More than 90 hospital rooms have been outfitted with special equipment that enable physicians, nurses, and other personnel to deliver much of the patient's care virtually from stations throughout the facility.
MarinHealth has flipped the model on virtual care. Rather than using this mode of care to treat patients remotely, the 235-bed independent California hospital is using this approach inside the facility to minimize staff exposure to inpatients with COVID-19 and conserve personal protective equipment (PPE).
More than 90 rooms, including 10 ICU beds, have been outfitted with special equipment—including a camera and large screen television inside the room—that enable physicians, nurses, and other personnel to deliver much of the patient's care virtually from multiple stations situated in quiet locations throughout the facility.
While many hospitals already have such platforms in place to monitor patients remotely, Omaha, Nebraska-based Banyan Medical Systems is adapting its technology, which is used by almost 800 U.S. hospitals for a variety of purposes, to address new issues that have emerged with the novel coronavirus crisis. This includes keeping frontline staff as safe as possible, says Tony Buda, Banyan's president and CEO.
Banyan also has pledged to provide new telehealth equipment to outfit 1,000 inpatient rooms across the nation at no charge for 90 days, says Buda. It will install up to five rooms at hospitals and healthcare systems on a first-come, first-served basis, provided the facilities have the right infrastructure in place. The $10 million Telehealth Aid Program for Hospitals (TAP4H) initiative includes flying PPE-equipped Banyan personnel via private plane to do the installation, which can take up to 10 days.
The number of COVID-19 patients at MarinHealth has varied over the last three weeks from two to four patients with positive diagnoses, and from five to 18 patients under investigation (PUI), says Karin Reese, RN, MSN, MarinHealth's CNO. "From what they say," Reese explains, "we have not hit our peak yet; that is still two weeks out." The Greenbrae, California, hospital is located about 17 miles north of San Francisco.
One of the primary ways the facility s used the virtual technology in the past was to enable remotely located safety companions to interact with patients and monitor rooms for potential falls, as well as for remote case management. With the expected influx of COVID-19 patients, the technology has been adapted to deliver a new approach to care. Here's how MarinHealth is using the technology and how it's impacting operations.
1. Conserves PPE
One of the most important benefits this technology delivers is the opportunity to conserve PPE, says Reese. "We have huge shortages looming," she says. "Through virtual technology we cut down—probably by at least 50%, if not greater—the number of personal protective equipment that is utilized because people don't have to go into the room. They can 'virtual in' and do their work through the virtual space. We can now mitigate some of the usage of that precious resource."
2. Minimizes Staff Exposure to COVID-19 Patients
Because nurses and, sometimes, respiratory therapists, are still needed at the bedside with COVID-19 patients, the equipment does not eliminate the need for them to enter the room, says Reese. However, it reduces the number of times they have to cross the threshold and the time it takes to change into and out of PPE.
"Nurses are so used to running in when we hear alarms and things like that," says Reese. The technology "gives people that breathing room to [realize] you don't have to rush in and potentially expose yourself."
Nurses now have the ability to interact with the patient virtually before they enter the room and determine whether the patient needs additional medication, for instance, so they can combine multiple tasks into a single in-person visit, she explains. "It really helps with batching care to minimize trips in and out of the room," she says.
"For the other providers," says Reese, the virtual care technology "[is a] huge relief. "Once that room is virtualized," she says, "you can bring any type of caregiver into that room. They're very happy to be able to 'virtual in' and not physically have to go in and spend time at the bedside." It also prevents the need for dietary, rehab personnel, and others to enter the patient's room. Nurses sometimes help to perform tasks, such as checking a patient's mobility while a physical therapist, for example, watches from a remote monitor.
3. Enables More Frequent Patient Interactions
Rather than reducing nursing interaction, this type of virtual care creates more opportunities for patients to interact with their nurses—safely, says Reese. "It allows them to check in with the patient more often."
While a typical ICU patient may get about 20 hours of direct care per patient day, "I can assure you the COVID patients across the country are not getting 20 hours of direct patient care because [nurses] are limiting their access to the room. They can't be in there, unless something's really going awry. But with virtual technology, you can actually check in with them more often." In addition, she says, it gives the patient instant connectivity to hospital personnel.
4. Changes Workflows
Caring for COVID-19 patients changes nursing workflow, says Reese. "It's not like the old days where you'd just blow through a door and say, 'Hi Mr. Jones. What can I get for you?' Our workflows have changed dramatically."
For example, MarinHealth now has a person observing those who enter and exit COVID-19 patient rooms to ensure they properly don and doff PPE.
Virtual technology can help streamline many such processes, says Reese. If a patient is given blood, for example, MarinHealth's protocols require the involvement of two nurses—one to administer the blood product; the other to double check the patient's armband and blood label. Thanks to in-room cameras, the second person can now perform their tasks remotely.
The quality of the cameras and the size of the in-room television screen enhance visibility for the caregiver and for the patient. Reese says it is easy to quickly see essential things such as IV infusions. It is state-of-the art-quality," she says. In addition, because patients are being observed by a centralized monitoring unit that watches patients around the clock, including an infrared camera at night, there is the added benefit of having an additional set of eyes on patients at all times.
"The technology is getting us to think differently about how we can do our work more efficiently," says Reese, "and yet give the patient what they need."
5. Supplements Staffing to Address Shortages
MarinHealth primarily uses its own staff members to perform all virtual care functions, although the work is supplemented by remotely located Banyan safety companions (telesittters) and care managers.
"We are quickly operationalizing our model where Banyan will provide relief for our safety companions," says Reese. In addition, the hospital may turn to Banyan for additional virtual relief if the facility begins to experience onsite staffing shortages. Personnel available for virtual consultations include physicians, social workers, case managers, LPNs, RNs, and MDs, including intensivists, hospitalists, and other specialists.
6. Brings Family Members Into the Room
Another advantage the technology offers to COVID-19 patients is the ability to virtually communicate with family and friends who are not allowed to visit during the pandemic. "While some can try to use their cell phone to FaceTime family members," says Reese, "the [virtual technology] TV screen offers a much bigger picture." This has been particularly helpful for elderly patients, she says.
Reese says using virtual care technology in this manner will be "transformative" for her organization and should become a "mandatory way of doing business" at hospitals.
"Sometimes it takes something like this [pandemic] for people to really start to think out of the box," says Reese. "This kind of crisis is really forcing everyone to go, 'Gosh. I wish, I wish, I wish.' Here at MarinHealth, we can say, 'Wow, we don't really have to wish because we have got something that really is a game changer.'
“Once that room is virtualized, you can bring any type of caregiver into that room.”
Karin Reese, RN, MSN, CNO MarinHealth
Mandy Roth is the innovations editor at HealthLeaders.
Photo credit: Courtesy Banyan Medical Systems
To minimize staff exposure to the coronavirus and conserve PPE, virtual care is being used to treat patients inside of hospitals.
Banyan Medical Systems has pledged to provide telehealth equipment to outfit 1,000 inpatient rooms in hospitals across the nation at no charge for 90 days.