Saint Luke's Gives Nurses Their Own Virtual Care Unit

The Kansas City-based health system has opened an inpatient virtual nursing unit that is managed almost entirely by nurses, and is fielding calls from health systems across the country interested in the concept.

A Kansas City–based health system is putting nurses at the center of the virtual care platform and seeing positive results not only in patient and nurse satisfaction, but clinical and business outcomes as well.

Saint Luke's Health System opened its virtual nursing unit in 2018. Launched by Susie Krug, chief nursing officer at Saint Luke's East Hospital in Lee's Summit, Missouri, the unit sits on a telemedicine platform built by Teladoc Health and managed by nurses at the health system’s technology center in downtown Kansas City.

"It's a new model of care," says Jennifer Ball, the health system's director of virtual care. "It's there to [help] the nurses as well as the patients, with a focus on virtual care. Virtual everything is going to be our future."

Saint Luke's isn't new to the telehealth bandwagon. The health system, which earned Digital Health Most Wired recognition in 2021 from the College of Healthcare Information Management Executives (CHIME), has been using digital health tools and platforms, ranging from virtual visits to an eICU program, for close to two decades. But the virtual nursing unit is a relatively new idea, in use in only a handful of health systems around the country.

Jennifer Ball, director of virtual care at Saint Luke's Health System. Photo courtesy Saint Luke's.

It was designed, Ball says, with the idea that nurses are often the focal point of care in the inpatient wings, handling different tasks in between and around rounds and visits made by doctors and specialists. Nurses have the most contact with patients and their families, handle the administrative and educational tasks, manage bedside devices and data-gathering, even lend a hand with everything from the meals to the TV, she says.

That kind of work is why nurses have been rated the most trusted profession for 20 straight years by Gallup, but it's also why so many are dealing with stress, anxiety and burnout—and why health systems are having a difficult time filling those positions. Add in the challenges of protecting both patients and care providers during a pandemic, and the job becomes tougher.

Due in part to the shift to virtual care caused by COVID-19, many health systems are rethinking how that strategy can be scaled and sustained beyond the pandemic—not only outside the hospital but inside as well.

Saint Luke's virtual nursing unit operates on the idea that many of the tasks performed by nurses in the inpatient setting not only are repetitive but inefficient, and that a telemedicine platform that connects every room in the unit can allow nurses to manage those tasks from one place. Nurses and staff on the unit would then be freed up to focus on patient-facing care, while those in the command center would monitor the patients and enter data in the medical record.

"They chart in the same system," Ball points out, "so everything is right in" the EMR.

Early results show positive outcomes for the virtual unit. Patient satisfaction is high, and patients are discharged within two hours of the discharge order, some 20% faster than in other units, and they're also out of the hospital before noon at a 44% faster rate. This, in turn, reduces the wait time for patients in the ED and reduces the time to treatment.

Turning those metrics around, health system officials say the unit has boosted nurse morale as well, improving workforce engagement, reducing fatigue (physical and intellectual) and even improving Saint Luke's recruitment capabilities.

Ball says the health system learned quickly that a virtual nursing unit is different from any other virtual care program. Workflows must be designed specifically with nursing in mind, and often go through a few iterations before working out.

"We've changed what the virtual nurse does several times," she says. "It was challenging at first because this is a new model, and we had to learn what works and what doesn't work. And while this is [modeled] as an observation unit, it has been anything but that over the past year. "

Ball says Saint Luke's had the advantage of launching the program in a new, specially designed unit, rather than integrating it into an existing wing. She expects to integrate virtual nursing to other wings in the future, and to deal with new challenges as they expand the footprint.

"There will be some culture change involved," she says.

For that reason, Saint Luke's launched its own virtual nurses training program about a year ago, with the idea that nurses should be trained specifically in virtual care rather than brought over from another area of the hospital and introduced to it. With virtual care the emphasis is more on technology, as well as on communication. After all, sitting in a command center surrounded by six large monitors isn't quite what nurses are taught to expect in school.

"For some of the nurses, it's a lot, but for others not so much," Ball says.

And that's why education and team-building are so important to the program. Unlike many doctors, nurses work in a team setting, with the understanding that care coordination and management are group-based rather than individual goals.

"You need buy-in from nurses at the beginning," Ball says. "You can't start too early with education … and team building. In some cases, you have to sell what a virtual nurse can do," but once they see what is possible, they're invested in the program.

That goes for the patients as well. Many might wonder whether a virtual nursing unit isolates patients too much, depriving them of the in-person care that helps them adjust to being in a hospital and puts them on the path to recovery. But Ball says patients have come to appreciate the idea that they're always being looked after, and they develop connections to their virtual nurses. They identify more closely with those nurses than with the nurse who shows up when someone pushes the help button.

Just as Saint Luke's checked in on Ochsner Health's virtual nursing model as it was developing its program, Ball says she's fielding requests from other health systems who want to adopt that strategy. And she has an eye to the future as well, including integrating the virtual nursing model into existing wings and hospitals in the system.

"There's always new technology as well," she says, eyeing the fast-developing telemedicine landscape and the emergence of digital health tools, including wearables. "This [model] is going to be used in new ways in the future," such as mentoring and precepting, and integrated with other services such as the pharmacy, social workers, dietitians, and chronic care management.