Novel nurse-driven virtual care model supports nursing home residents and nurses who care for them

A pilot study presents a novel nurse-driven virtual care model based on an in-person model developed by Regenstrief Institute research scientists and colleagues to support care delivery to long-term nursing home residents. Virtual clinical care is growing in importance as both the nursing home resident population and workforce shortage grow.

While many nursing homes in the U.S. have implemented telehealth for various purposes including engaging residents' families in care planning sessions, discussing palliative care or facilitating physician coverage of residents during nights and weekends, virtual care has not been routinely applied to enhance or support resident care by nursing home staff.

"There are many aspects to providing clinical care in the nursing home setting and many tasks that are needed to safely care for residents are behind a computer," said study co-author Kathleen T. Unroe, M.D., MHA, of Regenstrief Institute and Indiana University School of Medicine. "The goal of this study was to look carefully at what kind of clinical support well-trained nurses with nursing home experience, who have access to residents' electronic medical records, can provide virtually to support clinical care in the facility."

The nurses in this pilot program virtually reviewed the electronic medical records of residents transferred to the facility. They checked, for example, for changes in medications or dosage adjustments made during a hospital stay that might have been missed during the admission process.

"There are many times when nurses providing virtual clinical oversight can be helpful in acquiring information and filling workforce gaps," said Dr. Unroe.

"In addition to medication monitoring, if, for example, the discharge summary from the hospital notes a wound, the appearance and condition of the wound as well as care orders need to be clearly documented upon admission to the nursing home. If this information is not in the long-term care facility's system right away, it can lead to problems later that could result in poor communication among clinical providers and potentially another hospitalization."

Nurses piloting the virtual application of the highly successful OPTIMISTIC care model were interviewed for the new study to learn their perceptions of the virtually delivered variation.

OPTIMISTIC, an acronym for Optimizing Patient Transfers, Impacting Medical quality and Improving Symptoms: Transforming Institutional Care, was developed to improve care and communication within nursing facilities and between nursing homes and acute care institutions enabling problems to be caught and dealt with before transport of a resident to the hospital becomes necessary.

OPTIMISTIC reduced potentially avoidable hospitalizations of nursing home residents by 33 percent and overall hospitalizations of nursing home residents by 20 percent.

Long-stay nursing home residents typically have high rates of multiple chronic illnesses including dementia. Hospitalizations and re-hospitalizations significantly increase the likelihood of reduced functioning and overall negative impact on their health.

Nurses in the pilot study of virtual clinical care support cited importance of:

• a trusted relationship between the nurses providing virtual care support and the nursing home leadership/clinical staff;
• customizing the program to meet the unique needs of each nursing home; and
• consistent access to complete medical records to make timely recommendations specific to residents' most current health status.

"Problems with transitions of care and concerns about clinical care in nursing homes are national issues," said Dr. Unroe. "The findings of this paper are relevant to developing point-of-care models that can support the care of residents all over the country."

"Perceptions of Nurses Delivering Nursing Home Virtual Care Support: A Qualitative Pilot Study" is published in Gerontology and Geriatric Medicine.

The authors note that this study has potential implications for nursing home residents and their families, nursing home staff and administrators, long-term care industry leaders, policymakers, as well as providers of telehealth services.