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October 30, 2017
How CHI Franciscan Health’s Virtual Health Services Are Changing the Game in Medicine
Shannon Zawilski worked at St. Joseph Medical Center in Tacoma for 12 years. Then she went virtual.
Shannon is one of 14 ICU-trained registered nurses at CHI Franciscan Health’s Virtual Hospital in Tacoma. Located in a standard-looking office building on State Street, the virtual hospital has a team of more than 150 clinicians and IT professionals.
Thanks to a fleet of computers, phones, and even a Bluetooth-enabled stethoscope or two, the team monitors 850 beds across all eight CHI Franciscan hospitals — all without leaving the building.
The goal: rebuild healthcare around the patient. That means giving doctors iPads so they can consult with patients remotely. That means connecting in-hospital nurses with trained technicians with access to a patient’s case with the click of a button. That means the future.
“Right now, health care can feel choppy to a patient,” says Lana Adzhigirey, manager of care transformation at CHI Franciscan Health and a registered nurse. “We’re trying to make it more seamless.”
An ICU near you
Joining the Virtual Hospital’s ICU team was, Shannon says, “an adjustment.”
“I went from 14 hours on my feet to stationary at a desk,” she says. (The fix: a stepping machine under her desk to “help get my steps in” while she works a 12-hour shift.)
Some things haven't changed. Shannon starts each shift the same way she did at St. Joseph’s: by reviewing a patient’s chart. But in the virtual hospital and using tools including a CHI-created algorithm that ranks patients based on if and how they’re improving, Shannon has a whole new perspective.
“I can ask questions like ‘Is this antibiotic working the way it should?’ rather than being by a patient’s bedside and only having time to ask, ‘Is there even an antibiotic ordered?’” she says. “We’re like a second set of eyes but a really good set of eyes.”
The point is to “ move away from reactive care and toward proactive care,” explains Lana. “We’re asking ourselves, ‘How do we avoid complications before they happen.’”
Being outside a traditional hospital doesn’t mean a lack of interest, says Jayne Binnig, Virtual ICU manager. “Even though we’re not at the hospital, the patient is still at the core of what we do,” she says. “We still feel ownership over a patient’s outcome just like we would at the bedside.”
Working in the Virtual ICU allows her staff to “cut out the clutter and the noise,” says Jayne. “When you’re in here, you’re avoiding the multiple interrupts that a bedside nurse experiences so you can really zero in on something.”
That makes a Virtual ICU nurse — and the computer at her fingertips — an invaluable tool for the bedside team, she adds. “It allows us to be all one big critical care unit rather than disparate teams,” Jayne says. “We’re not a separate hospital out here.”
Eyes in the sky
Down the hall from the ICU is the Virtual Hospital’s telemetry monitoring room. It feels like air traffic control.
At each of the seven stations, a monitor technician commands six computer monitors that track the heart rates and rhythms of 30 to 50 patients.
No hospital can have a nurse in every patient room, 24 hours a day, says Matt Levi, director in healthcare administration and innovation at Franciscan Health System. That’s where the telemetry team comes in. Each hospital identifies patients for the telemetry technicians to monitor. Once they’re on the list, each state-licensed technician is trained to spot something that looks (or sounds) off on the patient’s monitor.
A faster-than-normal pulse, a slowed heart rate, an arrhythmia — these coded messages tell techs that’s something’s not right. Thanks to direct lines via computer, phone and the hospital-issue Vocera Communication System, each tech has direct access to in-hospital care teams as well as each other’s expertise. Or, as one tech put it, “push a button, call a nurse.”
LeAnne Ackles was the first monitor tech hired at the Virtual Hospital. She’s seen plenty in her three years on staff. One man checked into a CHI hospital complaining of chest pain. The virtual tech assigned to his case saw an unexpected change in heart rate and was able to tell his nurse, who’d been busy with another element of care, to take a closer look. Thanks to that quick action, “he had a good outcome,” says Leanne.
“The nurses at the hospitals are really thankful that we’re here,” she adds. Since 2014, her team has monitored patients’ heart rates for more than 2 million hours.
Those hours are time “we’re giving back to the hospitals,” says Laura Meacham, director of Clinical Operations Center at Franciscan Health System. By freeing up in-hospital staff to monitor patients, take required breaks, and field their myriad other duties, the telemetry team gives those on the ground room to do their jobs better. “More eyes,” says Laura, “better advocacy.”
Bedside manner, on demand
Located in the same room as telemetry are the Virtual Hospital’s companions. These care assistants each monitor six patients in a set-up reminiscent of Skype. A camera and microphone in the hospital room allows a patient to see and hear his or her virtual companion, and vice versa. The companion also has access to a digital case file that includes details ranging from what medicines the patient is on to whether or not the rails are up on the bed.
A care assistant for seven years, Damaris Muita joined the virtual care team three years ago. In that time, she’s seen her team do everything from redirect a confused and anxious patient back to his bed — ”He just felt bored and needed someone to be with him” — to calling in security when an unexpected visitor let themselves into a young patient’s room.
About 3 to 5 percent of patients need some kind of around-the-clock monitoring, says Matt. Historically, this has been done by having a CNA who physical sits at a patient’s bedside.
“That’s hard work and it’s monotonous,” says Matt. It’s also not particularly effective for either the patient, who may feel uncomfortable with a companion so close by, or for the companion, who has the training to assist more than one person at a time.
Since the virtual companion program started, the team has cared for more than 1,000 patients and covered nearly 50,000 hours of sitting. The Virtual Hospital also reports a decrease in the number of falls experienced by patients; in the last measured month, units working with the virtual companions had a fall rate of 4.4 falls per 1,000 compared to 9 falls per 1,000 for non-participating units at the same hospital.
It’s all about paying attention to patients, says Muita: “We’re keeping them company.”
House calls 2.0
Such digital and direct care isn’t limited to patients in the hospital. One of the Virtual Hospital’s oldest initiatives involves beaming in medical care where people need it most: at home.
Dr. Jessica Kennedy-Schlicher of St. Anthony Hospital in Gig Harbor has been seeing virtual patients for a year. She’ll receive a text on her phone that tells her to log on to a secure app where, like you would with FaceTime or Skype, she video calls the patient.
“It’s such a delight,” she says of the experience for both her patients and herself. “We’re able to provide a concierge-level of care.”
That can mean anything from drastically cutting wait times — the average virtual visit is between 15 and 30 minutes compared to the national average of 121 minutes — to allowing doctors to call in a specialist within the same visit rather than schedule a separate appointment.
In the past three years, CHI has conducted nearly 12,000 virtual visits, 75 percent of which didn’t require in-person follow-up. (The remaining 25 percent resulted in a mix of in-person follow-ups and urgent care, says Lana.) The newest virtual visits are specialty virtual visits where a patient is in a clinic near his or her home and the specialist consults virtually from a different clinic. The benefit? Decreased travel time and quicker access to specialty care.
Newer tools are in the works to improve virtual visits. On the docket: a Bluetooth-enabled stethoscope that allows patients to record their heartbeats and send the resulting audio files to their doctors. For now, doctors can do “patient-directed exams” where the doctor instructs the patient of what to do (“Hold that ruler up to your rash so I can see how large it is.”)
It works, too. From headache to mental health to chronic heart disease, studies show telemedicine — the catch-all for programs like Virtual Visits — to be just as effective as in-person care.
But the biggest selling point for Dr. Kennedy-Schlicher? “We can come to the patient.” That’s a game-changer for her older and more debilitated patients (think those with dementia, multiple sclerosis or ALS). For such patients, a trip to the doctor’s is “a whole day affair.” A virtual visit cuts out that travel time.
“People are excited,” says Dr. Kennedy-Schlicher. “They’re getting what they need on their terms.”
Partner, support, and provide — that’s what the Virtual Hospital strives to do, says Matt. “We’re able to provide our patients quicker and better access to medical experts who, in turn, are better able to partner and support one another,” he adds.
Patient security is also paramount, Matt says. It helps that the building used to be a bank; add 24-hour security, two levels of backup generators, and regular IT security checks and you’ve got a fortress. Inside, a team of trained medical professionals who are, quite literally, just a click away.