Becker's Hospital Review

38 INNOVATION Hospitals 'learning as we go' with virtual nursing By Giles Bruce H ealth systems are working out the kinks with virtual nursing, with some hospitals discovering the care model doesn't work for all its hoped-for uses, e Philadelphia Inquirer reported. Philadelphia-based Penn Medicine, for instance, discovered that having in-person nurses move the virtual nursing stations around cut into the time savings from the technology, according to the May 14 story. "Everyone is trying to figure out how to use the technology to improve patient care and safety, and we're all learning as we go," Penn Chief Medical Information Officer Bill Hanson, MD, told the newspaper. State inspectors cited Jefferson Abington (Pa.) Hospital in March for having the stations in behavioral health inpatient rooms, where the 8-foot-long power cords were a safety risk for potentially suicidal patients, the news outlet reported. e hospital removed the carts and went back to using in-person sitters. A spokesperson for Philadelphia- based Jefferson Health told the news outlet that the health system follows national guidelines for virtual sitters in psychiatric units. Penn Medicine also found that virtual sitters, who monitor several patients at a time, weren't a good fit for some patients who were already confused and disoriented and became agitated by the disembodied voices, according to the story. "Everyone is thinking the technology is going to create such efficiency. We bought into the hype," Ann Huffenberger, RN, director of the Penn Center for Connected Care, told the Inquirer. "It didn't really work out for us in that manner." e health system may also move to wall-mounted virtual nursing screens, as troubleshooting connectivity issues, changing batteries and locating carts can be a time drain, the newspaper reported. But the mounting will require regulatory approval and construction in rooms that are in use. Jefferson Health also found that patients prefer when virtual nursing units can be turned toward the wall so it doesn't feel like the nurses are always watching, according to the story. Programmers also implemented a virtual "knock" so nurses don't just pop up on the screen. n Why 'hospital at home' has a 'common agency problem' By Giles Bruce "H ospital at home" suffers from what economists call a "common agency problem," three experts on the care model wrote in Health Affairs. CMS started allowing health systems to apply for waivers to be reimbursed for acute hospital care at home in 2020, greatly expanding the number of hospital-at-home programs. But for the care model to truly reach its potential, this "common agency problem" must be fixed, according to the May 3 article by Bruce Leff, MD, geriatrician and health services researcher at Baltimore- based Johns Hopkins University School of Medicine, David Levine, MD, clinical director of research and development at Boston-based Mass General Brigham Healthcare at Home, and Albert Siu, MD, geriatrician and health services researcher at New York City-based Icahn School of Medicine at Mount Sinai. is obstacle arises when "multiple payers contract with a shared or common agent — the hospital in the case of HaH — that wishes to be paid for all patients eligible for a service," the researchers wrote. Resolving this will require the CMS waiver to be made permanent — it currently expires at the end of 2024 — and for all states and their Medicaid programs to get on board with "hospital at home." is will "incentivize other payers to overcome the inertia to enter the HaH market, creating a wide-ranging multipayer environment for HaH," the authors wrote. "Over decades, researchers have developed and tested multiple home- based care delivery models that can now be brought together into a distributed, decentralized healthcare system that puts the patient at the center of care at home, where they have more agency and power to affect their care," Drs. Leff, Levine and Siu wrote. "HaH is the keystone of this future home-based care ecosystem. It's time to claim the future." n HCA expanding use of AI automation tool By Naomi Diaz N ashville, Tenn.-based HCA Healthcare is expanding its use of an automated AI medical documentation tool to its network of emergency departments after a successful pilot. Emergency department physicians at four HCA hospitals piloted a generative AI-powered documentation tool from Augmedix for medical documentation, according to an April 24 news release from Augmedix. Physicians who used it said the tool gave them more time with patients and less time in front of computer screens as well as accurate note content even in noisy settings. n

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