Connect

At the beginning of the pandemic at UVA Health University Medical Center, 3 West was transformed into the Acute Care Special Pathogens Unit. With that came telehealth monitors installed in every patient room — allowing team members to connect with patients virtually while reducing unwarranted exposure to COVID-19. 

But as the pandemic slowed and 3 West resumed its regular function as an acute care unit, the monitors went largely unused. Interim Nursing Director for General Medicine Scott Austin, RN, BSN, and Telemedicine Systems Engineer Brian Dunn began brainstorming ideas to repurpose 3 West’s telehealth capability to benefit patients.

“Brian and I knew we could use that equipment for something,” recalls Austin. But they didn't know what that was until October 2023, when Austin and UVA Health University Medical Center Chief Nursing Officer Kathy Baker, PhD, RN, NE-BC, attended a session on virtual nursing at the Magnet conference. "I thought, we can do that at UVA Health!” 

Up and Running

Austin presented his idea for an innovative new virtual nursing program at UVA Health to leadership. Not only would it decrease the workload of bedside nurses, he explained, but it could also improve patient satisfaction. Without hesitation, Baker and Nursing Director Leigh Gauriloff, MSN, RN, CMSRN, pledged their enthusiastic support, and Austin and Dunn were up and running! By February 2024, Baker had approved three experienced 3 West nurses — Amy Blackman, MSN, RN, CMSRN, Carly Frazier, BSN, RN, CMSRN, and Lindsay Greiling, BSN, RN, CMSRN — to become the program’s first, full-time, virtual nurses. 

Laying the Groundwork

Over the next several weeks, Dunn ensured there was a clear audio/visual connection with each of the unit’s 26 acute care beds, replaced damaged equipment, and reviewed telemedicine etiquette. Austin, Blackman, Frazier, and Greiling spent that time laying the groundwork for a pilot program on 3 West that would focus on discharges: conducting research, developing criteria for virtual discharge candidacy, and collaborating with other departments to understand their workflows and how they influence the discharge process.

“It was great to be pulled out of staffing for a while to do project management and really dig deep into the literature,” says Blackman, who has a background in research.

Forging Ahead

On April 8, 2024, UVA Health's Virtual Nursing Program pilot went live. Austin explains the discharge process: “The virtual nurse calls into the patient’s room through the TV, so the patient and their family can see and hear her. She has already read through the discharge paperwork and makes sure the patient and the family understands every single page of it. When the virtual nurse is done, she puts in for transportation for that patient to be picked up from the unit and checks back in with the bedside nurse to say, ‘I've completed your patient’s discharge, the wheelchair is ordered, you're done with this patient.’” 

Since April, the team has completed 106 virtual discharges. They'll be forging ahead in pilot mode until they’ve gathered and analyzed more data, but so far, the feedback is all positive.

Covering All the Bases

“Being away from the bedside, we’re able to focus on the After-Visit Summary, thoroughly review it, coordinate discharge medications, correct discrepancies, and answer patients’ and families’ questions,” explains Greiling. “Our fellow nurses trust we're going to make sure discharges are done right. Patients are getting safer discharges, and bedside nurses are getting time back to work on other tasks and take care of their other patients.”

Virtual nursing at UVA Health has been beneficial not only for patients and bedside nurses, but also for the virtual nursing team. “I guess I didn't realize how burnt out I was doing bedside nursing,” says Frazier, who has been at UVA Health for nine years and has a toddler at home. “I now work from 8:30 a.m. to 5 p.m., which fits better in my life than a typical 12-hour inpatient nursing shift would. The virtual nursing program has allowed me to stay involved with 3 West and take care of my family.”

New Dimension

For Dunn, being involved in the virtual nursing program has strengthened his commitment to UVA Health and our mission, and his connection to patient care. “UVA Health has always sought to provide the right care, at the right time, at the right place. Virtual nursing adds a whole new dimension to that mission through timely, effective, and high quality care that allows inpatients to be discharged earlier, while providing a more comprehensive discharge experience."

"It is a huge sense of accomplishment to see virtual nursing get off the ground and have such a significant impact on many patients and nurses. I know that even as a member of Health Information Technology, I have impacted patient care — and that feels really good!”

Strengthening Our Foundation

Gauriloff says the success of the pilot has far surpassed expectations and she's looking ahead. “Scott has done a beautiful job networking with Duke University and other facilities,” she says. “Although we started behind many of them, we're actually farther down the road than many other organizations because of the support we have from leadership and IT, and the fact that we have three experienced nurses who are able to dedicate their time to this.”

Once the pilot is complete and learnings are incorporated into the program, the virtual nursing team hopes to expand to other areas of the hospital and take on other responsibilities beyond discharges. Although the team hasn’t finalized the details of how they’ll grow, one thing is certain: bedside nurses will remain at the center of it all.

“As we look to expand, we're soliciting feedback directly from our nurses,” says Greiling. “We’re asking them what they want to see next, taking their concerns into consideration, and making adjustments to the program as needed.”