UMass Memorial Health is the largest health system in Central Massachusetts and the clinical partner of UMass Chan Medical School. UMass Memorial is the only adult Level I Trauma Center and Level III Neonatal ICU in Central Massachusetts.

The health system's experienced caregivers include experts in behavioral health, cancer, cardiology, children and women's services, heart and vascular care, neurology, pulmonology and surgery.

THE PROBLEM

For years, UMass Memorial Health has leveraged technology as a means of augmenting in-person care at the bedside. Launched in 2006, its tele-ICU program remotely monitors more than 150 adult critical care beds across Central Massachusetts.

With the experience gained and quality outcomes demonstrated, the health system decided to take a similar approach in lower-acuity care settings that still required direct, continuous observation of at-risk patients.

"Like many other health systems, the need to control operating costs while at the same time improving patient safety was a challenge for our leadership team," said David Smith, associate vice president of virtual medicine at UMass Memorial Health. "The concept of a 'virtual sitter' program was considered several times as a way to reduce the inefficient and costly demand for one-on-one patient observation while preserving our commitment to patient safety.

"But we struggled to find an affordable solution at a scale that met our needs at the time," he continued. "It wasn't until COVID-19 emerged that we learned how effectively we could deliver high-quality virtual care to the bedside without the sophistication and complexity of a tele-ICU program."

This compelled the decision to move forward with a remote observation technology that could deliver the same level of care as an in-person sitter, but with a much higher return on investment, he added.

PROPOSAL

UMass Memorial already had selected Caregility as its video integration vendor to advance the health system's aging fleet of ICU cameras. That effort was well underway when COVID-19 struck.

"Suddenly we were faced with an imperative need to limit exposure to a deadly virus that we didn't yet understand," Smith said. "Telehealth quickly became a prominent means of contact precaution across our inpatient care settings.

"With everyone scrambling for mobile video solutions, Caregility rose to the challenge and equipped us with one hundred of their new APS250 mobile telehealth carts," he continued. "The carts were immediately deployed in every COVID surge unit and our field hospital."

"Remote monitoring has proven to be an effective strategy for augmenting care at the bedside or in the home."

David Smith, UMass Memorial Health

As the surge subsided, the health system began looking for innovative ways to capitalize on the rapid expansion of telehealth and repurpose those investments. With the hospitals still requiring full personal protective equipment, it presented a timely opportunity to reintroduce the concept of virtual observation.

"As chance would have it, Caregility offered a cost-effective solution in their iObserver platform," Smith noted. "iObserver allows a remote care team to monitor up to 12 patients per screen, with two-way audio/video support, night vision and rapid-response bedside alerts.

"In September 2020, the IT team partnered with nursing leadership and Caregility to launch a pilot for virtual observation to prove its effectiveness," he continued. "Labor-pool cost savings, staff efficiency and patient safety were the primary focus."

MARKETPLACE

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MEETING THE CHALLENGE

Unlike many other telehealth platforms, iObserver is designed for the sole purpose of remote patient observation.

"That means the features and functionality one would expect are inherent in the user interface," Smith explained. "The system can operate as a standalone, so no integration is required to get up and running. And the ability to retrofit our existing Caregility carts with IR sensors for night vision made it an ideal solution that could scale rapidly.

"For the pilot, we started with a hybrid hub-and-spoke model by having the remote observation hub embedded in one of our observation units," he continued. "This provided localized coverage in the event of a technology glitch, and it allowed us to optimize system performance and workflows in real time."

Staff initially started with a three-to-one patient ratio and gradually increased to six-to-one, ultimately with an additional six patients monitored as backup for another virtual sitter.

"Within several months, the pilot was deemed a success and the program went live at three hospital campuses," Smith reported. "Within that same year, we expanded our team to meet the growing number of remote observations, and we now are planning a state-of-the-art 'digital hub' to accommodate the virtual sitter program and several others like tele-ICU.

"With upwards of 50 in-person observations on any given day, our goal is to maximize our workforce through the use of remote patient monitoring," he added.

RESULTS

With some initial skepticism, the nursing informatics team and nursing leadership worked alongside IT and Caregility to deliver a new care model for UMass Memorial that drives efficiency, cost savings and patient safety, Smith said. It now is embedded in the standard of care that patients expect and deserve, and the health system continues to look for additional growth opportunities, he added.

"One such opportunity is to address the staffing needs at our community hospitals," he explained. "With a national labor shortage in healthcare, it is vital that we utilize our limited resources in the most efficient and cost-effective way possible.

"Remote patient monitoring allows for centralized management of large patient populations with far fewer resources than would be required for direct, one-on-one observation," he continued. "Much like our tele-ICU outcomes, we have shown that virtual sitting is as effective as in-person care."

In the first year of operation, the remote team logged more than 100,000 interventions through the iObserver system. This included direct patient engagement through the use of audio or two-way audio/video interaction, and alerting the bedside team to potential adverse events such as getting out of bed, tugging at lines and agitation.

This let staff maintain patient safety while at the same time reducing labor-pool costs.

"Perhaps the best measure of success is how dependent our clinical teams are on system performance and reliability," Smith observed. "And Caregility has been an excellent partner in that regard."

ADVICE FOR OTHERS

"Remote monitoring has proven to be an effective strategy for augmenting care at the bedside or in the home," Smith advised. "Likewise, a virtual sitter program can enhance quality care while at the same time reduce staffing demands and labor costs. For years our challenge was in finding a solution that could meet the needs of the day – but scale for the future – at a price we could justify.

"In the UMass Memorial experience, success required a willingness to work collaboratively with a vendor that listened to our feedback and offered solutions in the form of enhancements and bug fixes," he continued. "No technology is without its limitations or fail points, so it's important to have operational guardrails in place."

Start small and scale up – encourage advocacy among nursing teams and let them have a strong voice, he advised. Market the benefit to patients and continually measure and share the outcomes with stakeholders, he concluded.

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Email the writer: bsiwicki@himss.org
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