how the integration of virtual tools into bedside care can help health systems adapt and overcome, making a strong case for hybrid care and the push towards telehealth in every patient room.
The Immediate Need: Staffing Relief
The 2022 NSI National Health Care Retention and RN Staffing Report reveals that in 2021 hospital turnover increased 6.4 percent, resulting in a national average of 25.9 percent. McKinsey and Company research cites a 25 percent increase in labor costs per adjusted hospital discharge between 2019 and 2022, much of which was driven by the high cost of travel nurses and staff recruitment and relocation.
The potential for telehealth to help bridge staffing gaps and reduce labor costs is four-fold:
- Virtual workflows like tele-rounding, tele-nursing, and tele-sitting free up valuable time for bedside clinicians, helping to reduce burnout.
- Telehealth-enabled remote work opportunities can extend the careers of seasoned clinicians considering leaving or retiring.
- Virtual mentoring programs between new hires at the bedside and experienced remote clinicians improve staff onboarding, training, and experience.
- Telehealth platforms allow health systems to easily bring third-party clinical service support into hospital workflows as needed, regardless of where the clinician is located.
Virtual nursing is one area of opportunity that is gaining traction. Research and consulting firm ITIC reports a 34 percent increase in the number of virtual nursing programs around the U.S. in the past year.
The Primary Objective: Patient Safety
Research has repeatedly demonstrated that poor staffing ratios lead to poorer patient care and outcomes, including increased morbidity, medication errors, and risk of infection.
Additional factors are leading to worsening patient acuity levels. American Hospital Association recently issued areport that found that deferred patient care during the pandemic led to a 9.9 percent increase in the average length of stay from 2019 to 2021.
As hospitals treat sicker patients, often with fewer clinical resources, deploying telehealth endpoints in patient rooms across the hospital enterprise helps amplify patient coverage and safety and improve the speed of clinical intervention. Virtual observation programs, for example, are increasingly moving beyond critical care units to help care teams keep eyes on at-risk patients for things like fall prevention. The ability for care teams to move from a one-to-one in-person model to a one-to-many virtual caregiver-to-patient model maximizes staff resources while reducing the cost of care.
A single telehealth platform may serve many use cases in the patient care journey, from virtual rounding in the morning, to virtual behavioral health appointments in the afternoon, to virtual patient observation at night. When integrated with clinical decision support tools, virtual nursing can support patient stratification to detect and intervene when patients are in decline and potentially discharge those doing well early. Bringing virtual resources to the bedside also enhances clinical collaboration as well as family engagement, which reduces anxiety and speeds the recovery process.
The Future State: Strategic Differentiation
Another motivator driving health systems to adopt an enterprise approach to telehealth is the pursuit of competitive differentiation. Hospital Room of the Future initiatives are cropping up across the nation as healthcare organizations seek to attract tech-savvy consumers and partners. These digitally enabled rooms enhance the care experience for patients and care providers alike. Patients benefit from virtual access to their clinical team and interpreters, which can improve HCAHPS scores. Clinicians benefit from access to innovative connected health integrations that streamline workflows and improve efficiency.
Many additional healthcare initiatives that are on the horizon are only feasible when telehealth is involved. Hospital at Home, Chronic Care Management, Aging in Place, and even advancements in preventive care coordination all require or benefit significantly from the ability to virtually engage with patients between in-person encounters, representing additional use cases where telehealth can enhance patient care.
The Challenge and a Path Forward
Inflation, increased labor expenses, and a rise in patient acuity are all putting strain on hospital financials. According to recent research from Kaufman Hall, the hospital median operating margin was down by 29.9 percent year over year as of June 2022.
So how can health systems enable enterprise-wide telehealth in the midst of record-setting low margins? Many recognize the value and long-term ROI that augmenting inpatient care with virtual workflows can bring but struggle to invest the upfront capital typically associated with enterprise-wide implementations. Without a way for health systems to wade into enterprise telehealth, financially speaking, few will be swimming.
The good news is that new pricing and acquisition models are emerging to help providers step into hybrid care and enterprise telehealth. Subscription-based models that offer pay-as-you-go pricing reduce up-front capital investment requirements. New cost-effective endpoint options for lower-acuity patient engagement that does not warrant the same intensive clinical communications needed in higher-acuity environments like the tele-ICU are also entering the market.
Enterprise telehealth platforms that master the basics – security, centralized program and fleet management, integration adaptability, and scalability – offer a solid foundation to build on that will also help health systems mitigate solution sprawl and resource redundancy in the years to come.
Mitigating the Nursing Shortage with Telenursing
The U.S. will grapple with a critical nursing shortage for at least the remainder of the decade. Thus, health systems are now looking for ways to more efficiently ensure that patient needs are met, while recruiting and retaining qualified clinical staff. Many successful health systems are turning to telenursing to supplement and enhance traditional bedside care.
Across the country, healthcare organizations are experiencing difficulty recruiting, higher labor costs, and increased staff burnout. In a 2021 letter to HHS Secretary Xavier Becerra, the American Nurses Association noted that states were challenged by unfilled positions and failure to recruit enough replacements. Louisiana reported 6,000 unfilled positions even prior to the Delta variant, Tennessee had 1,000 fewer nurses than when the pandemic started, Mississippi lost 2,000 nurses between January and August that year, and Texas recruited 2,500 nurses outside the state but still did not meet its staffing need. These shortages feed on themselves, since working in a chronically-understaffed setting takes its toll.
In the first quarter of 2021, 36% of hospitals experienced an RN vacancy rate above 10%, according to the NSI National Health Care Retention & RN Staffing Report. RN turnover in 2020 was 19%, about three points higher than in 2019. Unsurprisingly, burnout is a big reason that almost half of nurses are changing roles, reducing hours, becoming “travelers,” and retiring. Conservatively, one-third of nurses reported being “burned out” or “very burned out” in 2021. This shortage of nurses and other qualified staff is increasing hospital and health system costs by $24 billion per year, averaging $17 million in additional costs for a 500-bed facility.
Approaching the shortage: a series of stop-gaps
Some health systems use travel nurses as a stop-gap to help staff more shifts. This does not actually solve the problem, though, as added expenses limit the long-term sustainability of this approach. Other hospitals are increasing their patient-to-nurse ratios, with some facilities relying on patient care techs and nursing aides to ease the burden. Unfortunately, thousands of qualified would-be nurses have been turned away from nursing schools due to shortages of faculty, clinical sites, classroom space, preceptors, and financial support.
While schools implement strategies that enable them to add student capacity, health systems must find ways to do more with less, without sacrificing care quality. With declining margins due to the pandemic, it is all the more difficult to simply hire more aides, even presuming they are available.
Besides actual procedures and hands-on care, bedside nursing includes charting, consulting with team members, accessing supplies, coordinating with other departments, and speaking with family members and friends. However, given the understaffing on many floors and unit, patients often interact with a variety of care team members on each shift. This fragmentation in turn makes it more difficult for patients and their visitors to decipher “who’s who,” and to bring forward important concerns.
Dividing to conquer
The pandemic accelerated acceptance of telehealth, along with more comfort with wearables, Bluetooth-enabled physical assessment, and virtual monitoring from patients, clinicians, and healthcare systems.
Incorporating telehealth programs within acute care facilities allows floor nurses to cover more ground. Virtual patient observation, for example, can support a number of goals, from greater patient safety to an improved patient experience.
Patients have long complained about the sleep deprivation caused by clinicians entering the room, along with the background noise from nurses’ stations and hallways. In addition to the discomfort and disorientation that interrupted rest entails, when a series of staff intrusions occur with no prior warning nor way to ask questions, the patient can easily feel like an “object,” with little control over the situation — not an ideal environment for healing.
With on-demand access to nurses and supporting care team members, patients can have their questions answered remotely, allowing floor staff to be notified and physically intervene only when needed; thus systems have seen their room entry needs, often with attendant needs for PPE or other precautions, significantly reduced.
With some basic concerns addressed by virtual nurses, the floor nurses can also cultivate an improved relationship with patients, providing more concentrated time for in-person care to focus on their needs. This is obviously a more desirable situation for a high-performing bedside nurse.
The best solutions are those that address a number of pain points, and virtual patient observation is gaining traction as a core workflow. Facilities have learned that consistent monitoring and early intervention, as is facilitated by virtual observers, can reduce wandering, falls, self-harm, and visitor security incidents.
Health systems can also reduce labor expenses by leveraging virtual infrastructure. For example, one 900-bed hospital reported a $3 million annual unbudgeted expense for bedside sitters alone. Furthermore, just one hospital-related fall injury can cost up to $30,000 (not to mention legal and reputational exposure).
Telenursing: more efficient delegation and workflows
Collaboration among virtual and on-site nurses can enable floor staff to spend more value-added time with patients at the bedside. Telenurses with “eyes on the patient” can address tasks such as admission and discharge planning, medication reconciliation, patient and family education, and some student/trainee preceptorship. Meanwhile, floor nurses can focus on the tasks requiring hands-on skills and in-person availability, including supervision of aides and less experienced staff.
Tele-nurses can train, mentor, back up and otherwise support bedside nurses, coaching them through unfamiliar tasks or procedures, while also being available for advice and counsel. Of course, they can also coordinate communication in urgent and emergent situations, and can instantly activate alarms on the floor.
Thus, telenursing does not solve the nursing shortage, but it can support optimal outcomes of care, staff development, retention, and morale — with fewer RN FTEs.
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Telehealth News Roundup: Strategies to Combat Hospital Labor Shortages
If COVID-19 weren’t enough of a challenge, hospitals and healthcare systems face significant labor shortages. Some healthcare workers are switching jobs for higher pay and better benefits, while others are choosing to leave the industry completely.
To maintain appropriate staffing levels and continue to provide high-quality patient care, hospitals must look to implement short- and long-term recruiting and retention solutions.
How can providers better understand and address the ongoing staffing shortages? Our monthly news recap explores the strategies that could combat labor shortages and improve staff recruitment, and retention in 2022.
There are several key factors contributing to the current nursing shortage: a lack of nurse educators, limited spots in community colleges, and the Great Resignation. However, there are proven strategies—including increasing diversity, prioritizing workplace culture, and adjusting protocols to meet nurses’ needs— that can increase nurse retention. By executing some or all of these strategies, healthcare leaders can positively change the outlook for the future of nursing.
Experts predict that staffing shortages and increased labor costs will continue to fuel higher expenses and declines in operating cash flow for healthcare systems. According to the American Nurses Association, there will be more than 100,000 registered nursing jobs available annually by next year. Fortunately, there are several factors that may help mitigate the labor shortage in the next year and beyond.
Infection Control Today
In the midst of labor shortages, hospitals are striving to strike the right balance between maintaining the safety of their staff and their ability to function adequately. With this in mind, the CDC recently reduced its recommended isolation time for healthcare workers exposed to COVID-19 from ten to seven days. Despite pushback from nursing organizations, and mixed evidence as to the period of contagion, systems following these recommendations have been able to ease their shortages somewhat, while monitoring the impact on in-house cases.
Becker’s Hospital Review
In response to the ongoing healthcare labor shortage, several hospitals and health systems have made recent investments in recruitment and retention. Initiatives range from millions of dollars in pay increases, bonuses, and benefit enhancements to investments in education and upskilling programs.