Discharging Patients Using Virtual Nursing: A Quality Improvement Pilot on an Acute Care Inpatient Unit

As the need for new, innovative nurse care models grows, a virtual nurse (VN) pilot was initiated to better support bedside nurses and improve patient throughput as a quality improvement initiative. This project evaluated the feasibility and impact of a VN pilot on patient progression, nurse helpfulness, and discharge times on a 26-bed adult general medicine unit at a large academic medical center.

Virtual nursing utilizes telehealth technology to support inpatient nursing. Institutions who have implemented care models that use VNs as part of the care team have reported improved patient experience scores, patient discharge times, and nurse mentorship. One way to optimize technology in the transition from hospital to home is by incorporating a VN into the care team. VNs bolster the discharge process by conducting discharge planning sessions and providing patient and caregiver education on post-discharge care instructions, allowing patient questions and concerns to be promptly addressed.

VNs delivered discharge education from a remote location within the hospital, providing eight-hour day-shift coverage, Monday through Friday. Three front-line nurses from the pilot unit were tasked with initiating this project along with a telehealth engineer and a public health statistician. Each bedside was equipped with a Cisco room kit mini initially deployed for isolation communication management (ISOCOMM) during the COVID-19 pandemic. These devices connect to a long-standing and existing infrastructure operated by telemedicine. The VN reviewed and reconciled the discharge instructions with the primary medical team, reviewed the discharge paperwork with the patient, coordinated transportation home, and completed nursing discharge documentation. Total discharge time was collected for each patient. This metric was compared to patients who had been cared for on this unit in the three months prior to the pilot and patients who were not discharged by a VN (synchronous controls). Additionally, a survey was created for nurses to rate the helpfulness of their experience utilizing a VN to conduct the discharge.

Over five months, 117 patients were virtually discharged, compared to the 164 patients in the pre-intervention group, and 112 synchronous controls. The mean discharge times, defined as the time the discharge order was placed to the time the patient left the unit, were 2 hours 25 minutes, 2 hours 29 minutes, and 2 hours 30 minutes respectively. Statistical analysis (ANOVA and Kruskal-Wallis tests) found no significant differences either in mean or median times. However, the median time virtual nurses spent on each patient discharge was 45 minutes, representing time the given back to the primary nurse to focus care on other patients. Of the 24 surveys completed, 91% of nurses reported VN discharge as “very helpful.”

This pilot established feasibility and helpfulness of a VN discharge program on our acute care inpatient medicine unit. Longer-term patient outcomes, such as readmissions within 90 days, ED visits within 30 days, and adherence to follow-up outpatient appointments, are currently being tracked. Although total discharge time was not significantly different, helpfulness reported by inpatient nurses support the continuation of this pilot. Our task force is currently developing the next phases.