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Category: Mary Washington Healthcare

When Virtual Nursing and AI Collide: Q&A with Mary Washington Healthcare

In our recent webinar When Virtual Nursing + AI Collide: Lessons from the Trenches, Mary Washinton Healthcare’s AVP of Hospital Operations Debra Marinari and Information Systems Analyst Trudy Osborne sat down with Caregility CNO Wendy Deibert to discuss their journey integrating remote nurses and artificial intelligence into inpatient care. Here are some key takeaways and practical strategies shared by our expert panelists.

1. How did you start your virtual nursing journey, and what were the initial challenges?

Mary Washington Healthcare began its virtual nursing journey a little over two years ago to modernize the health system’s approach to patient care. Reflecting on her 30-year nursing career, Marinari noted that many of the processes they used in the past would be considered outdated by today’s standards. She sees Virtual Nursing and AI as natural next steps in the health system’s journey to safer, more efficient patient care. One early challenge was getting experienced nurses to embrace the technology, but once they saw the benefits of improved support during staffing shortages, adoption quickly followed.

2. How is telehealth helping make care teams more agile?

Marinari and Osborne emphasized that telehealth has enhanced their ability to iterate quickly and uncover new opportunities for efficiency gains in nursing workflows. With a centralized Virtual Nursing hub on-site, remote nurses can triage and respond to inbound calls from the bedside, leaning on built-in backup coverage when multiple requests come in simultaneously. Mary Washington has seen improvements in nurse turnover rates and staff retention by implementing Virtual Nursing.

3. What workflows do Virtual Nursing and AI support?

In addition to supporting virtual admissions, discharges, and second signature verifications, virtual nurses also play a crucial role in supporting specialized workflows. For instance, virtual nurses can easily support MRI checklists and help determine the model of medical device (i.e. pacemakers) a patient has before procedures. The integration of Social Determinants of Health (SDOH) questionnaires into the virtual admissions process has increased completion rates to 98%, a dramatic improvement from before Virtual Nursing implementation. These workflows help ensure high-quality care and compliance.

4. How do you manage staffing and nurse-to-patient ratios for your Virtual Nursing program?

Mary Washington’s Virtual Nursing team is staffed with three virtual nurses per 12-hour shift, operating 24/7. The full-time roles were hired specifically for Virtual Nursing, with a minimum of two years of direct nursing experience required. Initially, the team was aligned by unit but later pivoted to a triage model that allows remote nurses to handle calls across multiple units as they come in. This flexibility has been key to managing staffing efficiently. The health system opted to add extra staffing support during peak hours when patient activity picks up between 11 am and 11 pm.

5. What platforms and AI tools are integrated with your Virtual Nursing program?

Osborne noted that the organization uses Epic for electronic health records, with virtual nurses leveraging secure chat within Epic to keep care teams connected. Mary Washington is in the process of integrating Critical Alert as their nurse call platform. Additionally, the organization is exploring health AI solutions like computer vision and ambient listening to assist with fall prevention and other early patient interventions. They are also lab-testing devices for contactless patient vital sign monitoring to improve early detection of patient deterioration and health issues.

6. How have Virtual Nursing and AI impacted patient care and staff efficiency?

One benefit of adding a remote nurse component to bedside care teams has been reduced documentation time, which has been a pain point for many nurses. By reassigning routine tasks, bedside nurses can focus more on direct patient care while remote nurses streamline workflows due to fewer interruptions. Although pilot programs are still in the early stages, the healthcare organization is excited about the promise of AI applications in areas like fall prevention and vital sign trending, which can further improve patient safety and nurse satisfaction.

7. Have patients or staff expressed concerns about virtual nursing or AI?

Marinari noted that patient resistance to Virtual Nursing has been minimal, with only one case involving a mental health patient who preferred in-person care. The staff’s attitude toward Virtual Nursing and AI has become increasingly positive, particularly as Mary Washington has fine-tuned its remote support processes over the last year. Marinari and Osborne actively work with nursing staff to continue to iterate and identify new workflows.

8. Are there specific metrics you’re tracking to measure success?

Since implementing Virtual Nursing, nurse satisfaction has improved significantly, and documentation time has decreased, both of which have been major wins for Mary Washington. The organization has also expanded its Virtual Nursing program into the emergency department and is actively tracking metrics related to nurse retention, patient outcomes, and fall rates to assess the program’s ongoing success.

9. What hardware supports your Virtual Nursing and AI implementation?

Dual-camera APS200 telehealth edge devices from Caregility, which include 40x zoom, far-end pan/tilt/zoom video capabilities, and night vision, are deployed in patient rooms to facilitate virtual nurse engagement. Bedside staff can press a vLert button to request remote nurse support. A minimalist, ceiling-mounted radar puck device supports contactless vitals capture. Osborne appreciates that deployment was straightforward, with centralized device management and strong vendor support throughout the process. The organization has also installed anti-ligature devices in the emergency department and is exploring facial scanning technology as a potential tool to support ED triage. The use of advanced hardware continues to evolve as the VN program expands.

10. What’s next for your Virtual Nursing and AI journey?

Looking ahead, Marinari expressed excitement about expanding AI capabilities, particularly in the area of computer vision for fall prevention. While the organization has made strides in reducing fall rates, this remains an area of focus, and they believe AI can further enhance early intervention. Additionally, the team is testing contactless devices that can provide early indicators of patient health trends, which they hope will lead to improved patient outcomes. They are also exploring new use cases in the emergency department and continue to work on integrating AI tools with existing platforms like Epic.


Hospital Leaders Weigh in on Virtual Nursing

Healthcare delivery is undergoing a transformation and virtual nursing is at the forefront. In a recent webinar co-hosted by Caregility and the American Telemedicine Association (ATA), healthcare leaders from institutions at various stages of implementing Virtual Nursing programs gathered to discuss their experiences.

Virtual care pioneer and Caregility CNO Wendy Deibert led the illuminating panel discussion featuring Tracey Kopenhaver, Operations Manager, Geisinger Inpatient Virtual Care; Christine Coriell, Director of Nursing Operations, OhioHealth Resource Center; and Debra Marinari, Associate Vice President, Hospital Operations, Mary Washington Healthcare.

2023-Virtul-Nursing-Webinar-Thumb-Caregility

Access the webinar recording here.


Here are some key takeaways from the discussion:

Adoption Drivers

All panelists pointed to nursing workforce challenges as key motivators to pursue Virtual Nursing, but technology and ROI had to line up.

Addressing Nursing Shortages and Burnout

The virtual nursing model allows healthcare organizations to tackle staffing shortages and burnout by distributing the workload more evenly.

“We were motivated by a few things – primarily the nursing shortage, nurse turnover, nurse burnout, and really looking at our care team redesign. Looking at current state, where we don’t have quite enough nurses to go around, and our nurses are overworked and busy and can’t get to all the things that they need to do in a day… How can we try to future-proof or buffer that?” – Tracey Kopenhaver

Technology Aligns with Strategic Goals

By leveraging existing technology that supports remote patient observation teams and tele-ICU programs, Virtual Nursing programs align well with strategic goals to centralize and scale virtual care.

“When we think about our Nursing strategic goals at OhioHealth, one is having a flexible workforce and second is maximizing the technology we have at OhioHealh. So, this was just a natural next step into the virtual world.” – Christine Coriell

Demonstrated ROI

Panelists addressed the importance of justifying costs, typically vetted through pilot programs.

“It had to be cost neutral – that’s the model that we took. So, we had to make sure that whatever we brought in was going to have a good return on investment – not just the quality metrics, but [improving] satisfaction and decreasing turnover.” – Debra Marinari

Strategy

While there is variation in how Virtual Nursing workloads are assigned within each organization, some standard practices emerged. Each panelist’s healthcare organization uses Epic’s EHR in different capacities for streamlining workflows. Each organization also staffs virtual nurses onsite, with Geisinger employing a hybrid model that also includes nurses working from home.

Getting Started

“The number one recommendation I would give to anybody who is thinking about starting a virtual nurse program is don’t let perfection get in the way of progress. We started very low budget. We repurposed carts. We hired per-diem staff to start with and borrowed some staff from our virtual ICU program. We really went in on a shoestring to get it off the ground. We’ve been able to demonstrate the return and we have the financial support to move ahead with a more permanent solution.” – Tracey Kopenhaver

Staffing Models

Virtual nurse staffing models varied across panelists. Coriell noted that, in their current phase, OhioHealth virtual nurses work Monday through Friday from 7 a.m. to 7 p.m., with plans to extend to 24/7 coverage.

“The virtual nurse will be assigned to patients that all will roll up to the many nurses overseeing that care at the bedside. We’re utilizing a flex team of nurses with knowledge across different care sites for now. A future focus is on having dedicated full-time employees (FTEs) for the program.” – Christine Coriell

Geisinger takes a slightly different approach, with Virtual Nursing overseeing specific tasks.

“There are no specific patient assignments for virtual nurses since they currently focus mainly on admissions and discharges.” – Tracey Kopenhaver

Meanwhile, Marinari and the Mary Washington Healthcare team elected to bring on additional FTEs for virtual nursing from the very beginning.

“The model had to be really such that the nurses at the bedside did not feel like they had less resources, but actually more. We had to balance the FTEs for each of the departments, and what that workload was going to be [in terms of] patient ratios. The virtual nurses are assigned to patients, currently managing around 15 to 16 patients during the day and up to 20 at night.” – Debra Marinari

Goals and Results

Positively impacting nurse and patient experience are core objectives for each organization.

KPIs

“Key outcomes that we really want from this program [include] retention of nurses, decreasing that workload and stress at the bedside, increasing time for the bedside nurses to be able to provide care for their patients, improving nurse satisfaction [and] patient satisfaction, and then some cost savings. Ultimately, we would look at time saved with length of stay and a few other metrics as well.” – Christine Coriell

“We’re looking at our HCAHPS – nurse responsiveness and communication with the nurse scores in particular.” – Tracey Kopenhaver

Time Management & Efficiency

All panelists agreed that virtual nursing significantly improves time management, reducing the workload of bedside nurses.

“The thing that we’ve been able to measure the most is the time saved for the bedside nurses.” – Tracey Kopenhaver

Marinari and the Mary Washington Healthcare team conducted time studies to demonstrate time savings, assessing the time from when the discharge order is written to the time the patient leaves as a metric. Coriell highlighted the role of existing relationships between virtual nurses and unit staff in speeding up tasks and improving efficiency.

Conclusion

Virtual Nursing programs are not just a trend; they are a substantial step toward enhancing healthcare delivery. These programs alleviate staff burnout, improve patient experience, and provide financial returns. With insights from leaders in the field mounting, it’s clear that Virtual Nursing is a viable and vital part of the future of healthcare.

Watch the full Virtual Nursing panel discussion with Geisinger, OhioHealth, and Mary Washington Healthcare here.


Looking for guidance on how to implement, optimize, or expand your Virtual Nursing Program? Set up a Virtual Nursing discovery call today.