Impacts of an Acute Care Telenursing Program on Discharge, Patient Experience, and Nursing Experience: Retrospective Cohort Comparison Study (Preprint)

Abstract

Despite the widespread growth of televisits and telemedicine, it is presently unclear whether or how telenursing could be applied to augment nurse labor and support nursing practice in the acute care setting.

This study evaluated the outcomes associated with a large-scale acute care telenurse (ACTN) program to support virtual admission and discharge processes for hospitalized patients.

This study was conducted in a large academic hospital system (approximately 2100 beds) in Houston, Texas. A retrospective, observational cohort comparison was performed comparing all patients within our pilot units for the ACTN program (telenursing cohort) between June 15, 2022, and December 31, 2022, with all patients who did not participate (non-telenursing cohort) on the same units in the same timeframe; we employed a case mix index (CMI) analysis to confirm comparable patient cases (demographics, acuity and severity) between groups. The outcomes investigated were: (1) patient experience, measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey; (2) nursing experience, using an online questionnaire with both quantified multiple choice and qualitative open-ended questions; (3) time of day discharge (from electronic health record data); and (4) length of time for discharge education processes (also from operational data).

CMI analysis found that case differences between cohorts were not significant (P=.75). For the first 4 units that rolled out in Phase 1, all units experienced improvement in at least 4 and up to 7 HCAHPS domain. Out of the 289 nurses who were invited to participate in the survey, 106 nurses completed the nursing experience survey (37% response rate). Of the 106, 101 (95%) indicated that the ACTN program was “very helpful” or “somewhat helpful” to them as bedside nurses. The only noticeable difference between the telenursing cohort and non-telenursing cohort for time-of-day discharge was a shift in volume of patients discharged before 2pm versus after 2pm at a hospital-wide level. ACTN admissions averaged 12 minutes and 6 seconds, and the discharges averaged 14 minutes and 51 seconds. The average length of time for all calls was 13 minutes and 17 seconds.

This study shows that ACTN programs are feasible and effective, in terms of enhancing patient and nursing experience, as well as reducing the amount of time allocated to admission and discharge education processes.

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