Tech allows community care nurses to make rounds remotely

OSHAWA, ONT. – The “virtual ward” project at the Central East Local Health Integration Network (LHIN) was pushed ahead of schedule by an unlikely force: the COVID-19 pandemic.

“It’s been an organizational goal for quite some time,” said Dr. Ilan Lenga, a nephrologist and chief information officer for Lakeridge Health, part of the Central East network. But COVID-19 was “a major impetus” to accelerate things.

The “virtual ward” is exactly that – nurses can monitor the recovery of whole groups of remote patients as if they were doing rounds. The difference is, the patients aren’t in the hospital.

Built on the Vivify remote-care platform, an app pushes questions to the patient’s smartphone – the same questions a nurse might ask on his or her rounds. Community care nurses monitor the results, communicate with patients to address issues, and consult with doctors to determine whether the patient should return to the hospital.

There are several reasons to clear the brick-and-mortar wards more quickly, said Dr. John Dickie, chief of surgery and section chief of thoracic surgery at Lakeridge. The longer patients stay in the hospital, the more likely they are to be exposed to pathogens. And a likely second wave of COVID-19 infections is looming ominously on the horizon.

Meanwhile, hospitals are trying to catch up with a five-month backlog of surgical patients, whose operations were delayed due to the pandemic. There are additional pressures to get them in and out of hospital quickly, but with the best possible outcomes.

“Hospitals are looking for capacity,” said Cathy Slevin, senior manager of clinical care and home and community care programs for the LHIN.

Once they are discharged, patients are faced with a “white space”, those nerve-rattling weeks before the follow-up appointment with a doctor. Patients may encounter a serious problem while at home, and might need to see a medical professional earlier. Or they may get the jitters and return to the hospital unnecessarily.

However, remote nurses can check on them “virtually”, by using the Vivify platform. In this way, they can advise the patient on what to do for serious problems – such as calling an ambulance or seeing the doctor right away. If the problem is less urgent, the nurse can advise the patient on how to handle things at home.

“Every day, (the virtual ward) is like a nurse doing a bedside assessment,” Slevin said.

And that assessment can be done while nurses are performing their other duties. Nurses have a “traffic light” dashboard to determine what needs follow-up by phone or video, and an escalation path for more serious cases. Patients can be referred directly to a doctor or team rather than waiting in the ER.

The first virtual ward cohort, launched August 6, was composed of recovering COVID-19 patients. Congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) were scheduled next, followed by patients recovering from thoracic surgery.

While the program is only taking thoracic surgery patients at first, Lakeridge intends to extend it to all post-operative patients, said Dr. Dickie. Orthopedic surgeons are “very motivated” to be included in the program, said Dr. Lenga.

Dr. Lenga said surgeons are “onboarding” community care nurses, training them in the specific issues and escalation paths related to their particular specialty.

In addition to bedside assessments, community care nurses are good at navigating available resources for patients in the community, said Slevin. For example, if a patient is homebound and out of groceries, they can connect the patient with a community organization that can help.

Leveraging existing technology made the program very low-budget and quick to implement, Slevin said. Patients don’t need any hardware aside from their existing smartphones, although the COVID-19 patients were also provided with an oximeter, which measures oxygen saturation through a non-invasive fingertip device.

Working with the Ontario Telemedicine Network (OTN), the region didn’t have to go through a request for proposals (RFP) process, as Plano, Texas-based Vivify Health has been a vendor of record for OTN’s remote patient monitoring programs since 2017.

Vivify’s Remote Patient Monitoring (RPM) platform boasts more than 90 clinical and engagement pathways. Users can modify the content, or create their own custom pathways.

In its 10-year history, Vivify claims a record of 97 percent patient satisfaction, 65 percent readmission reduction and 8.2x return on investment.