Using an innovative, web-based technology, a large portion of southwestern Ontario has been able to use a new model of care for complex pediatric and palliative patients in their homes.
eShift is a secure, web-based technology that enables a registered nurse to remotely care for as many as six patients in their own homes – simultaneously. Each patient has an unregulated provider, known as a homecare technician, at their bedside, who is continuously connected to and supervised by the RN.
The technology enables the RN to direct the technician in the collection of patient data, which is then reported in the application. The result is a robust, real-time view of the patient. With ‘virtual eyes’ on the patient, the RN can assess, monitor and even direct the technician to provide care, or summon another nurse if required.
This seemingly simple solution may revolutionize care in Ontario and abroad, as the technology can be used for patients with a variety of ailments – from frail seniors to housebound youngsters with complex needs.
It means that instead of keeping these patients with higher needs in expensive hospital beds, they can return to their homes.
But when home can be anywhere, getting a nurse with the specialized skills when the patient needs them can be a stumbling block.
Those patients who have returned home, without specialized nursing care, can run into trouble – and trigger a cycle of unnecessary use of emergency department or hospital readmissions.
“It used to be that if something went wrong, and a caregiver panicked, they’d call 911 and the patient would be taken right away to the hospital emergency department,” said Gordon Milak, senior director and the lead for e-home care at the South West Community Care Access Centre (SW CCAC).
Moving patients into the ED, of course, only contributes to hospital crowding and cost-overruns.
It is also a great inconvenience to patients and their families.
Milak explained that under the eShift system, RNs are in constant contact with the patient. The unregulated technician acts as their eyes, ears and hands.
Because the RN is remote, it means patients can access the right care, no matter where they live.
That’s reducing the pressure on hospital emergency rooms, cutting costs, and improving the quality of care for palliative patients and their families in southwestern Ontario.
The project was pioneered by the SW CCAC, whose catchment area stretches from London, Ont., to Owen Sound. In partnership with the Victorian Order of Nurses and CarePartners, along with technology partner Sensory Technologies, of London, Ont., the developer of eShift.
Together, the partners “are bringing technology to a problem that needs solving,” said Milak. “It’s about enabling home care workers to work differently.”
Milak noted in a two-year period that was studied, the eShift project in the SW CCAC cut hospital re-admissions for palliative care from 35 percent to just 1.9 percent, a dramatic reduction.
As Milak explained, the approach not only enables an RN to care for patients through a technician, but documentation about patients can be also be shared with their physicians.
There are several key indicators that are regularly charted, such as pain and shortness of breath.
The information also helps RNs who are contacted about patients in emergencies or when something unusual comes up.
In addition to the documentation, there’s also a visual dashboard that shows the condition of the patient in an instant.
Significantly, one remote nurse can monitor four patients, and in some cases, the nurse can keep tabs on six. In the SW CCAC, eShift nurses are now supervising 60 beds, predominantly palliative patients who are being cared for at home.
“eShift has revolutionized Registered Nurses’ abilities to provide expert palliative care and care to children with complex medical needs. The technology guarantees that the information collected by the technicians is shared consistently, timely and accurately,” said Charlotte Koso, Director of Program Development & Innovation at Care Partners. “I honestly can say, eShift is the most exciting program that I have ever led in my 43 years of nursing.”
What’s more, the system operates 24 hours a day, seven days a week. “It’s like having virtual eyes on the patient,” said Milak.
And with close collaboration between nurses and technicians, it’s also like having the nurse’s hands at the point-of-care, too. Since the project started in 2010, the eShift nurses and technicians have cared for more than 4,000 patients and logged over 750,000 hours of care.
Significantly, the service brings expertise to areas that haven’t been able to attract highly skilled nurses to provide overnight care. Milak said that in the rural Grey-Bruce area of Ontario, the CCAC had not been able to offer shift nursing care at night for six years. Now, a remote nurse has been able to work with a team of technicians to care for patients in their homes.
The original effort started in 2009 with $100,000 in seed money from the Ontario government, and initially focused on caring for children with complex conditions at home. These children often needed watching around the clock, which turned out to be too difficult for the parents to do alone.
As Milak observed, the parents would quickly burn out. But by making use of remote pediatric nurses connected to technicians in the home, care could be provided 24/7.
The system was then expanded to include palliative care, which requires similar, intensive care for patients.
Milak noted that families who bring their loved ones home for end-of-life care start with the best of intentions, but they don’t realize how challenging the task can be.
Family members who support palliative patients need time off to rest and recuperate, too, and eShift is a life-saver for them. “They’re brave and stoic, but they don’t always know what they’re in for,” said Milak. “They can crash.”
The eShift technology is the brainchild of entrepreneur Patrick Blanshard, who launched Sensory Technologies, the developer of the platform, in conjunction with several partners.
It’s being rolled out to other Ontario CCACs, as well as to care-givers in the U.K., France and parts of the United States. (A Sensory Technologies system in Michigan is being used for adult complex care, including COPD and chronic heart failure.)
The system has many useful features. For example, when a technician needs support and isn’t getting a response, the system automatically rolls over to another nurse to take charge.
In many cases, if the Sensory Technologies solution wasn’t in place, the patients it is currently monitoring would likely be in hospital care. Now, they have the choice to die at home, or stay at home longer.
To make this possible, Sensory Technologies trains nurses and technicians in the use of the computerized platform. The technicians are taught how to report the data that’s needed by the nurses.
Directing RNs can work from home or a telemedicine centre, and interact with technicians who use smartphones. In Ontario, Sensory Technologies owns and operates data centres that store the information logged by the system.
Blanshard explains that the company was originally launched in 2006, with the purpose of providing in-home directions to physiotherapists from orthopedic surgeons in hospitals.
The local CCAC caught wind of the project, and approached Blanshard with its own problem: whether the system could be used by RNs and unregulated staff (technicians) to provide overnight care for pediatric patients in their homes.
The CCAC couldn’t find enough nurses to do this work,” said Blanshard. “So we modified our existing tool set, and created a new solution. It was successful, and it’s still running to this day.”