Virtual Care Teams Enhance Patient Care
MercyOne Des Moines Finds Telehealth Improves Communication, Efficiency and Outcomes
Author: Pam Malinoski
When patients suffering from the complications of COVID-19 started streaming into our nation’s hospitals in the spring 2020, health care facilities faced a unique set of infectious disease challenges. How could you maximize care for these critically ill patients while minimizing exposure to health care workers? What could you do to facilitate communications when entire households are infected at one time? Who could you bring into patient care teams from remote locations?
The team at MercyOne Des Moines resurrected a vision from 2011 created by Dr. Kathleen Sanford, then Catholic Health Initiative’s (CHI) Chief Nursing Officer. During her time as CNO, she supported innovative virtual nursing care models in several different markets including Nebraska and Colorado. Now, as Executive Vice President, Chief Nursing Executive of CommonSpirit Health, her Virtually Integrated CareSM model is being re-invented again through an iterative process to support patient care during the COVID-19 pandemic. Although the videoconferencing platform was urgently set up to support a cohort of COVID-19 patients on both a medical surgical unit and intensive care unit, the immense benefits that have been realized will shape how virtual technology and care is used in the future.
Employing a Virtually Integrated Care Nurse
At the heart of MercyOne Des Moines’s virtual care program is a special nurse with years of experience, excellent rapport with the staff, and a gift for multi-tasking. This individual is in charge of monitoring the entire unit through dedicated devices available in each patient room. MercyOne Des Moines uses video conferencing technology to connect providers, nurses, specialists and family members as needed to provide the best care while minimizing exposure to the disease itself.
“When COVID-19 hit, we needed to isolate patients to reduce exposure while still providing care,” said Wendy Miller, a registered nurse and performance excellence coach at MercyOne Des Moines. “We set the system up quickly in just a couple of weeks. We have a virtual nurse at the center of the care team. She’s a talented expert who facilitates all doctor and ancillary care communications from a remote location.”
Immediate Efficiencies Result in Improved Patient Care
One of the first benefits realized at MercyOne Des Moines was a significant improvement in efficiency. “Before we had this virtual system, our nursing staff was confronted with multiple interruptions, alert fatigue and the added challenges of donning and doffing protective equipment,” said Dr. Joel Ward, Chief Medical Informatics Officer for the central Iowa region of MercyOne. “There might be 20 different people in a single day that had to see each patient by the time you included doctors, specialists, and other therapists. The bedside nurses were facing constant interruption. With telehealth devices in patient rooms, virtual nurses can video conference into a room without interrupting the bedside nurse’s workflow.”
In addition, it became much easier for all the members of the patient care team to video conference into meetings, listen to updates, compare notes, and ask questions. This team-focused, more frequent communication replaced different professionals working independently, which has led to improved patient care.
For example, “The virtual nurse participates in daily interdisciplinary rounds then ensures the team is meeting daily goals and serves as a resource to staff along the way,” Miller explained. “Everyone is talking more and working as a team to create a collaborative practice environment. We have more consistent nursing support with the virtual role versus the challenges of multiple bedside nurse shift changes that naturally lead to inefficiencies.”
According to Miller, MercyOne Des Moines is seeing early evidence of a trend toward decreasing readmission rates as well as decreasing the length of hospital stays with the use of virtually integrated care. While analytics are still being developed to effectively track other measures, MercyOne Des Moines believes this supportive care structure will also aid in the reduction in falls and skin breakdown, while assisting compliance with patient care guidelines and positively impacting nurse retention and consumer and colleague satisfaction.
Technology Allows Families to Stay Connected
As we’ve all heard on the news, the isolation from family members has been a particular challenge of the COVID-19 pandemic. MercyOne Des Moines has also been able to use its telehealth program to keep families connected and involved during patient stays while visitation has been limited.
“One of the unique things about this disease is that it can take out entire households at one time,” Dr. Ward said. “Since we use simple video conferencing technology, which is so ubiquitous these days, family members are very comfortable utilizing this tool from home.”
As a result, MercyOne Des Moines can not only help family members who are all concurrent inpatients communicate between rooms but can also help family members at home to join in virtual visits. Although social visits can be easily facilitated by other hospital staff, the virtual care program can facilitate family members’ participation during patient care meetings with doctors or specialists more easily when they are reviewing the patient’s case through the virtual platform.
For instance, when it’s time to discharge a patient, telehealth technology can facilitate better patient hand-offs. If everyone is together in a virtual room, instructions and questions can be more easily addressed.
“The doctor can explain the diagnosis and easily share labs, images and test results with the patient, family or other health care professionals,” Dr. Ward said. “A virtual pharmacist can discuss medications, and health coaches can listen to discharge instructions. Family members are right there to ask questions and understand how to care for the patient at home.”
MercyOne Des Moines is also able to use telehealth technology to ease more painful outcomes. “We had a situation during the pandemic when we had a husband and a wife both in the hospital with COVID-19,” Dr. Ward said. “The husband needed to make end-of-life decisions for his wife, and we could use the technology to help him connect with other family members and doctors to talk through the process. After the wife passed, our pastoral care team was able to connect virtually with the husband to offer care and support as well.”
Limited by Only Our Imagination
As more healthcare professionals hear about MercyOne Des Moines’s Virtually Integrated CareSM program, the team is getting requests from different hospital departments as well as critical care providers in Iowa to get on the bandwagon.
Dr. Ward said the benefits of telehealth at MercyOne Des Moines are making amazing stories commonplace. “We’re sort of getting used to these stories,” he said. “It seems like every day, we see good outcomes and solutions as a result of telehealth technology. Moving forward, we’re really only limited by our imagination.”
For example, telehealth technology is being used to help train and mentor new nurses. Miller said, “We can easily use videoconferencing to help novice nurses in their training. For instance, we had a new nurse who was not familiar with a chest tube site. An expert nurse was able to video conference into the room, assess the site via the equipment and guide the novice nurse through next steps.”
With Iowa’s immense rural population, telehealth technology can help extend the reach of experts and specialists to bring care closer to home.
“In Iowa, we have about 82 critical access hospitals that all feed into a big health care system,” Dr. Ward explained. “If one of those rural locations has a patient with a stroke, they typically can’t keep the patient there. However, if telehealth allows that patient to receive the same quality of care as in a tertiary location by connecting local staff with expert doctors, nurses, speech therapists, then that patient may be able to stay local. That allows family and friends to visit more easily, and those visits are just as important to that patient’s healing.”