Virtual care touted as a way to optimize and extend care staffing

Hospitals consider new ways to use technology to counteract reductions in nursing numbers and rising calls for hybrid approaches to delivery.

The COVID-19 pandemic has accelerated trends in healthcare that are, at the same time, frightening and hopeful.

The pandemic response has laid bare staffing challenges, as healthcare systems have encountered shortages of clinical caregivers – just as patient populations rose, both in numbers and in severity of conditions. The U.S. Bureau of Labor Statistics estimates that, to avoid a nursing shortage, the nation will need 1.1 million new registered nurses to replace retirees and expand the workforce.

That and other trends highlight the potential of technologies that extend the reach of care, enabling clinicians to multiply their reach, observe and care for more patients, and pull in essential resources virtually, efficiently within their workflows.

Mike Brandofino, president & COO, Caregility:

“give that patient the care they need or the interactive engagement they need, whether they’re in the ICU or in a room or the ED or even when they go home”

Those are among the capabilities that healthcare executives are looking to exploit to deal with rising capacity pressures facing their organizations today, according to executives at Caregility, an Eatontown, N.J.-based technology provider that offers solutions for remote patient monitoring. Increasingly, such approaches are finding uses within the walls of hospitals, says Mike Brandofino, president and COO of the company.

Virtual or non-in-person care approaches first emerged in intensive care unit arrangements more than a dozen years ago. These enabled healthcare organizations to have outside entities monitor their ICU patients from offsite – this gave organizations more capacity to provide 24-by-7 observation of critically ill patients.

Some efforts also used this capability for telestroke units, Brandofino says. However, these early initiatives were often hardware-centric, and succeeded or failed based on the quality of the technology implemented onsite.

Caregility had worked on technology solutions in this space – it was working in partnership with Philips before being spun out as a separate company. About two years ago, Caregility executives began to see a growing need for an expanded vision for virtual care within healthcare organizations, where shrinking clinical staffing was encountering growing patient care acuity.

That only accelerated when the COVID-19 pandemic exploded, and healthcare organizations began to look for ways to provide solutions that enabled care or observation without direct patient contact – during the pandemic, that is often time-intensive, requiring caregivers to put on protective personal equipment each time they entered a room of a patient suspected of having COVID, and it also increased clinicians’ risk of exposure to the virus.

Designing the Inpatient Virtual Engagement

“So we took the approach of designing a purpose-built solution where you have to have a camera and microphone that monitor that room, but it’s designed in a way so that it’s connected to a cloud platform where we can actually monitor what’s going on” with a patient, Brandofino explains.

Other capabilities have been built into the Caregility solution, enabling clinicians to patch in specialists through the system to assess patients. In addition, virtual technology also allows healthcare organizations to add in family members or interpreters for consultations, without having them physically present.

Other virtual activities have the potential to lessen the burdens on nursing staff. For example, nursing assessments of incoming patients typically take 15 to 20 minutes, and that’s a process that can be handled to a great extent by a nurse who does not have to be physically present in the patient’s room.

Expand critical care staff

This type of technology also can help healthcare organizations “expand” their clinical staff by reaching back to retired nurses or those who may not be able to handle the physical requirements of providing care to inpatients. These nurses have significant experience that they can share virtually, assessing patients even though they’re not physically present in hospital rooms, and passing on critical information to onsite caregivers.

This approach is being used by Atrium Health, a Charlotte, N.C.-based healthcare system. Nurses in their facilities may not have experienced every care eventuality, but using technology, Atrium “can bring in these talented, experienced nurses (virtually), which extends their careers and also augments the knowledge base in the hospitals,” Brandofino said.

Atrium also has extended virtual care capabilities to ambulances bringing patients to its facilities, he said. That enables responding paramedics to tap into the knowledge of emergency department clinicians when they first begin care for patients being transported.

Hybrid care approach

Technologies that enable a mix of approaches and capabilities for patient care support what is widely being described as hybrid care, which uses cloud-based solutions to work together with a mix of onsite and virtual staff to “give that patient the care they need or the interactive engagement they need, whether they’re in the ICU or in a room or the ED or even when they go home,” Brandofino says.

Hybrid care approaches could enable healthcare organizations that are struggling to maintain efficient staffing levels, he adds. “It’s so hard for hospitals to maintain the right level of skills for various reasons, and to be able to bring in that skill set as needed. It’s really a game changer from a healthcare perspective – if (you can use technology to) get that specialist in one or two days earlier on a consult, rather than waiting for them to cycle through the hospital location, what does that mean for the patient and patient care?”

Research in this arena conducted for Caregility predict expanded use of virtual care and telehealth services. In two years, most of the executives surveyed predict their organizations will have strong virtual care and telehealth programs across multiple lines. The executives say that the COVID pandemic has played an important role in pushing these initiatives forward, but other drivers include the reimbursement environment, which became more supportive of virtual care.

Staffing pressures and shortages are likely to encourage the use of such solutions, and the executives say that organizations also will respond by networking hospitals so as to use virtual care as a way to leverage expertise across the system.

The executives also noted increased adoption being supported by dedicated departments or executives responsible for virtual health initiatives, or expanded roles or responsibilities for this type of delivery in existing departments.

Technological capabilities, continued efforts to optimize staffing and patient acuity pressures could result in hospitals using video monitoring and interactive systems in every patient room, thus enabling fewer nurses to actively monitor patients with greater oversight, Brandofino predicts in envisioning the capabilities of future hospital rooms.

Video: “Telehealth is not just that outpatient call” - watch the full video interview

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