Nurses Lead the "Wild Ride" to Telehealth Rapid Adoption

Nurse with several monitors 

 

UW Health nurses led the sea change that saw inpatient video telehealth visits go from zero in mid-March to about 80 a day by early April.

 

Kim Riese, BSN, MSHI, the RN Coordinator for telehealth, describes the growth as, “Like nothing I’ve ever experienced in 40 years in healthcare.”

 

“Telehealth has touched so many parts of UW,’’ she says. “Especially the nurses, they’ve just stepped up and done what they needed to do to care for their patients. It’s been a wild ride, but we’re still standing.”

 

Some of those nurses are visible to patients, holding an iPad for them and assisting in assessments during virtual inpatient rounds or taking a health history for a Vidyo-powered ambulatory visit.

 

Others, like Jason Laseman, BS, MA, RN-BC, and his colleagues at nursing informatics, are behind the scenes, providing the training, programming the iPads and creating the workflows.

 

Laseman recalled the wild week in March, when virtual rounds went from an idea to reality in four workdays. His group trained nurses on about 25 units at the three Madison hospitals. They started with having two iPads per unit but have since evolved so that all inpatient iPads have the capability, as well as a Webex app they can use to video chat with family and friends who can’t visit them in the hospital.

 

Laseman says the group is doing a patient satisfaction survey among parents of PICU patients at American Family Children’s Hospital, where complex cases may have 15 specialists joining by video.

 

“We want to know if they are effective and how comfortable patients’ families are with virtual rounds,’’ he says. “There isn’t a lot of data on this right now.”

 

UW Health Care Anywhere video visits with Urgent Care launched in late 2017, but really took off as the COVID-19 pandemic hit. Last year, UW Health had approximately 2,800 video visits all year. The first six months of 2020, there were 6,800 visits.

 

“By the end of the year, I’m sure we will have more than tripled last year's numbers of patients being cared for in this way,’’ says Riese, who spent the first weeks of the pandemic training more providers to deliver care via the UWH Care Anywhere platform. UW Health increased both the numbers of APPs doing visits and the hours the calls were staffed by UW staff (rather than a service) from eight hours a day to 12 hours.

 

“Now everyone, across the planet, knows what telehealth is,’’ she says. “Patients really like it, although it does have some limitations for detailed patient diagnostics.”

 

In an inpatient setting, telehealth was used to preserve precious Personal Protective Equipment (PPE) and to allow doctors to still be able to see patients even if they were quarantined at home.

 

“Nurses were the backbone of it, they were the ones in the room with the iPad, facilitating the meeting between patient and doctor,’’ Riese said.

 

The telehealth team provided educational materials to nurses and medical assistants on technology, so they could do “virtual rooming” with remote patients, going through all the questions they would normally ask in a clinic setting.

 

“The glue in all of that is the staff,’’ Riese says. “The nurses have to help patients with technology they may never have used before. Really those nurses were front line to make sure patients were able to have their visit with the doctor.”

 

Bill Yerges, MSN RN CPN, a coordinator with the pancreas/kidney transplant team, quickly became a Vidyo superuser, using video to educate patients post-surgery so they would be able to care for themselves at home. He says the transplant group continues to find new uses for video, from selection conferences to using video to interview potential organ recipients.

 

“It’s really served the transplant division well for moving patients forward to get transplants, and for making sure they get the necessary education so they can go home,” he says. “We follow patients for life.”

 

Another group that saw a big jump in use was UW Health’s eICU team, headed by nursing supervisor Lynn Jacobs, BSN, RN, CCRN and eICU medical director, Jeff Wells, MD.

 

The eICU team consists of 13 experienced intensive care nurses, like Cindy Pressnell, BSN, RN, PCCN (pictured here), 19 intensivists and 6 nursing assistants who monitor and collect data on ICU patients at UW Health and in community hospitals from Medford in northern Wisconsin to Freeport in northern Illinois. The average experience level on the nursing team is over 25 years.Before COVID-19, the group was monitoring 93 ICU beds at University Hospital, The American Center, Swedish American Hospital and community hospitals in Freeport, Ill., Medford, Richland Center and Monroe. They’re now up to 126 beds, as mobile monitoring carts were innovatively added at several sites and a D6/5 wing was converted to a 10 bed COVID ICU using spare eICU hardwired monitoring parts to create mobile carts.

 

“Usually we have six months of work before we go live with a new ICU, but D6/5 went live in three days,’’ she says. “Our nurses and nursing assistants have been through a massive amount of change very quickly in preparing to take care of patients with COVID 19 along with our typical intensive care patients and their professionalism over how they embraced this challenge during this pandemic should be applauded.”

 

In addition to extensive data collection and monitoring patients’ vital signs, best practice compliance, and preventing falls and extubations, the eICU staff mentors the new to ICU practice nurses at the remote locations, with check-ins at the beginning and end of every shift.  These novice nurses are encouraged to call the experienced eICU nurses during their shift with any questions as well.

 

“We provide a pretty detailed post-orientation mentoring,’’ Jacobs says. “It’s a scary time to be a new nurse in any ICU but especially now during COVID 19. The eICU nurses are able to walk them through a wide variety of patient care issues and our sites think it’s important that we bring additional physician and nursing expertise in light of the COVID-19 pandemic.”

 

The eICU monitoring equipment also tracks outcomes, and the vendor, Philips, is compiling COVID-19 outcome data from ICUs across the country, as well as locations in Japan and Great Britain. UW nurses and physicians will be co-authors on the study. The ability to track this data is made possible by the dedicated work of eICU nursing assistants.

 

View the full nursing annual report, 2020: The year of the resilient, remarkable nurse here:

 

Please send feedback and questions to Teri Shore at tshore@uwhealth.org