JMIR Publications

ABSTRACT

Background:

The COVID-19 pandemic prompted widespread implementation of telehealth, including in the inpatient setting with the goals to reduce potential pathogen exposure events and personal protective equipment (PPE) utilization. Nursing workflow adaptations in these novel environments is of particular interest given the association between nursing time at the bedside and patient safety. Understanding the frequency and duration of nurse-patient encounters following the introduction of a novel telehealth platform in the context of COVID-19 may therefore provide insight into downstream impacts on patient safety, pathogen exposure, and PPE utilization.

Objective:

To evaluate changes in nursing workflow relative to pre-pandemic levels using real-time locating system (RTLS) following the deployment of inpatient telehealth on a COVID-19 unit.

Methods:

In March 2020, telehealth was installed in patient rooms in a COVID-19 unit and on movable carts in 3 comparison units. Existing RTLS captured nurse movement during 1 pre- and 5 post-pandemic stages (January-December 2020). Change in direct nurse-patient encounters, time spent in patient rooms per encounter, and total time spent with patients per shift relative to baseline were calculated. Generalized linear models assessed difference-in-differences in outcomes between COVID-19 and comparison units. Telehealth adoption was captured and reported at the unit level.

Results:

Change in frequency of encounters and time spent per encounter from baseline differed between the COVID-19 and comparison units at all stages of the pandemic (all P’s<0.0001). Frequency of encounters decreased (difference-in-differences range: -6.6 to -14.1 encounters) and duration of encounters increased (difference-in-differences range: 1.8 to 6.2 minutes) from baseline to a greater extent in the COVID-19 units compared to the comparison units. At most stages of the pandemic, the change in total time nurses spent in patient rooms per patient per shift from baseline did not differ between the COVID-19 and comparison units (p’s>0.17). The primary COVID-19 unit quickly adopted telehealth technology during the observation period, initiating 15,088 encounters that averaged 6.6 minutes (standard deviation = 13.6) each.

Conclusions:

RTLS movement data suggests total nursing time at the bedside remained unchanged following the deployment of inpatient telemedicine in a COVID-19 unit. Compared to other units, frequency of nurse-patient in-person encounters decreased and duration lengthened on a COVID-19 unit, indicating “batched” redistribution of work to maintain total time at bedside relative to pre-pandemic. The simultaneous adoption of telehealth suggests virtual care was a complement to, rather than a replacement for, in-person care. Study limitations, however, cannot casually link movement changes with telehealth, and further evaluation is needed to determine the additive use of telehealth and potential impact on patient outcomes and pathogen exposure.