Impact of virtual nursing on discharge planning and readmission rates on medical/surgical units
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Date
2018-05-12Author
Hinueber, Danielle
Weber, Jayme
Scroggs, Nancy
Barnes, Emily
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ABSTRACT
Background: The concept of virtual nursing has become increasingly popular as technology evolves, and hospitals across the world have begun using virtual nursing to improve patient education, patient satisfaction, discharge instructions, and readmission rates.Problem Statement: The virtual nurse directs the care of the patient remotely, in partnership with an inter-professional care team via a Virtual Command Center (VCC). The VCC is connected to patient rooms through videoconferencing equipment. These interactions are designed to support efficient, effective person-centered care and education while also providing a virtual support system for care team members. Included in the virtual nurses’ duties are admission and discharge care. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores were disclosed in a report posted on the company intranet of CHI Health. Prior to implementation of the virtual nurse role, the medical/surgical unit was rated fifty-five percent top box at Good Samaritan for discharge information for fiscal year 2016, below the benchmark of sixty-one percent (Personal Communication, 2017).Purpose: The purpose of the project was to evaluate the effect of the virtual nurse care delivery model in a rural, medical-surgical unit using the following outcome measures: a) 20% increase in HCAHPS discharge planning scores and b) 10% decrease in readmission rates.Procedures: The specific aims for data in years 2015 and 2017 include: to conduct a trend analysis of discharge HCAHPS scores, identify the percent difference in discharge HCAHPS scores, conduct baseline assessment of readmission rates, and identify the percent differences in readmission rates between the intervention unit and control unit.Literature Review: Developing a new model of care that allows for efficient and effective transitions in care will not only improve patient satisfaction and quality of care, but will increase hospital revenue as well. A review of the literature highlights the importance of a dedicated discharge staff member, medication reconciliation, coordinating appointments, and intense education throughout the hospital stay in providing quality discharges.Data Collection/Results: Discharge HCAHPS scores from 2015 and 2017 were compared to evaluate the impact of the Virtual Nurse project implemented in 2016. Baseline readmission rates were compared to post-intervention readmission rates on the medical-surgical VIC unit. The progressive care unit (PCU) served as a control unit when evaluating improvements.Conclusion: Outcome cases in 2015 were 1,799 and 1,193 for PCU and MSU, respectively. Outcomes cases in 2017 were 1,826 and 905 for PCU and MSU, respectively. Readmissions for PCU were 193 in 2015 and 17 in 2017. Readmission for MSU were 124 in 2015 and 72 in 2017. The risk-adjusted observed over expected readmissions for MSU was 0.93 in 2015 and 0.81 in 2017. The risk-adjusted observed over expected readmissions for PCU was 0.85 in 2015 and 0.95 in 2017. A percentage decrease of 2.43 on MSU and a percentage decrease of 1.04 on PCU was found. The difference in readmissions is 1.39%. This would result in approximately 13 less readmissions.
Background: The concept of virtual nursing has become increasingly popular as technology evolves, and hospitals across the world have begun using virtual nursing to improve patient education, patient satisfaction, discharge instructions, and readmission rates.Problem Statement: The virtual nurse directs the care of the patient remotely, in partnership with an inter-professional care team via a Virtual Command Center (VCC). The VCC is connected to patient rooms through videoconferencing equipment. These interactions are designed to support efficient, effective person-centered care and education while also providing a virtual support system for care team members. Included in the virtual nurses’ duties are admission and discharge care. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores were disclosed in a report posted on the company intranet of CHI Health. Prior to implementation of the virtual nurse role, the medical/surgical unit was rated fifty-five percent top box at Good Samaritan for discharge information for fiscal year 2016, below the benchmark of sixty-one percent (Personal Communication, 2017).Purpose: The purpose of the project was to evaluate the effect of the virtual nurse care delivery model in a rural, medical-surgical unit using the following outcome measures: a) 20% increase in HCAHPS discharge planning scores and b) 10% decrease in readmission rates.Procedures: The specific aims for data in years 2015 and 2017 include: to conduct a trend analysis of discharge HCAHPS scores, identify the percent difference in discharge HCAHPS scores, conduct baseline assessment of readmission rates, and identify the percent differences in readmission rates between the intervention unit and control unit.Literature Review: Developing a new model of care that allows for efficient and effective transitions in care will not only improve patient satisfaction and quality of care, but will increase hospital revenue as well. A review of the literature highlights the importance of a dedicated discharge staff member, medication reconciliation, coordinating appointments, and intense education throughout the hospital stay in providing quality discharges.Data Collection/Results: Discharge HCAHPS scores from 2015 and 2017 were compared to evaluate the impact of the Virtual Nurse project implemented in 2016. Baseline readmission rates were compared to post-intervention readmission rates on the medical-surgical VIC unit. The progressive care unit (PCU) served as a control unit when evaluating improvements.Conclusion: Outcome cases in 2015 were 1,799 and 1,193 for PCU and MSU, respectively. Outcomes cases in 2017 were 1,826 and 905 for PCU and MSU, respectively. Readmissions for PCU were 193 in 2015 and 17 in 2017. Readmission for MSU were 124 in 2015 and 72 in 2017. The risk-adjusted observed over expected readmissions for MSU was 0.93 in 2015 and 0.81 in 2017. The risk-adjusted observed over expected readmissions for PCU was 0.85 in 2015 and 0.95 in 2017. A percentage decrease of 2.43 on MSU and a percentage decrease of 1.04 on PCU was found. The difference in readmissions is 1.39%. This would result in approximately 13 less readmissions.