Impacts of an Acute Care TeleNursing Program

Written by Steve Klahn , Lindsay R. , Meagan Howard , and Melissa Gomez

Since launching the Houston Methodist TeleNursing Program for inpatient units in June 2022, we have successfully deployed to over 1,300 beds at all Houston Methodist acute care hospitals. Our pilot program results were recently published in the Journal of Medical Internet Research . In total, our virtual nurses cover 49 service units and we’ve experienced over 121,000 patient encounters. However, this success did not start out so easy.? Widespread nursing shortages, which worsened during the COVID-19 pandemic, caused us to turn towards innovation for ways to redesign our normal day-to-day patient care practices that could no longer be sustained.?

Virtual care had already been implemented in various forms across Houston Methodist, including the TeleStroke, TelePsych, TeleSitter programs; virtual ICU; and outpatient virtual visits. The main goal with our virtual care programs is always to enhance human touch without replacing it and to use technology to improve the overall patient experience and satisfaction. Before implementing virtual nursing, we completed a time study for the bedside nurses at our main hospital, which concluded that they were spending approximately 10 minutes per hour on documentation tasks that could otherwise be outsourced.? This survey allowed us to hone in on the goals for this program and focus our qualified virtual nurses on admission and discharge paperwork.? ??????

We had some eager and early adopters, but as with most new technologies, there were some initial hesitancies.? Yet, within 10 days of go-live, we started to see increased patient and staff satisfaction with the enhancements to their workflows.? The implementation was relatively seamless, leveraging the already existing MyMethodist Patient Engagement Tablets at each inpatient bedside to introduce patients to a TeleNurse who collects their information through real-time, uninterrupted video chat.? Since then, we have started to transition from using the MyMethodist Patient Engagement Tablets to two-way audio-video conversations with wall-mounted cameras and TVs in patient rooms.? We plan to have every inpatient room equipped with this new set-up by July 2024.

Regarding our “return on investment” with TeleNursing, we have experienced both hard savings and soft savings through this program including in places we did not initially expect.? For example, we successfully reduced the average time spent on documentation activities from 40 minutes with our bedside nurses to 13 minutes with our TeleNurses. This has resulted in giving more time back to the bedside nurses to provide better personalized care to each of their patients.? It also allows them to quickly respond and intervene where needed without interruption to important admission and discharge conversations which keep patients healthy and well. ?

?TeleNursing had an early impact our quality metrics:

• 95% completion of malnutrition screening during admission, up from 60-70%
• 25% improvement in completed pre-operative paperwork
• Incremental support of improvements with timely discharging of patients
• Softening/reduction in RN turnover in pilot units

With virtual health care constantly on the rise, TeleNursing has proven to not only alleviate several hospital pain points but also improve the efficiency and quality of care we can provide our patients.? TeleNursing is now becoming a standard of care within our Houston Methodist experience.? Our team is committed and dedicated to continually leveraging this technology and new innovations to create virtual care that provides unparalleled safety, quality, service, and innovation to our community.?