S1E19: Clinical Staffing – Pt Ratio & Documentation Burden (ft. Ginny Torno, Houston Methodist)

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Torno, Ginny L.
Great question. So at the beginning, you know, we realized that there’s a nationwide nursing shortage. You know, as well as physicians as well. And so you know, at first the traditional methods of fixing that were tried offering retention bonuses, raises, bringing in travel nurses, but that might work for a short period of time. But it was quickly realized that that is not a long term solution. And so instead of hoping that we’ll magically give more nurses than anybody else.

0:1:25.690 –> 0:1:57.400
Torno, Ginny L.
Uh, you know, a decision was made to see how we can make our existing stopping levels of, you know, work work better and more and more efficiently and, you know, make sure that we meet the needs of our patients. So a, it started with a meeting at night with a lot of our main campus leaders. What can we do quickly to really help relieve the burden on our nursing staff and make sure we take care of our patients. And so it initially started with expansion of an existing technology that we have.

0:1:57.690 –> 0:2:7.600
Torno, Ginny L.
That allows us to do a virtual nursing on the inpatient side. It was previously used for outpatient things in our virtual ICU.

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Jordan Cooper
Mm-hmm.

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Torno, Ginny L.
But we figured out a way to roll that out pretty quickly with iPads. While we figured out a longer term solution, which is what is what you were referencing at the beginning of this. So what we’re doing now is we’re partnering with Kerrii to develop two different camera solutions. One is a two way camera that will be placed in rooms and used for to start virtual nursing. But ideally we could use it for anything spiritual care.

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Torno, Ginny L.
Ohh, bringing family members in to see how the patients doing and participate in care activities et cetera. So that and then we also have another camera going up in the rooms that’s more of an ambient monitoring technology and what it does for us is it learns the patient room and then from there it can monitor things that are abnormal. So things like if the patient is a fall risk, it can alert.

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Torno, Ginny L.
Uh, you know, alert our staff that the patients trying to get out of bed and might hurt themselves, it can alert things like incontinence. It can, but it also can do quality metrics for us such as our hourly rounding, hand hygiene, making sure that our staff is doing what we expect them to do to take care of our patients. So those are two technologies that we’re working on that we really believe will really transform inpatient care for both our patients.

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Jordan Cooper
Yeah.

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Torno, Ginny L.
And our clinical staff and then you, we’re also partnering with Bio Intellisense for a biosensor that will be placed on each patient. It’s like a sticker that goes right above their heart.

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Jordan Cooper
Mm-hmm.

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Torno, Ginny L.
And that can stream vitals about 20 different vitals can be collected from that device and monitored centrally, and then also has the capability to alert our bedside teams if there’s, you know, a trend that looks concerning with the patient. But really the main reason that we’re going after that is to eliminate the need for nurses to round on patients in the middle of the night, the Q4 vitals, things like that. So instead of waking the patient up.

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Jordan Cooper
I.

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Torno, Ginny L.
To do something that can be captured with this device, we can just monitor it centrally and increase both patient satisfaction and relieve the burden on our nursing team. Think the last thing you asked was, have we seen it impact our staffing levels? Right now we’re we’re working on these. So we don’t have them out in production quite yet, but there’s definitely a lot of discussion going on and excitement about implementing some of these and making sure we do it the right way.

0:4:49.790 –> 0:5:20.480
Jordan Cooper
So I think many of the listeners of this podcast are dealing with staffing challenges themselves and are also looking at virtual care and trying to improve their quality metrics. So I see that this message may resonate with a lot of our listeners and they may be thinking, well, what exactly went on that night and that meeting and how did you come to this decision versus other sort of interventions? What were some of the acute challenges that were?

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Jordan Cooper
We driving a nursing attrition and how and and to what was it was it for example that they found that they didn’t want to do rounds in the middle of the night or you you wanted to have one nurse monitor 20 patient beds instead of needing 5 nurses to do it or you know was that they wanted to have improved patient experience or they didn’t like interrupting patients in the middle of the night. So could you give us more insight perhaps even with an anecdote about that particular night when you were?

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Jordan Cooper
Determining what paths forward you would take in order to address staffing challenges at Houston Methodist.

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Torno, Ginny L.
Sure. So some of the main things that that were being noticed was for one, either nurses were having to pick up more patients, you know, on their staff than we would like on the round than we would like or they were being asked to pick up additional shifts just because there weren’t enough people to cover. So there were being burned out. And so in addition to that, the level of documentation that they need to complete would cause them to spend an hour or two hours after each shift.

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Torno, Ginny L.
Uh, you know, staying late to make sure all their documentation was done. So put all that together, you know, that’s just a recipe for.

0:6:36.300 –> 0:7:1.130
Torno, Ginny L.
You know people eventually giving up on that. So we’re really focusing on, you know, what are some ways that we can reduce documentation burden, which is where some of our voice exploration is coming in. And then in some ways that we can reduce the ratio of patients that they’re being asked to take care of at a certain time, which is where some of this remote monitoring technology comes into play.

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Torno, Ginny L.
Umm. As far as what you know, what happened that night? It was basically, you know, hey, we all know we have this problem. We can’t just keep.

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Torno, Ginny L.
Uh, you know, continuing on and and you know, with things that aren’t that aren’t working for us. So let’s come up with something during this meeting and then operationalize in two weeks.

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Jordan Cooper
Wow.

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Torno, Ginny L.
So that that quickly led the group to say, well, OK, to do something in two weeks, we need to start with something we already have. So what do we already have?

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Torno, Ginny L.
Ohh and so you know, we already had some remote technology in place for our virtual ICU. That’s probably the main one and some Telus sitting applications so quickly just went through which which of those could we try to expand and you know and help with some of these use cases and then what do we want to tackle with those and So what came up as what could be done with the virtual nurse, obviously not everything but.

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Torno, Ginny L.
So we came up with admissions and discharges so.

0:8:6.120 –> 0:8:36.130
Torno, Ginny L.
That’s what we’re doing right now with our both our existing technology that we have expanded and the new technology we’re working on with our partners. So really tackling those two use cases and it’s rapidly expanding across our different hospitals and very quickly it’s very clear with the patients of from what we’ve seen on H caps and our own surveys as well and from our other internal departments that it’s, it’s really been a success, I mean everything.

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Torno, Ginny L.
Uh patient feels like they have dedicated attention and then our internal groups feel like they have much better information, you know, during the course of the patients stay because there’s someone that’s can sit there and complete everything instead of being interrupted constantly for everything else they’re being asked to do so seems so very quick. Success.

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Jordan Cooper
And operationally.

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Jordan Cooper
How have how has it integration gone between nurses? It sounds like in call centers off site with the integration of care provided by on site nurses.

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Torno, Ginny L.
So we’ve been lucky at the beginning. We started with nurses that previously worked for Houston Methodist and we were able to recruit them back. So they were already very familiar with our environment and then going forward, there’s a plan to rotate nurses between being a virtual nurse and a bedside nurse. So that way they have experiences with both sides of the house or both sides of care, and they don’t lose touch one way or the other as far as what the other side of the camera is dealing with.

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Jordan Cooper
Got it. So mixed training with your staff and then kind of leveraging some people who may have left already who may be willing to do a different sort of role.

0:9:53.820 –> 0:10:24.320
Jordan Cooper
So, OK, you did mention that the first you said there were two main issues that were driving burnout. One was just two, the the ratio of patients to staff was too high and the second was a documentation burden, Annette. Note I wanna shift our conversation to voice technology now for a listener is Houston Methodist has brought voice technology, impatient exam rooms and operating rooms, developing an ambient listening tool for physicians and clinics in partnership with AWS.

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Jordan Cooper
This tool, still in its pilot phase at Houston Methodist, uses NLP to capture billing and clinical documentation. That’s natural language processing pertaining to the procedure or appointment, and then populating the Houston Methodist EHR with this data. So Jenny, I’d like to ask you if you could share the origination story for this technology.

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Torno, Ginny L.
I’d be happy too, so I was actually, uh, not part of the group when it first came about. But I do know how it started and it was really along similar lines. But on the physician side of how can we?

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Torno, Ginny L.
Ohh, get them away from the keyboard and really be able to focus on interacting with the patient and providing you know higher level of patient care and then taking some of that administrative burden off of our positions. So conversations, we’re starting with AWS who’s a very strong partner of ours.

0:11:15.100 –> 0:11:33.350
Torno, Ginny L.
You know on can we just develop a tool and you know and try to solve this problem at that time there weren’t really, there wasn’t really anything in the market to to solve that. So a development partner was selected and it’s really an impressive tool. It went through multiple phases of testing and.

0:11:34.350 –> 0:12:3.660
Torno, Ginny L.
You know, tweaking and all of that, but right now we really have a strong product that’s deployed across several of our clinics and it really is, I mean you initiate the conversation and then you can watch the tool record what it’s going to capture at the end, it presents everything in a note and there’s an opportunity to make any edits if needed and then it can send directly to epic. It’s real time at this point. There are some tools in the market that.

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Torno, Ginny L.
Uh do capture voice, but they’re a little delayed several hours up to even a couple of days. This tool is real time, and so we’re pretty excited about it.

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Jordan Cooper
Yeah. So you say that you have a development partner again, I’m keeping in mind our audience who may be interested in potentially deploying this technology in their own institution. So when you see development partner, is that a software development house that’s independent that’s contracted to work with both Houston Methodist and AWS?

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Torno, Ginny L.
Correct. We did not have that expertise in House. So we we engaged a third party development company.

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Jordan Cooper
Got it. And is this a product that is productized under AWS marketplace that could be purchased by another organization or is this proprietary Houston Methodist?

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Torno, Ginny L.
Right now it’s proprietary to Houston Methodist, but we are exploring options, you know, to broaden its use.

0:13:0.200 –> 0:13:18.790
Jordan Cooper
OK, so if so, if a CIO is listening to this episode and says, well, that’s interesting, you know, provide documentation, burdens are huge problem at orange situation as well. How would you advise them to go about exploring how to ameliorate that burden?

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Torno, Ginny L.
At first I would see if they have anything you know in their portfolio that might be able to fit that need. The voice is getting more and more integrated into everything at this point, but if not then it’s a really an analysis of is there anything in the market that can fit what we’re looking for at a, you know, at a price point and support level that that we’re looking for or do we need to look you know at developing our own solution. And so at the time we were at that crossroads developing our own solution was was a choice.

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Jordan Cooper
And what sort of what’s been the adoption?

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Jordan Cooper
Attitudes, behaviors. Has there been any pushback from clinicians about using this voice technology, especially older clinicians who may be are are you finding that they’re enthusiastically embracing this technology, or are they perhaps reluctant to do so or they’re different cohorts of different types of providers that have different reactions to this new technology?

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Torno, Ginny L.
That’s a great question. And what right now we have it piloted with positions who volunteered to be part of the pilot. So you know, definitely they’re on board. And all of that. But yeah, we’re what you say is a great point that there’s definitely an awareness that not everybody’s gonna want change at all. They might just want to keep doing what they’re doing. So as we make a decision of how to further expand this tool, I would definitely would expect some, you know change management conversations and planning.

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Torno, Ginny L.
And really, a decision on the organizations point is this going to be an optional tool or is something that we’re going to try to require?

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Jordan Cooper
And how did you select the initial volunteer physicians who agreed to be on the pilot? Did you target certain people or just open it up to any physician in an e-mail and they just saw self selected?

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Torno, Ginny L.
That’s a great question. I you know, I was, I was not unfortunately on the team during that point. But I know there are some physicians across the organization that are already, you know, part of our pilot groups for any type of innovative technology. So that was definitely part of it. And then from there it was, you know, pinging different physicians that they thought might be on board to do it. So.

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Jordan Cooper
Mm-hmm.

0:15:36.400 –> 0:15:36.960
Jordan Cooper
So.

0:15:38.390 –> 0:16:7.140
Jordan Cooper
I guess we’re on the topic today of how to address I guess, provider burnout and and we spoke about care redesign, which is designed to reduce the staffing to patient ratio. And we’ve spoken about voice technology to try to reduce documentation burden of providers. What would you say is the strategic vision for the organization going forward to address their staffing challenges?

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Jordan Cooper
It sounds like both care redesign and voice technology are still in the in in a place where they’re being rolled out across the organization but are not yet fully deployed in every aspect of the organization. Have there been any other programs you’ve tried and piloted and decided to discontinue? Are there any other programs that are a great Plan B or phase two that you’ve discussed rolling out once care redesign and voice technology are more fully developed?

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Jordan Cooper
Ohh what? You know what? What? What is the recipe that you’ve been identifying as potentially a most successful at retaining staff and attracting new staff?

0:16:51.60 –> 0:17:21.840
Torno, Ginny L.
That’s uh, that’s a great question. Uh. So I think as far as other things that we’ve tried, I’ll just quickly mention that we we piloted another voice technology in our operating rooms to really take again try to take a burden off staff in the room from having to document everything in the OR and instead have the surgeon be able to say, you know, incision started different commands like that though would update our electronic health record system. That was a custom developed tool.

0:17:21.940 –> 0:17:52.530
Torno, Ginny L.
And it was. It was pretty difficult to get that one to work. So for now, we have paused that one and we’ll make a final decision on that one later. As far as other things that we plan to do, we actually have a smart hospital that we’re building on the North West side of Houston and that hospital, you know, we’ve already planned a lot of new technology in there that we don’t already have at our other institutions. A lot of voice for sure. And of course, you know the buzzword AI, but really.

0:17:53.50 –> 0:18:23.680
Torno, Ginny L.
We’re looking at several technologies to provide conversational AI tools for our patients. So smart, smart technology that they can interact with to ask anything from, you know, when’s my next appointment to, you know, what medication should I take for this? What are these symptoms mean? For me, things like that. That should both help our patients get quick answers and reduce the burden on our staff from asking questions that they could.

0:18:24.100 –> 0:18:54.90
Torno, Ginny L.
Potentially find other ways we’re also thinking about technology that will allow patients to request things that doesn’t necessarily need a nurse to solve it. For example, you know, I just need some water or ice being able to request that and have that go to someone that can really operate at that level and keep the nurses operating at the top of their license and our position. So definitely looking at more voice technology and conversational AI.

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Torno, Ginny L.
As as part of that.

0:18:57.240 –> 0:19:10.810
Jordan Cooper
Thank you, Ginny. We are approaching the end of this podcast episode, so I’d like to offer you the opportunity to perhaps offer a final word of advice to our listeners who may be dealing with staffing challenges at their own institutions.

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Torno, Ginny L.
But I would say, and what I’ve learned, especially talking to other organizations, is being able to implement and try some of these innovative technologies to to help in these areas really starts from the top down. We have great support from our executive leadership to, you know, to work on these and and use technology to solve these problems. And so that’s where I would start if that’s not currently, you know, part of the organization and make sure that there there’s that support because you know it’s.

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Torno, Ginny L.
It’s needed to to do some of this groundbreaking work.

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Jordan Cooper
Well, thank you. This has been a Ginny Torno, administrative director and innovation and IT clinical ancillary in research systems at Houston Methodist who has spoken to us today about various different technologies that Houston Methodist has been leveraging in order to address the challenges associated with frontline staffing. So, Ginny, I’d like to thank you for joining us today.

0:20:11.730 –> 0:20:12.480
Torno, Ginny L.
Thank you, Jordan.

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