Sentara Health embraces virtual nursing and AI

Sentara Health has made some ambitious changes in the way nurses deliver care.

Sentara has recently rolled out virtual nursing across all of its hospitals. The health system operates 12 hospitals serving patients in Virginia and part of North Carolina. The system has more than 50 nurses working virtually to help patients with orientation, asking questions, and preparing for discharge.

As part of that effort, Sentara has also launched initiatives using artificial intelligence in some ways, including ambient documentation in virtual nursing. And more AI initiatives are being deployed.

Amber Price, senior vice president and enterprise chief nursing officer of Sentara Health, tells Chief Healthcare Executive® that the efforts are showing encouraging results.

“We wanted to improve our patient experience,” she says. “We wanted a sustainable workflow and care model for our nurses, something that would help us recruit and retain.”

Nurses have played a key role in driving these efforts, and she says that’s been critical to build momentum.

“Our nurses really took a huge interest in helping us develop what the future might look like,” Price says. “And then we developed a set of guiding principles that we could all agree on to execute it. And so that's how we began. And we began with the virtual component, and then slowly the AI component came into that. And everything that we're choosing to use is going to either improve safety, nurse well-being, or patient experience and outcomes.”

• Read more: How hospitals can do better in retaining younger nurses

Engaging nurses

Nurses have been engaged in conversations and have helped influence the implementation of the programs, Price says. She says it was important to recognize that developing virtual nursing and the AI initiatives would be as significant as moving from paper charting to electronic health records.

“It means that people will be uncomfortable,” she says. “And so we decided to start with our nurses. I went straight to the front lines and included them and pulled them in. And I think creating transparency with nurses helps them be the problem solvers, and that creates voice, and that creates alignment and engagement.”

The virtual nursing unit helps handle admissions, patient education, and prepares patients for what they need to know when they are leaving the hospital, including going over medications.

Some nurses expressed apprehension about having nurses in the virtual unit handle those tasks. Price says some nurses said they felt their personal connection in guiding patients at the time they are discharged was a key factor in patient experience.

But Sentara’s data shows patient experience ratings have improved with the virtual nurses.

“We've got more than 70,000 encounters in that data set, and we can prove that when we use virtual nursing anywhere in the care of the patient, we see a significant increase in patient experience,” Price says.

With virtual nursing, she says patient hospital ratings rose 2.9%, with a 2.6% increase in patients saying they’re likely to recommend the hospital.

She adds that it has been the ideal time to test patient experience with virtual nurses and those on the floor handling tasks such as discharge, because there is now a clean comparison.

Price says she has been especially interested in seeing the effectiveness in virtual nurses helping patients prepare for discharge. Nurses in the virtual unit can spend more time answering questions than the nurse on the floor who may be managing other patients. Better education before discharge reduces the risk of a patient returning to the hospital.

“It's where our readmissions are … the people not understanding their medications, or potentially not filling those or getting confused. And so that was a really important metric for me,” she says.

Virtual nurses have also improved access for patients who need translation services, Price says.

Recently, Sentara has also launched “Nurse Connect,” which allows nurses to touch base with a virtual nurse to review a procedure or double-check medication. “That has been very popular, even in this early rollout,” Price says.

The virtual nursing roles can appeal to veteran nurses who have many years of experience but may want a change from being on the floor for long days.

“That has gotten a lot of interest from our nurses,” Price says. “They're realizing that their bodies get a break for that day, that they are the virtual nurse.”

She also sees the potential for hybrid roles, with nurses working virtually some days and on the hospital floor on other days.

• Read more: SSM Health’s Seth Lovell on AI and nursing

Aiming to improve safety

Sentara introduced ambient documentation, which uses AI-powered technology to summarize conversations with patients, in the virtual nursing unit. The system is starting to roll that out at the bedside for nurses on the floor.

The AI-powered documentation tools require some changes in the nursing workflows. Instead of silently filling out charts, nurses are speaking aloud to document what they’re doing with the AI tools. More experienced nurses are enthusiastic, since that aligns with their earlier training of talking through assessments of patients, Price says. It may be an adjustment for some nurses.

“The excitement is there, and our nurses understand that they have to learn how to prompt AI to document, and they're trying to wrap their head around it,” Price says.

Early tests have shown ambient documentation is reducing the time nurses spend on an admission or a discharge by about 15 minutes.

Price says the goal is to give nurses some time they are losing on documentation.

But she says she has stressed to nurses that the goal is not about getting them to care for a higher volume of patients.

“One of the things that I've guaranteed to our nurses is that we will not change our ratios,” Price says. “I am asking for that time back to go to critical thinking, to go to being able to breathe, for your charge nurse to stay out of staffing, and to do the things that create an optimal healing environment for our patients and improve safety and quality.”

Sentara has also rolled out several other AI efforts, including automated hand hygiene audits and tools to document when patients have been turned in bed.

“Everything we're doing in AI and in virtual is to make the day of the patient and the nurse better, so that in return, we drive retention, we drive a care model that's sustainable, and get excitement from our nurses to participate,” Price says.