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Nursing Workflow Change in a COVID-19 Inpatient Unit Following the Deployment of Inpatient Telehealth: Observational Study Using a Real-Time Locating System.
Vilendrer, Stacie; Lough, Mary E; Garvert, Donn W; Lambert, Monique H; Lu, Jonathan Hsijing; Patel, Birju; Shah, Nigam H; Williams, Michelle Y; Kling, Samantha M R.
  • Vilendrer S; Evaluation Sciences Unit, Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States.
  • Lough ME; Evaluation Sciences Unit, Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States.
  • Garvert DW; Office of Research Patient Care Services, Stanford Health Care, Palo Alto, CA, United States.
  • Lambert MH; Evaluation Sciences Unit, Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States.
  • Lu JH; Office of Research Patient Care Services, Stanford Health Care, Palo Alto, CA, United States.
  • Patel B; Center for Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA, United States.
  • Shah NH; Center for Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA, United States.
  • Williams MY; Center for Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA, United States.
  • Kling SMR; Evaluation Sciences Unit, Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States.
J Med Internet Res ; 24(6): e36882, 2022 06 17.
Article in English | MEDLINE | ID: covidwho-1875295
ABSTRACT

BACKGROUND:

The COVID-19 pandemic prompted widespread implementation of telehealth, including in the inpatient setting, with the goals to reduce potential pathogen exposure events and personal protective equipment (PPE) utilization. Nursing workflow adaptations in these novel environments are of particular interest given the association between nursing time at the bedside and patient safety. Understanding the frequency and duration of nurse-patient encounters following the introduction of a novel telehealth platform in the context of COVID-19 may therefore provide insight into downstream impacts on patient safety, pathogen exposure, and PPE utilization.

OBJECTIVE:

The aim of this study was to evaluate changes in nursing workflow relative to prepandemic levels using a real-time locating system (RTLS) following the deployment of inpatient telehealth on a COVID-19 unit.

METHODS:

In March 2020, telehealth was installed in patient rooms in a COVID-19 unit and on movable carts in 3 comparison units. The existing RTLS captured nurse movement during 1 pre- and 5 postpandemic stages (January-December 2020). Change in direct nurse-patient encounters, time spent in patient rooms per encounter, and total time spent with patients per shift relative to baseline were calculated. Generalized linear models assessed difference-in-differences in outcomes between COVID-19 and comparison units. Telehealth adoption was captured and reported at the unit level.

RESULTS:

Change in frequency of encounters and time spent per encounter from baseline differed between the COVID-19 and comparison units at all stages of the pandemic (all P<.001). Frequency of encounters decreased (difference-in-differences range -6.6 to -14.1 encounters) and duration of encounters increased (difference-in-differences range 1.8 to 6.2 minutes) from baseline to a greater extent in the COVID-19 units relative to the comparison units. At most stages of the pandemic, the change in total time nurses spent in patient rooms per patient per shift from baseline did not differ between the COVID-19 and comparison units (all P>.17). The primary COVID-19 unit quickly adopted telehealth technology during the observation period, initiating 15,088 encounters that averaged 6.6 minutes (SD 13.6) each.

CONCLUSIONS:

RTLS movement data suggest that total nursing time at the bedside remained unchanged following the deployment of inpatient telehealth in a COVID-19 unit. Compared to other units with shared mobile telehealth units, the frequency of nurse-patient in-person encounters decreased and the duration lengthened on a COVID-19 unit with in-room telehealth availability, indicating "batched" redistribution of work to maintain total time at bedside relative to prepandemic periods. The simultaneous adoption of telehealth suggests that virtual care was a complement to, rather than a replacement for, in-person care. However, study limitations preclude our ability to draw a causal link between nursing workflow change and telehealth adoption. Thus, further evaluation is needed to determine potential downstream implications on disease transmission, PPE utilization, and patient safety.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Telemedicine / COVID-19 / Nursing Care Type of study: Experimental Studies / Observational study / Prognostic study Limits: Humans Language: English Journal: J Med Internet Res Journal subject: Medical Informatics Year: 2022 Document Type: Article Affiliation country: 36882

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Telemedicine / COVID-19 / Nursing Care Type of study: Experimental Studies / Observational study / Prognostic study Limits: Humans Language: English Journal: J Med Internet Res Journal subject: Medical Informatics Year: 2022 Document Type: Article Affiliation country: 36882