How CHI's virtually integrated care model seeks to transform nursing

More hospitals are looking to adopt virtual care solutions to enhance the role of nurses and improve patient care.

Take for example Englewood, Colo.-based Catholic Health Initiatives — which is part of Chicago-based CommonSpirit Health, the organization created by the merger of CHI and San Francisco-based Dignity Health.

In 2014, CHI launched its trademarked VIC (Virtually Integrated Care) model as a pilot program at Lincoln, Neb.-based CHI Health St. Elizabeth, thanks to initial funding through CHI's Institute for Research and Innovation. After receiving a $1.45 million HHS grant, CHI expanded the virtual care program to 20 beds in the adult inpatient unit at St. Elizabeth, and 24 adult inpatient beds at CHI Health Good Samaritan in Kearney, Neb., in 2016.

That same year, CHI applied for a patent for "systems and methods for virtually integrated care delivery." The patent names Kathy Sanford, RN, CNO of CommonSpirit Health and formerly CHI's senior vice president and CNO, as the inventor and describes a model that connects bedside staff and a licensed nurse to the care team virtually.

"We've been tinkering around the edges on this kind of technology," Ms. Sanford said. "This is the next big step in connecting to virtual care management — we will break down siloes and reduce or eliminate fragmented care at the same time we improve care and reduce costs."

Now, CHI seeks to expand the model.

How the model works

The initial idea for the model came from a team led by Ms. Sanford.

The team considered that nurses in hospitals often care for multiple patients at one time amid distractions in the facility. This can take the caregiver's attention away from an individual patient and lead to errors. By using technology and changing the traditional nurse staffing and team model, they saw opportunities to improve quality and safety in hospitals and other sites of care.

"Individuals often experience their care as fragmented. Telehealth can be used to connect patients across the entire continuum of care," said Ms. Sanford.

Under CHI's model, the virtual nurse, who coordinates and manages care for up to 12 patients at a time, is the primary caregiver for the patient and has real-time access to patient records. He or she is also able to talk to the patient at any time via a two-way camera and virtually makes rounds with physicians on medical-surgical units. The virtual nurse is available to help with admissions and discharge planning and has access to lab results, test results and vital signs to closely monitor patient changes.

Under CHI's model, patients can maintain their privacy while having access to a virtual nurse, according to Ms. Sanford. The camera is not on the patient all the time. Whenever the nurse is about to "enter the room" there is a doorbell chime a minute before the camera activates.  

Virtual nurses also help keep patients and their families informed. If a patient's family members miss the physician's rounds, they can contact the virtual nurse (with the patient's permission) when they come to the hospital. The virtual nurse can explain to the patient or family what the physician said and answer any questions. Since virtual nurses consistently communicate with patients as well as the onsite integrated care team, the nurses can identify care issues that need to be addressed and notify the team about these.

The virtual care nurses must have at least a master's degree in nursing. Ms. Sanford said they focus on the science behind the patient's care, while managing and coordinating the hospital stay, and provide guidance and leadership to newer on-site nurses and the care team.

"This model is not just about the technology utilized for tele-nursing. It also changes the roles of various team members and provides nursing leadership for non-licensed unit personnel. It is high-tech because, of course, the virtual person isn't there physically," said Ms. Sanford, "but it's still high-touch, because the team on the nursing unit is concentrating on personal patient-centered care."

Next steps

Ms. Sanford said CHI has received positive feedback from patients about the virtually integrated care, and the health system plans to expand the model to more units.  

"We need to take the acute virtually integrated care model, spread it, and try different team configurations to see what works best on various types of nursing units. Then, the next step will be to tie the inpatient virtual nurse to virtual care managers located outside of the hospital," said Ms. Sanford.

Under CHI's model, the acute virtual team will connect with virtual outpatient care managers who interact with patients to help them integrate their wellness activities and medical care.

The goal is for virtual care managers to use technology to maintain a relationship with the patients for a certain period of time post-hospitalization. Those professionals would be available to answer questions about any post-discharge needs. For example, they could check in on a patient who is not making a follow-up appointment after they leave the hospital.

"It is our goal to have a personalized care model, with a care plan started in the hospital or provider's office. That plan would include how the patient desires to communicate. Do they want a phone call? Do they want Skype? Or do they want Facebook?" Ms. Sanford said. "We now have a good start on the inpatient portion of a coordinated virtually integrated care model. The next step is to figure out how to implement the model across the continuum."


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