Tracking Key Metrics to Virtual Nursing Success

At the HealthLeaders Virtual Nursing Mastermind event this week in Atlanta, healthcare leaders discussed the KPIs they're measuring to prove ROI.

Healthcare executives are embracing innovative ideas like virtual care to stabilize a shrinking nursing workforce and boost clinical outcomes, but they need to know what to measure to prove ROI.

Virtual nursing programs are becoming popular in health systems across the country, either as a stand-alone program or, more commonly, as one part of a more comprehensive reimagining of care. And while each health system or hospital is advancing its own strategy, there are common objectives, such as nursing turnover and well-being, administrative tasks, and patient engagement.

Executives from a dozen health systems met in Atlanta this week for the HealthLeaders Virtual Nursing Mastermind program, in a forum to establish common goals, challenges, and successes. The program, which included three virtual roundtables, established a number of key metrics that executives are focusing on as they evaluate their virtual nursing strategies.

Staff turnover and well-being. The initial impetus for many health systems in launching virtual nursing programs is to address a shrinking workforce. Nursing executives are looking for ways to not only reduce turnover, but improve the environment so that nurses want to stay (and others want to join in). Virtual nursing programs create new opportunities for the workforce while revising workloads so that floor nurses are doing less administrative work and spending more time doing what they trained to do: spend time with patients.

While the trurnover rate is a key metric, others include nurse satisfaction (measured in surveys) and time spent on the computer, usually tracked through the EHR platform. While these metrics often are difficult to translate into dollars, Clair Lunt, RN, DHSc, Senior Director of Nursing Informatics at New York’s Mount Sinai Health System, noted they’re seeing a decline in the use of travel nurses and overtime, as well as PTO and even sick time (such as so-called mental health days), all of which significantly affect the bottom line.

The results aren’t limited to nurses, either. Providence is one of seeing a reduction in all-staff turnover, according to Sherene Schlegel, RN, BSN, COO and CNO of Virtual Care and Digital Health. These programs can thus impact all members of the care team, including CNAs and physicians.

As these programs involve, the executives in the Mastermind class noted that virtual nursing can be used as a marketing tool to attract new talent, especially as programs grow to include work-at-home policies.

Patient satisfaction. With the industry’s gradual shift to value-based care, health systems are placing more emphasis on patient experience—and a virtual nursing program can have a profound impact on how a patient feels about the care they receive. Most health systems see these effects in their HCAHPS scores, and some are even tailoring patient surveys to include specific questions on patient interactions with nurses.

It's important to remember that patient satisfaction and engagement do factor into an effective care management plan. Engaged patients are more likely to communicate freely with their nurses, listen to their care teams and adhere to those plans—something that can be measured in medication adherence.

To see those high patient satisfaction scores, health systems need to make sure patients are comfortable with virtual care, including the idea of having a camera in the room, trained on them. Mastermind participants recommended engaging with the patients as soon as they’re settled in their rooms to explain the technology and its uses, as well as designing the technology so that patients know when the camera is off.

Sara Pletcher, MD, MHCDS, SVP and Executive Medical Director of Strategic Innovation at Houston Methodist, pointed out that patients need to understand that virtual care is a routine standard of care, and not an add-on or a luxury. She noted that Houston Methodist now includes virtual care monitoring as part of its consent form, rather than as a separate opt-out.

Patient Throughput. Many health systems are embracing virtual nursing to address patient admission and discharge times, and consequently patient length of stay, all key metrics. But those processes are often complex, involving more than just nurses.

Emily Warr, Administrator of the Center for Telehealth at the Medical University of South Carolina (MUSC), noted that patient discharge is a key pain point in healthcare, one that affects patient satisfaction as well as clinical outcomes, and health systems like Intermountain have a benchmark of three hours from the time a discharge notice is entered to when the patient leaves the hospital. A virtual nursing program is then designed to reduce that time by having a virtual nurse handle as much of the administrative details as possible, including patient education, while the floor nurse manages in-person care duties.

The upshot is that a virtual nurse can oversee those details that a floor nurse would have had to do, reducing time spent and helping the patient get home faster. The same could be said for getting a patient settled into his or her hospital room, with the virtual nurse handling data entry and the floor nurse making sure the patient is comfortable. Both of those processes, as well as any data entry during the patient’s stay, contribute to the overall PLOS.

Again, healthcare executives need to understand that these metrics involve much more than just the nursing department, and that one aspect like virtual nursing won’t necessarily move the needle to a large degree. But incremental improvements are just as important, and for health systems engaged in a redesign of the entire care process, this is one vital step in that evolution.

Administrative tasks. Aside from handling admission and discharge processes, a virtual nursing program can also take on most, if not all, tasks which involve putting a floor nurse in front of a computer (a pain point noted in nurse well-being measurements). This could range from virtual rounding to physician visits to surveys for ancillary programs like sepsis detection, wound care, or medication adherence.

Health system executives can measure success here in accuracy of data entry, or in time taken to complete a task. Some executives have noted that floor nurses are often so busy they fail to do all the data entry and paperwork they should be doing. The end result is that care management is more efficient, and in turn leads to better outcomes.

Additionally, in a separate interview, Warr noted that after a while, floor nurses and virtual nurses in their program were so adept at working together that they could handle tasks without stopping to let the other person know. They also felt comfortable jumping in when needed and helping each other with tasks.

A key to success here is the relationship between the virtual nurse and the floor nurse. Health systems must establish clear protocols for both nurses before launching a program, so that each nurse knows their responsibilities. A good collaboration will be seen in efficient documentation, timely care delivery, and nurse satisfaction.

The HealthLeaders Mastermind series is an exclusive series of calls and events with healthcare executives. This Virtual Nursing Mastermind series features ideas, solutions, and insights on exceling your virtual nursing program. Please join the community at our LinkedIn page.

To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.