Category: telehealth
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.
Download Caregility’s latest eBook to discover how virtual workflows can streamline bedside care and improve patient and clinician experience. The eBook includes tele-nursing use case examples, staffing model best practices, and guidelines for implementation.
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Spotlight on National Nurses Month: Caregility Supports ANF’s “Reimagining Nursing Initiative”
Nurses are an indispensable part of U.S. healthcare delivery. Standing on the front line of patient engagement and at the crux of care coordination, RNs have long served as the backbone of the medical industry, helping to keep healthcare consumers, their loved ones, and clinical staff in step in their shared pursuit of improved patient health.
During National Nurses Month each May, these care team members are formally recognized and celebrated for their ongoing commitment and contributions. The hardship experienced by many nurses during the COVID-19 response over the past two years serves as a particularly salient reminder of the sacrifices that are frequently required of these vital resources. As our nation emerges from the pandemic to confront a national nursing shortage and unprecedented rates of clinician burnout, many organizations aligned to the field of healthcare are amplifying efforts to identify new ways to better support our RNs.
It is in the spirit of that mission that Caregility has teamed up with the American Nurses Foundation (ANF). As the philanthropic arm of the American Nurses Association (ANA), ANF’s vision is to “achieve a healthy world through the power of nursing.” Relying on the generosity of donors to help achieve and expand this mission, the Foundation funds “bold thinkers to pilot and evaluate new ideas that accelerate widespread transformation in nursing.” The ANF’s Reimagining Nursing Initiative focuses on three core pilot program areas:
- Practice-Ready Nurse Graduates
- Technology-Enabled Nursing Practice
- Direct-Reimbursement Nursing Practice Models
To support the ANF’s cause and honor National Nurses Month 2022, Caregility donated $3,000 to the Foundation’s Technology-Enabled Nursing Practice program, which supports the design and implementation of technology-based tactics and tools that meaningfully enhance the practice of nursing. The program’s emphasis on nurses as key drivers of effective healthcare IT design echoes Caregility’s core development principles for telehealth.
“Like the ANF, we recognize the fundamental role that nurses play in successfully reimagining healthcare,” said Caregility SVP of Clinical Solutions Wendy Deibert. “We’ve seen first-hand the tremendous positive impact that our own clinical leadership team has had on virtual care program design, so we see tremendous value in ANF’s efforts to similarly advance nurse involvement in digital transformation.”
Donations from Caregility and others will fund as many as 11 innovative pilot programs that will receive three-year grants totaling a combined $15 million.
“The American Nurses Foundation is extremely grateful for Caregility’s recent contribution to The Reimagining Nursing Initiative in honor of National Nurses Month,” said a spokesperson on behalf of ANF. “This gift will enable the Foundation to fund innovative pilot programs designed to create and implement cutting-edge, technology-based tools and strategies that will significantly enhance the practice of nursing.”
The donation was made as part of the Caregility Cares program, honoring members of the medical community who go above and beyond to bring relief to others. Learn more about the Caregility Cares Essential Worker Scholarship and Frontline Worker Recognition Programs here.
Looking for virtual workflow relief to reduce pressure on your nursing staff? Contact us today to see how Caregility can help.
AI and Preventive Care: New Solutions for More Effective Prevention
Preventive care is a pillar of values-based care and a critical element of patient-centered virtual care solutions. Preventive medicine helps patients avoid the onset of illness, slows disease progression, and reduces the chance of developing severe complications.
Preventive interventions reduce unnecessary testing, treatments, and procedures. Interventions involving collaboration between patients, providers, and care management teams can reduce the risk of hospital readmission. Such interventions offer measurable cost savings for hospitals by eliminating readmission fines for Medicare patients.
Advances in augmented intelligence continually provide new solutions for more effective prevention, improved primary care quality, and lower medical costs. AI-driven preventive care can extend life expectancy and improve quality of life in patients living with chronic conditions, including diabetes, asthma, and chronic obstructive pulmonary disease (COPD).
Preventive Analytics Models
Augmented intelligence uses AI algorithms to enhance clinician understanding and decision-making regarding an individual patient. Predictive and prescriptive analytics are designed to enhance prevention and support positive outcomes.
Predictive Analytics
Predictive models use past patient data to identify trends that suggest future outcomes. Machine learning continuously incorporates ongoing patient data to make individual predictions more accurate. Predictive models help clinicians understand risks and potential paths of disease progression and healthcare requirements so they can design more effective care plans.
Prescriptive Analytics
Prescriptive models look beyond medical history, incorporating cultural, economic, and environmental factors associated with specific health outcomes. These models support provider decision-making with patient-specific recommendations that make interventions more effective. They also offer guidance designed to empower patients in their health management choices.
Medication and Prevention
In chronic conditions, medication adherence directly impacts outcomes, longevity, quality of life, and healthcare costs. Adherence to at-home medication administration is essential in managing diabetes and asthma. Research published in the journal Nature Medicine in 2021 describes a wireless sensor system that uses AI to detect when patients use their insulin pens and inhalers. The system also identifies errors in steps followed for proper administration and flags them so patients can improve their technique.
The study confirmed that the system accurately identified when patients used an insulin pen (99%) or inhaler (97%). The results also show accuracy in detecting missing steps and inaccurate duration of administration.
Care Management
Virtual care innovations have the potential to elevate patient engagement and care management. Augmented intelligence provides solutions that increase participation in disease management programs and customize care management options.
A 2019 study conducted by McKinsey & Company revealed that in-depth analytics tools can help care managers recognize patterns associated with negative outcomes and higher healthcare costs.
The McKinsey model identified a connection between poor medication adherence and increased ER visits in chronic obstructive pulmonary disease (COPD) patients. Machine learning algorithms then identified patterns associated with willingness to change behavior to improve health.
Those insights help care managers implement targeted interventions to increase medication adherence. Patient-specific guidance for intervention delivery, such as optimal times, frequency, and communication methods (phone calls, email, text), also boost patient compliance.
Preventive Diagnostics
Diagnostic AI models analyze symptoms to assist providers in accurately diagnosing health conditions. Diagnostic analytics are most commonly used in diagnosing patients who already present with concerning symptoms. However, AI enables diagnostics to play a larger role in preventive medication.
Innovations in preventive diagnostic models can detect serious conditions in their earliest stages, in some cases earlier and more accurately than standard health screenings.
Medial EarlySign, an Israeli company focused on AI healthcare solutions, developed a machine-learning model to diagnose non-small cell lung cancer (NSCLC) earlier than exiting methods. According to research published in 2021 in the American Journal of Respiratory and Critical Care Medicine, this model outperformed standard NSCLC screening protocols.
Early confirmation of an NSCLC diagnosis provides the highest chance of effective treatment and reduces the risk of dying from lung cancer. Considering that NSCLS currently has a life expectancy of just five years past diagnosis, Medial EarlySign could dramatically change what this diagnosis means for patients and families.
Patient monitoring
New advances in AI have placed image-signal processing techniques in the foreground of remote vital signs monitoring. Simple cameras can provide enough digital data for leading-edge machine learning to accurately monitor heart and respiratory rates, blood oxygen levels, and blood pressure.
Like wearable sensors, image-based AI can identify risk factors in real-time, enabling early interventions that help prevent declining health and adverse patient events. However, smartphone solutions, such as this software development kit currently pursuing FDA approval, have advantages over wearables, including lower costs and simplified user interfaces.
Care facilities can utilize in-room cameras to monitor patient vital signs. A 2021 paper exploring contactless, image-based monitoring of hospitalized COVID-19 patients describes AI and machine learning applied to images captured by ordinary cameras. Such platforms detect barely perceptible changes in skin color and subtle body movements to measure vital signs and identify abnormal patterns associated with negative health trajectories.
Conclusion
Preventive analytics have far-reaching potential for value-based healthcare. However, like all technology, they do carry some risk. Ongoing development must continue to address issues arising from inadequate or corrupted datasets, technical and user errors, and over-reliance by providers. Raw data and human bias can compromise prescriptive models, undermining the goal of health equity.
Proactive developers and other stakeholders are working to correct these issues. Nevertheless, providers must remember that AI tools support, but do not replace, clinical experience, knowledge, and critical reasoning skills.
Combining precision AI with provider expertise, however, has already caused a shift in the healthcare industry. As the technology continues to evolve, patients and providers will continue to experience the transformative benefits of augmented intelligence.
Caregility uses data analytics to provide robust decision support for providers in acute settings across the care continuum. Our award-winning, HIPAA-certified, interoperable platform connects all stakeholders, optimizing patient engagement, care delivery options, and clinician workflows. To learn more about how our virtual care platform enhances preventive care, contact us today.
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.
NurseJournal
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.
Fierce Healthcare
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.
