Virtual Patient Companions Keep 24/7 Eyes on Patients

To improve clinical safety and combat the challenges posed by national healthcare staffing shortages, Cleveland Clinic is using virtual technology to augment patient care. Developed by the Office of Nursing Informatics, the institution’s new virtual patient companion (VPC) program enables remote, around-the-clock observation of at-risk patients by specially trained caregivers.

By providing an “extra pair of eyes,” the initiative is already helping to address staffing shortages and reducing the amount of time nurses are needed at the bedside, says Erin Losey, Nursing Informatics Specialist Lead for Cleveland Clinic’s Office of Nursing Informatics.

“Our goal was to expand access to patient companions so our nursing staff can tend to other tasks,” she says. “The technology has proved to be particularly ideal for monitoring patients who are impulsive, forgetful or at increased risk of falling.”

A true team effort

The program relies on the support and expertise of remote caregivers who monitor hospitals and free-standing emergency departments across northeast Ohio and the Cleveland Clinic Florida Region. Using strategically placed, transportable cameras, each VPC can visualize multiple rooms at a time. The cameras also feature a microphone and built-in, two-way speakers that enable real-time communication between the VPC and anyone in the patient’s room.

Virtual companions can also use the technology, which is integrated into the electronic medical record, to document patient redirections, escalations, notifications and status changes; add supplemental information; and view activity reports, trends and more. A customized dashboard offers an overview of the entire VPC department, including the number of patients waiting for assignment, VPC distributions and camera use.

Working off-site from centralized hubs, the remote caregivers have already become vital, trusted members of the care team, says Losey. “Our VPCs are well equipped to provide the same level of support as someone sitting by the patient’s bedside,” she adds. “They are attentive, responsible and highly attuned to patient safety and privacy needs.”

The workflow of the virtual caregiver reflects that of an in-person companion, explains Mercedez Avsec, RN, an assistant nurse manager on the medical-surgical telemetry floor at Cleveland Clinic Martin Health’s Tradition Hospital. If a patient’s behavior warrants an intervention, the VPC can verbally redirect them. If redirection is unsuccessful, the remote caregivers can notify the patient’s nurse by triggering an alarm on the camera.

Avsec notes that the additional safeguards provided by the VPCs have already “improved productivity and morale on our unit.”

Extending care

Stressing the essential role that communication plays in the program’s success, Avsec says, “It’s so important to talk openly with patients and their families about how the technology is being used to support their care. Patients will often ask why they’re being watched by a camera, and it’s critical for nurses to address those privacy concerns by emphasizing how the VPC can help keep them safe. It’s also important to explain that the camera can be turned off when privacy is needed.”

Cleveland Clinic’s VPC program was built with specialized tools that are custom tailored to the clinical decision-making needs of the health system and its nursing team. The intake form, for example, allows caregivers to see if – and why – a patient was enrolled in the program at any time during their current admission and review criteria that could exclude them from virtual monitoring.

Caregivers can also prioritize patients who are in greatest need of continuous monitoring, thanks to a system developed by the institution’s VPC leaders and nursing quality and operations experts. Prioritization is based on each individual’s fall risk, delirium screening scores, psychosocial and neurocognitive assessments, and the use of special precautions like isolation and nonviolent restraints. Additional factors, including drug or alcohol withdrawal, confusion and general safety concerns, may also influence how a patient is prioritized.

Practice, practice, practice

Above all, Losey emphasizes the importance of caregiver training to the success of any VPC program. “Hospitals and healthcare systems that are interested in creating a program like ours should have a strong training protocol in place to ensure that staff understand what VPCs can – and can’t – do,” she says. “It’s important to note that this technology enables hospitals to provide their patients with better access to their caregivers. It’s an investment that directly and positively affects nursing units, staff and patients.”

The policies and tools Losey and her team developed to train nursing staff include an informational packet on patient qualifications and a VPC training video. “We introduced the program to our nursing units through live, hands-on ‘roadshows’ that gave caregivers several days to get familiar with the technology,” she explains, noting that VPCs are available in Cleveland Clinic’s emergency departments and inpatient units. “Spending time at each site also gave our training team the opportunity to outline expectations and explain how the program works.”

On-site network testing is equally vital, Losey notes. “Virtual companion programs require cameras to run continuously, so a poor network connection can affect patient safety by leading to a lapse in monitoring,” she says. “Extensive on-site network testing is imperative.”

When developing and introducing a VPC program, she also encourages hospitals to engage their nursing leaders. “The benefits of virtual monitoring are tremendous, and leaders are far more likely to support and promote the model if they are involved in the process from the beginning,” she adds.