Battling the Nursing and Clinical Staffing Shortage Utilizing Real-Time Patient Surveillance & Remote Patient Monitoring
Contributors: Al Berning, Chief Executive Officer at Ambient Clinical Analytics & Tim Kuebelbeck, Chief Customer Officer at Ambient Clinical Analytics
The staffing shortage problem
According to HealthAffairs, “The US has enjoyed steady growth in the registered nurse (RN) workforce since the 1970s, providing the backbone of the nation’s growing and evolving health care delivery systems. When this growth was threatened in the late 1990s as new entry into the profession stagnated, Millennials embraced registered nursing and reversed the trend in the early 2000s.” Also, “New data covering the entirety of 2021, show the total supply of RNs decreased by more than 100,000 in one year—a far greater drop than ever observed over the past four decades.”1 This is a shocking number of nurses that have stopped providing clinical care leaving hospitals across the country with massive clinical staffing shortages that are expensive and putting patients in danger.
In a recent Fierce Health article, “burnout and stress from working throughout the COVID-19 pandemic are taking a major toll on nurses, with more than one-third (34%) of nurses saying it's very likely that they will leave their roles by the end of 2022, and 44% cited burnout and a high-stress environment as a reason for their desire to leave, according to a new survey by staffing firm Incredible Health.” In that same survey “Nurses cited benefits and pay are the second leading reason (27%) for quitting their jobs.”2
American nurses and healthcare workers have been the feature of news stories throughout the COVID-19 pandemic. Some of these articles highlight their extraordinary dedication to their job despite unprecedented conditions, while others share stories of the extreme strain they are experiencing in their roles. The pandemic has been a catalyst of struggle for healthcare workers, including low pay, burnout, limited resources, and labor shortage. The US health systems is projected to see nursing deficits ranging between 200,000 to 450,000 registered nurses dedicated to direct patient care by the year 2025.
The new estimates and analysis come from a McKinsey report published May 11. The shortfall range of 200,000 to 450,000 holds if there are no changes in current care delivery models. The consulting firm estimates that for every 1 percent of nurses who leave direct patient care, the shortage worsens by about 30,000 nurses. To make up for the 10 to 20 percent gap, the United States would need to more than double the number of new graduates entering and staying in the nursing workforce every year for the next three years straight.
3 From world wars and economic recessions, there have been many causes of nursing shortages throughout history. However, the magnitude of the current nursing shortage is greater than ever before in this country. This is a nightmare for hospitals, as staffing shortages have been associated with both increased costs and decreased patient safety.
These should be alarming numbers for any hospital or health system. The cost of a staffing shortage is far too great, and it is not looking to improve anytime soon. Given the growing demand for healthcare services, reports project that 1.2 million new registered nurses (RNs) will be needed by 2030 to address the current shortage. 4
However, the combination of limited faculty in training programs and universities, the upcoming baby boomer retirement of a large part of the workforce, and the association of burnout to the profession are going to make that goal of new nurses very difficult to hit. As the pandemic continues, health systems will continue to face limitations and resource shortages for everything from equipment, supplies, and beds to doctors and administrative staff. However, the shortage of qualified nurses due to burnout will be the most significant challenge of all.
Solving the staffing shortage
Today’s EHR solutions are not designed for clinical care delivery especially for patient surveillance or remote patient monitoring. Instead they are built and based on previously existing hospital billing systems. These systems are adapted as a nested spreadsheet with clinical data to attempt to deliver clinical care. This model has created multiple data areas that doctors and nurses need to search to find relevant clinical data and are a source of intense pain and anguish for healthcare workers.
In addition, “RaDonda Vaught's March 25 conviction for a fatal medical mistake has driven an outcry from nurses across the U.S., who believe the conviction sets a dangerous precedent for the profession and will discourage nurses from speaking up about errors.”5 In terms of the labor shortage, many are worried that Ms. Vaught’s conviction is adding to the anguish for healthcare workers and ultimately will sway future nurses from entering the profession.
A recent article in The Atlantic illustrates these points very clearly. They state, “Health-care workers aren't quitting because they can’t handle their jobs. They’re quitting because they can’t handle being unable to do their jobs. Even before COVID-19, many of them struggled to bridge the gap between the noble ideals of their profession and the realities of its business. The pandemic simply pushed them past the limits of that compromise.”6 Clearly EHR solutions are the major contributor in healthcare workers inability to do their jobs and continues to create undue stress on our healthcare heroes.
While healthcare organizations can research incentives to attract and retain top nursing talent, one major aspect that cannot be overlooked is technology advancements. Health systems are extremely slow to adopt technologies that can help. Hospitals must begin to research tools that make the jobs of their current clinical staff easier. The benefits are endless if they can effectively alleviate the workload of each worker. This includes reductions in mortality, cost savings, an increase in quality of care, decreases in physician and nurse burnout, and much more. A major technology that health systems are turning to is the use of clinical analytics tools for patient surveillance and remote patient monitoring that reduce the clicks and manual computer effort required to care for patients in any acute care setting.
Retaining and investing in clinical staff
The University of California San Francisco, Science of Caring publication states that, “There are approximately 3.9 million registered nurses (RNs) in the U.S., and the U.S. Bureau of Labor Statistics (BLS) projects that more than 500,000 RNs will retire by 2022. Accounting in large part for replacing those retirees as well as other factors, the BLS estimates 1.1 million new RNs will be needed to prevent a shortage.” 7
In a recent Medical Economics publication, they suggest that “Instead of hiring, healthcare organizations can forge ahead with a straightforward solution: Reduce manual workloads and improve staff efficiency through technology. By automating time-consuming processes...health systems can alleviate their hiring challenges and boost staff efficiency without adding new employees. Automating many tasks also can help ease employee burnout and increase retention by opening up staff time to concentrate on higher-value tasks, including focusing on the patient experience.” 8
Outside of massive pay increases, the only high-value short-term mechanism for hospitals and health systems to survive this extended clinical staff shortage is to invest in retaining your existing clinical staff with patient surveillance and remote patient monitoring technologies. Making your data work for you through digital health investments will make clinical staff more efficient and lower the stress and burnout levels staff are experiencing in today’s EHR environment. There are many other arguments for investing in patient surveillance and remote patient monitoring technologies, such as reducing errors, readmits, and mortality. While ultimately it is most important for your digital health tools to save lives, utilizing patient surveillance and remote patient monitoring solutions that also relieve stress on your clinical staff is essential too.
One specific technology that is proven to make doctors and nurses much more efficient is a portable and real-time clinical analytics solution from Ambient Clinical Analytics that is Software as a Medical Device (SaMD) and FDA cleared. Solutions like Ambient’s AWARE Patient Surveillance™ allow nurses, hospitalists, and intensivists to leverage ambient clinical intelligence to provide complex, comprehensive, and collaborative virtual-ICU or virtual acute care from anywhere using just a laptop. In today’s patient surveillance and remote patient monitoring of acute care environments, a nurse, hospitalist, or intensivist doesn’t have access to all EHR data integrated into a single view on a clinical analytics platform. True digital health platforms that deliver patient surveillance and remote patient monitoring allow the physician or nurse to skip having to flip back and forth between multiple EHRs. This drives astonishing clinical efficiency and delivers massive labor savings around the EHR, ultimately alleviating much of the stress physicians and nurses are experiencing today.
Avant Healthcare Professionals is a firm dedicated to making long-term matches between qualified, healthcare professionals and healthcare facilities in the U.S. to fill critical staffing needs. Avant documented the healthcare staffing shortage has already created five long-term negative effects.9 The five areas are increases in patient mortality, a rise in nurse burnout, insufficient staff, and reduced patient care, all of this is forcing crisis pay levels that are stressing the U.S. healthcare system. Investing in technologies that help your clinical staff perform their jobs in a much more efficient way will go a long way in alleviating many of these issues, especially in the short term.
The ability to have physicians and nurses utilize remote patient monitoring from anywhere in any acute care setting including a virtual-ICU, will drive massive efficiency and help ease the current and escalating clinical labor shortage in two ways. One, it will reduce the stress placed on nurses and physicians (or any provider for that matter). Second, the efficiency from these systems will allow existing clinicians the ability to effectively care for much larger numbers of patients without creating fatigue and stress. This is especially important in rural areas where physician shortages are growing more rapidly and putting people who live in remote areas at major risk of not having the clinical expertise available when needed.
Solutions like AWARE Sepsis DART™ use algorithms to significantly reduce the amount of time required to assess and treat patients. In addition, peer-reviewed research shows it reduces errors by up to 50% thereby also reducing a primary driver of clinician and nursing time, fixing errors 10. The AWARE Sepsis DART platform was developed by combining Health IT with human factor ergonomics and System Engineering to design a system that extracts high-value data from the EMR and presents it to the clinical and nursing teams in patient-centric information packages 11. Again, proving that well-designed patient surveillance and remote patient monitoring solutions will deliver short-term help for your clinical staffing shortages and long-term improvements in care, mortality, and readmits.
The financial case for digital health driving clinical efficiencies
Maximizing clinical labor efficiency allows physicians and nurses to care for much larger numbers of acute care patients more efficiently, without adding additional burdens, ultimately minimizing many of the effects of today’s labor shortage. Hospitals using the AWARE™ platform will save on average 25% of the time it takes to assess, diagnose, and deliver care to a patient, resulting in an overall potential of 5% or greater physician and nursing staffing time relief to ease the clinical staffing shortage.
Nurses spend an average of 22% of their time per day on EHR systems and Physicians spend an average of 37% of (their) time per day on EHR systems.12 This does not consider any of the pajama time (after-hours time) physicians and nurses spend in EHR systems, so the labor savings potential is even greater.
Performing a conservative calculation of staffing relief from using AWARE Patient Surveillance™ and Sepsis DART™, in a clinical setting based on the relevant research, shows the following results:
• Nurses: 22% Time on EHR * 85% of the time that is relevant to AWARE savings * 25% reduction by using AWARE = 5% Overall potential staffing relief, not including improvements from Sepsis DART. • Physicians: 37% Time on EHR * 50% of the time that is relevant to AWARE savings * 25% reduction by using AWARE = 5% Overall potential staffing relief, not including improvements from Sepsis DART.
Further improvements are possible from time saved by calculators and alerts in AWARE and Sepsis DART that automate many tasks currently being done manually using the EHR system. As an example, AWARE Sepsis DART uses a digitally assisted workflow process to detect sepsis, and using automated communications supports and drives the entire bundle delivery for the treatment of sepsis to provide additional clinical labor relief.
AWARE™ research shows a 50% reduction in errors which further improves clinical labor savings by reducing a primary driver of clinician and nursing time, fixing errors. Eliminating errors and the unnecessary work to fix them will also increase staff satisfaction and retention.
The historical data collected by AWARE Sepsis DART™ can also be used to drive significant improvement in all clinical processes using Lean Quality – Six Sigma quality improvement techniques. As an example, the historical data can be used to identify and provide trend analysis on which steps and which providers of the CMS sepsis treatment bundle are causing the failure of sepsis bundle compliance. Having this global view of which element or with whom the clinical process is breaking down, adds significant insight into the delivery issues of the sepsis bundle. This insight allows clinical executives to take corrective action that drives performance efficiency ultimately leading to much higher clinician job satisfaction and just as important, improved patient outcomes. The data can also be used to track the timing between sepsis detection and the start of treatment to determine if there are impediments in the launch of the sepsis treatment bundle to analyze if they are caused by EHR disruptions, process flow, staffing, or other issues.
Years of lack of investments in digital technologies coupled with a mass exodus in clinical staff have made it clear that if hospitals and health systems don’t immediately start taking a multi-tiered approach to solving the clinical labor shortage, nurses will continue to leave in droves. The nursing shortage (and physician shortage) is a growing national healthcare crisis in the U.S. and is rapidly spiraling out of control putting patients, hospitals, and health systems at risk. Doubling the amount of RN graduates in nursing degrees for the next three years just to fill the gap that already exists in terms of nursing shortages is unrealistic, especially considering teaching staff would have to be doubled as well. This makes a very strong case for CFOs and COOs to invest now in patient surveillance technologies and remote patient monitoring technologies that make your physicians, nurses, and other care providers more efficient.
About Ambient Clinical Analytics
AWARE Patient Surveillance™
Ambient has achieved FDA Class II Clearance, CE Marking, and ISO 13485:2016 Certification on the AWARE™ platform. AWARE™ provides remote patient monitoring, patient surveillance, and predictive analytics combined with novel clinical decision support tools that reduce provider fatigue and errors while saving lives. Created by clinicians for clinicians, AWARE™ delivers real-time virtual-ICU & virtual acute care surveillance, situational awareness, and actionable information to the care team, improving outcomes and reducing costs in critical care and general inpatient areas.
In addition to providing virtual-ICU and acute camera functionality, AWARE’s (Ambient Warning and Response Evaluation) Patient Surveillance and virtual-ICU solution is designed to provide bedside and remote patient monitoring from anywhere using data visualization and clinical analytics. The AWARE™ Multi-Patient Viewer (MPV) and Single-Patient Viewer (SPV) allow all nurses and physicians to view a patient through the eyes of an intensivist regardless of location. Critical and acute care requires turning massive amounts of raw data into actionable knowledge and many of the electronic tools at your disposal make this much more complicated than necessary.
This complication, commonly known as information overload, frustrates clinicians and exposes patients to diagnostic errors and therapeutic harm. AWARE™ is different, it was built by intensivists with Mayo Clinic using principles of human factors engineering, gathering the data that’s important to critical care teams and displaying it in a way that minimizes cognitive load. AWARE™ is the gold standard for how smart clinical analytics and data visualization can improve communication, efficiency, situational awareness, and safety. Unlike any other system, AWARE™ Patient Surveillance shows you what you need to see, at the point of care, or for remote patient monitoring, and in virtual-ICU and acute settings, organized the way an intensivist approaches their patient’s data.
AWARE Clinical Control Tower™ is a solution designed to provide patient surveillance via a Clinical Mesh Network™, virtual ICU, or virtual acute care anywhere for both AWARE™ and Sepsis DART™. AWARE has centralized or decentralized remote patient monitoring, and patient surveillance, facilitating collaboration for both physicians and nurses. AWARE™ and Sepsis DART™ capabilities are delivered to all locations in a standardized format, eliminating EMR differences. Clinical Control Tower™ provides a breadth of distributed telehealth including virtual ICU, virtual acute care, patient surveillance, and remote patient monitoring within your hospital or health system, and can easily be extended to any contracted facilities.
Whether deployed in a Clinical Mesh Network™, an ICU, as a virtual ICU solution, or for acute care patient surveillance, the AWARE™ enterprise-class family of solutions including Sepsis DART, AWARE Patient Surveillance, and Clinical Control Tower all help you approach your patients in a more effective, informed, and organized fashion while decreasing provider fatigue, reducing errors, and saving lives. Created by clinicians for clinicians, AWARE™ delivers real-time patient surveillance, situational awareness, and actionable information to the care team, improving outcomes and reducing costs in any acute care area including critical care and general inpatient areas.
The combination of effective predictive analytics and advanced clinical decision support tools helps to reduce errors, improve patient outcomes, reduce the cost of care, and deliver best-care practices for ICUs and other inpatient care areas. AWARE’s predictive analytics system provides a “smart view” via data visualization of Electronic Health Record data that reduces the risk of medical errors and improves patient outcomes with high-reliability healthcare. It works with your EHR/EMR and bedside monitors to present only relevant information for care delivery. This minimizes information overload, which is a leading cause of medical errors and results in a lower cost of care. By facilitating quick access to a patient's information at the point of care and in remote patient monitoring centers using AWARE’s Clinical Control Tower™, Ambient aids interventional decision-making and is proven to reduce the incidence of cognitive errors by 50%.
AWARE Sepsis DART™
Ambient Clinical Analytics has developed an FDA Class II cleared clinical decision sepsis alert tool called Sepsis DART which assists hospitals with the sepsis alert, timely delivery and management of treatment, and reporting.
Sepsis DART™ (Detection and Response Tool) is the ultimate patient surveillance and alerting solution. With bedside and remote patient monitoring designed to analyze patient data and identify potential sepsis conditions early, offering medical staff the right information for detection, and using smart sepsis alerts supports tracking of the treatment process. It moves with the patient across multiple hospitals and through different hospital units, services, and environments. DART™ integrates with any EMR system and is configurable for various institutional purposes.
Sepsis DART™ is an FDA Class II approved remote patient monitoring solution that was clinically vetted with Mayo Clinic and has a strong return on investment. One of the main reasons Ambient leads the market is because they are an end-to-end sepsis solution. Ambient, along with their customers, have the capability to configure algorithms, and this allows us to tune algorithms to fit any health system, hospital location, or unit.
The Sepsis DART™ system monitors and communicates regarding all aspects of sepsis treatment bundles to the right practitioners at the right time, maintaining information on septic patients even between care locations and shifting staff. This reduces errors and omissions, as the entire care team understands on a real-time basis what treatment elements have and have not been delivered, and how much time is left to successfully complete treatment. Published research from Mayo Clinic shows that AWARE Sepsis DART provides a high level of sensitivity and specificity as well as improved compliance with sepsis treatment delivery guidelines. Because Sepsis DART keeps all the pertinent data for each case in a single repository, all centrally available and correlated to the “time zero” of the sepsis event, the effort required to abstract and report on sepsis cases is substantially reduced and that alone, not including improvements in outcomes and CMS compliance, cost justifies any system costs.
For more detailed information about Ambient Clinical Analytics please contact tim.kuebelbeck@ambientclinical.com.
About Ambient Clinical Analytics - Ambient is an industry leader supporting leading healthcare systems and has done so since its founding in 2013. Our solutions are designed by clinicians to be easy-to-use by every caregiver in your organization and are configured to be up and running rapidly. We are trusted by a community of high-performing healthcare providers across the United States. Our solutions are powerful real-time point-of-care and remote healthcare platforms designed to deliver life-saving patient surveillance and analytics using data visualization, communication, and rules-based clinical decision support.
Ambient’s AWARE™ and Sepsis DART™ solutions are exceptionally secure, high-performance, FDA Class II approved and CE Marking certified Software as a Medical Device (SaMD) platforms. Ambient’s Sepsis DART™ product has been accepted into the Patient Safety Movement’s Actionable Patient Safety Solutions (APSS) #9 for Sepsis. Ambient has achieved ISO 13485:2016 certification, an internationally recognized quality standard specific to the medical device industry. The ISO 13485 standard sets out the requirements for a quality management system specific to the medical device industry. Ambient’s remote patient monitoring, virtual-ICU, virtual acute care and patient surveillance platforms are ideal for any acute patient care setting from the ICU to the home. For more information, visit https://ambientclinical.com.
1 “A Worrisome Drop In The Number Of Young Nurses” HealthAffairs, 13 Apr. 2022, https://www.healthaffairs.org/do/10.1377/forefront.20220412.311784
2 Landi, Heather “Third of nurses plan to leave their jobs in 2022, survey finds” Fierce Healthcare, 22 Mar. 2022, https://www.fiercehealthcare.com/providers/third-nurses-plan-leave-their-jobs-2022-survey-finds
3Gamble, Molly “US faces defeicit of 450,000 nurses by 2025, Beckers Hospital Review, 12 May, 2022, https://www.beckershospitalreview.com/workforce/us-faces-deficit-of-450-000-nurses-by-2025.html?origin=BHRE&utm_source=BHRE&utm_medium=email&utm_content=newsletter&oly_enc_id=6899D9320367E8A
4 Young LK; Adams JL; Lundeen S; May KA; Smith R; Wendt LE; “Nurses for Wisconsin: A Collaborative Initiative to Enhance the Nurse Educator Workforce.” Journal of Professional Nursing : Official Journal of the American Association of Colleges of Nursing, U.S. National Library of Medicine, 2016, https://pubmed.ncbi.nlm.nih.gov/27424929/.
5Bean, Mackenzie, Carbajal, Erica, & Gleeson, Cailey “Nurses make exit plans after RaDonda Vaught’s conviction,” Becker’s Hospital Review, 6 May 2022, https://www.beckershospitalreview.com/nursing/nurses-make-exit-plans-after-radonda-vaught-s-conviction.html?origin=BHRE&utm_source=BHRE&utm_medium=email&utm_content=newsletter&oly_enc_id=6899D9320367E8A
6Young, ED, Why Healthcare Workers Are Quitting in Droves, The Atlantic, https://www.theatlantic.com/health/archive/2021/11/the-mass-exodus-of-americas-health-care-workers/620713/ , Nov 16, 2021
7Martinovich, Milenko, “The Nursing Shortage is a National Problem. How We Can Solve It?” University of California San Francisco, Science of Caring, Jan 2022, https://scienceofcaring.ucsf.edu/patient-care/nursing-shortage-national-problem-how-we-can-solve-it
8Kuruna, Teagan, “Short of staff?, Efficiency-not hiring-May be the answer” Medical Economics, 3 Nov. 2021 https://www.medicaleconomics.com/view/short-on-staff-efficiency-not-hiring-may-be-the-best-answer
9Avant Healthcare Professionals, “5 Long-Term Effects of the Nursing Shortage, 22 Jul 2021, https://avanthealthcare.com/blog/effects-of-nursing-shortage.stml#
10Pickering, et al., Novel Representation of Clinical Information in the ICU, Applied Clinical Informatics, 2010
11Pickering, Litell, et al, Clinical review: The hospital of the future – building intelligent environments to facilitate safe and effective acute care delivery, Critical Care, 2012
12Pinevich Y, et al., Interaction Time with Electronic Health Records: A Systematic Review. Appl Clin Inform. 2021 Aug;12(4):788-799, PMID: 34433218
The staffing shortage problem
According to HealthAffairs, “The US has enjoyed steady growth in the registered nurse (RN) workforce since the 1970s, providing the backbone of the nation’s growing and evolving health care delivery systems. When this growth was threatened in the late 1990s as new entry into the profession stagnated, Millennials embraced registered nursing and reversed the trend in the early 2000s.” Also, “New data covering the entirety of 2021, show the total supply of RNs decreased by more than 100,000 in one year—a far greater drop than ever observed over the past four decades.”1 This is a shocking number of nurses that have stopped providing clinical care leaving hospitals across the country with massive clinical staffing shortages that are expensive and putting patients in danger.
In a recent Fierce Health article, “burnout and stress from working throughout the COVID-19 pandemic are taking a major toll on nurses, with more than one-third (34%) of nurses saying it's very likely that they will leave their roles by the end of 2022, and 44% cited burnout and a high-stress environment as a reason for their desire to leave, according to a new survey by staffing firm Incredible Health.” In that same survey “Nurses cited benefits and pay are the second leading reason (27%) for quitting their jobs.”2
American nurses and healthcare workers have been the feature of news stories throughout the COVID-19 pandemic. Some of these articles highlight their extraordinary dedication to their job despite unprecedented conditions, while others share stories of the extreme strain they are experiencing in their roles. The pandemic has been a catalyst of struggle for healthcare workers, including low pay, burnout, limited resources, and labor shortage. The US health systems is projected to see nursing deficits ranging between 200,000 to 450,000 registered nurses dedicated to direct patient care by the year 2025.
The new estimates and analysis come from a McKinsey report published May 11. The shortfall range of 200,000 to 450,000 holds if there are no changes in current care delivery models. The consulting firm estimates that for every 1 percent of nurses who leave direct patient care, the shortage worsens by about 30,000 nurses. To make up for the 10 to 20 percent gap, the United States would need to more than double the number of new graduates entering and staying in the nursing workforce every year for the next three years straight.
3 From world wars and economic recessions, there have been many causes of nursing shortages throughout history. However, the magnitude of the current nursing shortage is greater than ever before in this country. This is a nightmare for hospitals, as staffing shortages have been associated with both increased costs and decreased patient safety.
These should be alarming numbers for any hospital or health system. The cost of a staffing shortage is far too great, and it is not looking to improve anytime soon. Given the growing demand for healthcare services, reports project that 1.2 million new registered nurses (RNs) will be needed by 2030 to address the current shortage. 4
However, the combination of limited faculty in training programs and universities, the upcoming baby boomer retirement of a large part of the workforce, and the association of burnout to the profession are going to make that goal of new nurses very difficult to hit. As the pandemic continues, health systems will continue to face limitations and resource shortages for everything from equipment, supplies, and beds to doctors and administrative staff. However, the shortage of qualified nurses due to burnout will be the most significant challenge of all.
Solving the staffing shortage
Today’s EHR solutions are not designed for clinical care delivery especially for patient surveillance or remote patient monitoring. Instead they are built and based on previously existing hospital billing systems. These systems are adapted as a nested spreadsheet with clinical data to attempt to deliver clinical care. This model has created multiple data areas that doctors and nurses need to search to find relevant clinical data and are a source of intense pain and anguish for healthcare workers.
In addition, “RaDonda Vaught's March 25 conviction for a fatal medical mistake has driven an outcry from nurses across the U.S., who believe the conviction sets a dangerous precedent for the profession and will discourage nurses from speaking up about errors.”5 In terms of the labor shortage, many are worried that Ms. Vaught’s conviction is adding to the anguish for healthcare workers and ultimately will sway future nurses from entering the profession.
A recent article in The Atlantic illustrates these points very clearly. They state, “Health-care workers aren't quitting because they can’t handle their jobs. They’re quitting because they can’t handle being unable to do their jobs. Even before COVID-19, many of them struggled to bridge the gap between the noble ideals of their profession and the realities of its business. The pandemic simply pushed them past the limits of that compromise.”6 Clearly EHR solutions are the major contributor in healthcare workers inability to do their jobs and continues to create undue stress on our healthcare heroes.
While healthcare organizations can research incentives to attract and retain top nursing talent, one major aspect that cannot be overlooked is technology advancements. Health systems are extremely slow to adopt technologies that can help. Hospitals must begin to research tools that make the jobs of their current clinical staff easier. The benefits are endless if they can effectively alleviate the workload of each worker. This includes reductions in mortality, cost savings, an increase in quality of care, decreases in physician and nurse burnout, and much more. A major technology that health systems are turning to is the use of clinical analytics tools for patient surveillance and remote patient monitoring that reduce the clicks and manual computer effort required to care for patients in any acute care setting.
Retaining and investing in clinical staff
The University of California San Francisco, Science of Caring publication states that, “There are approximately 3.9 million registered nurses (RNs) in the U.S., and the U.S. Bureau of Labor Statistics (BLS) projects that more than 500,000 RNs will retire by 2022. Accounting in large part for replacing those retirees as well as other factors, the BLS estimates 1.1 million new RNs will be needed to prevent a shortage.” 7
In a recent Medical Economics publication, they suggest that “Instead of hiring, healthcare organizations can forge ahead with a straightforward solution: Reduce manual workloads and improve staff efficiency through technology. By automating time-consuming processes...health systems can alleviate their hiring challenges and boost staff efficiency without adding new employees. Automating many tasks also can help ease employee burnout and increase retention by opening up staff time to concentrate on higher-value tasks, including focusing on the patient experience.” 8
Outside of massive pay increases, the only high-value short-term mechanism for hospitals and health systems to survive this extended clinical staff shortage is to invest in retaining your existing clinical staff with patient surveillance and remote patient monitoring technologies. Making your data work for you through digital health investments will make clinical staff more efficient and lower the stress and burnout levels staff are experiencing in today’s EHR environment. There are many other arguments for investing in patient surveillance and remote patient monitoring technologies, such as reducing errors, readmits, and mortality. While ultimately it is most important for your digital health tools to save lives, utilizing patient surveillance and remote patient monitoring solutions that also relieve stress on your clinical staff is essential too.
One specific technology that is proven to make doctors and nurses much more efficient is a portable and real-time clinical analytics solution from Ambient Clinical Analytics that is Software as a Medical Device (SaMD) and FDA cleared. Solutions like Ambient’s AWARE Patient Surveillance™ allow nurses, hospitalists, and intensivists to leverage ambient clinical intelligence to provide complex, comprehensive, and collaborative virtual-ICU or virtual acute care from anywhere using just a laptop. In today’s patient surveillance and remote patient monitoring of acute care environments, a nurse, hospitalist, or intensivist doesn’t have access to all EHR data integrated into a single view on a clinical analytics platform. True digital health platforms that deliver patient surveillance and remote patient monitoring allow the physician or nurse to skip having to flip back and forth between multiple EHRs. This drives astonishing clinical efficiency and delivers massive labor savings around the EHR, ultimately alleviating much of the stress physicians and nurses are experiencing today.
Avant Healthcare Professionals is a firm dedicated to making long-term matches between qualified, healthcare professionals and healthcare facilities in the U.S. to fill critical staffing needs. Avant documented the healthcare staffing shortage has already created five long-term negative effects.9 The five areas are increases in patient mortality, a rise in nurse burnout, insufficient staff, and reduced patient care, all of this is forcing crisis pay levels that are stressing the U.S. healthcare system. Investing in technologies that help your clinical staff perform their jobs in a much more efficient way will go a long way in alleviating many of these issues, especially in the short term.
The ability to have physicians and nurses utilize remote patient monitoring from anywhere in any acute care setting including a virtual-ICU, will drive massive efficiency and help ease the current and escalating clinical labor shortage in two ways. One, it will reduce the stress placed on nurses and physicians (or any provider for that matter). Second, the efficiency from these systems will allow existing clinicians the ability to effectively care for much larger numbers of patients without creating fatigue and stress. This is especially important in rural areas where physician shortages are growing more rapidly and putting people who live in remote areas at major risk of not having the clinical expertise available when needed.
Solutions like AWARE Sepsis DART™ use algorithms to significantly reduce the amount of time required to assess and treat patients. In addition, peer-reviewed research shows it reduces errors by up to 50% thereby also reducing a primary driver of clinician and nursing time, fixing errors 10. The AWARE Sepsis DART platform was developed by combining Health IT with human factor ergonomics and System Engineering to design a system that extracts high-value data from the EMR and presents it to the clinical and nursing teams in patient-centric information packages 11. Again, proving that well-designed patient surveillance and remote patient monitoring solutions will deliver short-term help for your clinical staffing shortages and long-term improvements in care, mortality, and readmits.
The financial case for digital health driving clinical efficiencies
Maximizing clinical labor efficiency allows physicians and nurses to care for much larger numbers of acute care patients more efficiently, without adding additional burdens, ultimately minimizing many of the effects of today’s labor shortage. Hospitals using the AWARE™ platform will save on average 25% of the time it takes to assess, diagnose, and deliver care to a patient, resulting in an overall potential of 5% or greater physician and nursing staffing time relief to ease the clinical staffing shortage.
Nurses spend an average of 22% of their time per day on EHR systems and Physicians spend an average of 37% of (their) time per day on EHR systems.12 This does not consider any of the pajama time (after-hours time) physicians and nurses spend in EHR systems, so the labor savings potential is even greater.
Performing a conservative calculation of staffing relief from using AWARE Patient Surveillance™ and Sepsis DART™, in a clinical setting based on the relevant research, shows the following results:
• Nurses: 22% Time on EHR * 85% of the time that is relevant to AWARE savings * 25% reduction by using AWARE = 5% Overall potential staffing relief, not including improvements from Sepsis DART. • Physicians: 37% Time on EHR * 50% of the time that is relevant to AWARE savings * 25% reduction by using AWARE = 5% Overall potential staffing relief, not including improvements from Sepsis DART.
Further improvements are possible from time saved by calculators and alerts in AWARE and Sepsis DART that automate many tasks currently being done manually using the EHR system. As an example, AWARE Sepsis DART uses a digitally assisted workflow process to detect sepsis, and using automated communications supports and drives the entire bundle delivery for the treatment of sepsis to provide additional clinical labor relief.
AWARE™ research shows a 50% reduction in errors which further improves clinical labor savings by reducing a primary driver of clinician and nursing time, fixing errors. Eliminating errors and the unnecessary work to fix them will also increase staff satisfaction and retention.
The historical data collected by AWARE Sepsis DART™ can also be used to drive significant improvement in all clinical processes using Lean Quality – Six Sigma quality improvement techniques. As an example, the historical data can be used to identify and provide trend analysis on which steps and which providers of the CMS sepsis treatment bundle are causing the failure of sepsis bundle compliance. Having this global view of which element or with whom the clinical process is breaking down, adds significant insight into the delivery issues of the sepsis bundle. This insight allows clinical executives to take corrective action that drives performance efficiency ultimately leading to much higher clinician job satisfaction and just as important, improved patient outcomes. The data can also be used to track the timing between sepsis detection and the start of treatment to determine if there are impediments in the launch of the sepsis treatment bundle to analyze if they are caused by EHR disruptions, process flow, staffing, or other issues.
Years of lack of investments in digital technologies coupled with a mass exodus in clinical staff have made it clear that if hospitals and health systems don’t immediately start taking a multi-tiered approach to solving the clinical labor shortage, nurses will continue to leave in droves. The nursing shortage (and physician shortage) is a growing national healthcare crisis in the U.S. and is rapidly spiraling out of control putting patients, hospitals, and health systems at risk. Doubling the amount of RN graduates in nursing degrees for the next three years just to fill the gap that already exists in terms of nursing shortages is unrealistic, especially considering teaching staff would have to be doubled as well. This makes a very strong case for CFOs and COOs to invest now in patient surveillance technologies and remote patient monitoring technologies that make your physicians, nurses, and other care providers more efficient.
About Ambient Clinical Analytics
AWARE Patient Surveillance™
Ambient has achieved FDA Class II Clearance, CE Marking, and ISO 13485:2016 Certification on the AWARE™ platform. AWARE™ provides remote patient monitoring, patient surveillance, and predictive analytics combined with novel clinical decision support tools that reduce provider fatigue and errors while saving lives. Created by clinicians for clinicians, AWARE™ delivers real-time virtual-ICU & virtual acute care surveillance, situational awareness, and actionable information to the care team, improving outcomes and reducing costs in critical care and general inpatient areas.
In addition to providing virtual-ICU and acute camera functionality, AWARE’s (Ambient Warning and Response Evaluation) Patient Surveillance and virtual-ICU solution is designed to provide bedside and remote patient monitoring from anywhere using data visualization and clinical analytics. The AWARE™ Multi-Patient Viewer (MPV) and Single-Patient Viewer (SPV) allow all nurses and physicians to view a patient through the eyes of an intensivist regardless of location. Critical and acute care requires turning massive amounts of raw data into actionable knowledge and many of the electronic tools at your disposal make this much more complicated than necessary.
This complication, commonly known as information overload, frustrates clinicians and exposes patients to diagnostic errors and therapeutic harm. AWARE™ is different, it was built by intensivists with Mayo Clinic using principles of human factors engineering, gathering the data that’s important to critical care teams and displaying it in a way that minimizes cognitive load. AWARE™ is the gold standard for how smart clinical analytics and data visualization can improve communication, efficiency, situational awareness, and safety. Unlike any other system, AWARE™ Patient Surveillance shows you what you need to see, at the point of care, or for remote patient monitoring, and in virtual-ICU and acute settings, organized the way an intensivist approaches their patient’s data.
AWARE Clinical Control Tower™ is a solution designed to provide patient surveillance via a Clinical Mesh Network™, virtual ICU, or virtual acute care anywhere for both AWARE™ and Sepsis DART™. AWARE has centralized or decentralized remote patient monitoring, and patient surveillance, facilitating collaboration for both physicians and nurses. AWARE™ and Sepsis DART™ capabilities are delivered to all locations in a standardized format, eliminating EMR differences. Clinical Control Tower™ provides a breadth of distributed telehealth including virtual ICU, virtual acute care, patient surveillance, and remote patient monitoring within your hospital or health system, and can easily be extended to any contracted facilities.
Whether deployed in a Clinical Mesh Network™, an ICU, as a virtual ICU solution, or for acute care patient surveillance, the AWARE™ enterprise-class family of solutions including Sepsis DART, AWARE Patient Surveillance, and Clinical Control Tower all help you approach your patients in a more effective, informed, and organized fashion while decreasing provider fatigue, reducing errors, and saving lives. Created by clinicians for clinicians, AWARE™ delivers real-time patient surveillance, situational awareness, and actionable information to the care team, improving outcomes and reducing costs in any acute care area including critical care and general inpatient areas.
The combination of effective predictive analytics and advanced clinical decision support tools helps to reduce errors, improve patient outcomes, reduce the cost of care, and deliver best-care practices for ICUs and other inpatient care areas. AWARE’s predictive analytics system provides a “smart view” via data visualization of Electronic Health Record data that reduces the risk of medical errors and improves patient outcomes with high-reliability healthcare. It works with your EHR/EMR and bedside monitors to present only relevant information for care delivery. This minimizes information overload, which is a leading cause of medical errors and results in a lower cost of care. By facilitating quick access to a patient's information at the point of care and in remote patient monitoring centers using AWARE’s Clinical Control Tower™, Ambient aids interventional decision-making and is proven to reduce the incidence of cognitive errors by 50%.
AWARE Sepsis DART™
Ambient Clinical Analytics has developed an FDA Class II cleared clinical decision sepsis alert tool called Sepsis DART which assists hospitals with the sepsis alert, timely delivery and management of treatment, and reporting.
Sepsis DART™ (Detection and Response Tool) is the ultimate patient surveillance and alerting solution. With bedside and remote patient monitoring designed to analyze patient data and identify potential sepsis conditions early, offering medical staff the right information for detection, and using smart sepsis alerts supports tracking of the treatment process. It moves with the patient across multiple hospitals and through different hospital units, services, and environments. DART™ integrates with any EMR system and is configurable for various institutional purposes.
Sepsis DART™ is an FDA Class II approved remote patient monitoring solution that was clinically vetted with Mayo Clinic and has a strong return on investment. One of the main reasons Ambient leads the market is because they are an end-to-end sepsis solution. Ambient, along with their customers, have the capability to configure algorithms, and this allows us to tune algorithms to fit any health system, hospital location, or unit.
The Sepsis DART™ system monitors and communicates regarding all aspects of sepsis treatment bundles to the right practitioners at the right time, maintaining information on septic patients even between care locations and shifting staff. This reduces errors and omissions, as the entire care team understands on a real-time basis what treatment elements have and have not been delivered, and how much time is left to successfully complete treatment. Published research from Mayo Clinic shows that AWARE Sepsis DART provides a high level of sensitivity and specificity as well as improved compliance with sepsis treatment delivery guidelines. Because Sepsis DART keeps all the pertinent data for each case in a single repository, all centrally available and correlated to the “time zero” of the sepsis event, the effort required to abstract and report on sepsis cases is substantially reduced and that alone, not including improvements in outcomes and CMS compliance, cost justifies any system costs.
For more detailed information about Ambient Clinical Analytics please contact tim.kuebelbeck@ambientclinical.com.
About Ambient Clinical Analytics - Ambient is an industry leader supporting leading healthcare systems and has done so since its founding in 2013. Our solutions are designed by clinicians to be easy-to-use by every caregiver in your organization and are configured to be up and running rapidly. We are trusted by a community of high-performing healthcare providers across the United States. Our solutions are powerful real-time point-of-care and remote healthcare platforms designed to deliver life-saving patient surveillance and analytics using data visualization, communication, and rules-based clinical decision support.
Ambient’s AWARE™ and Sepsis DART™ solutions are exceptionally secure, high-performance, FDA Class II approved and CE Marking certified Software as a Medical Device (SaMD) platforms. Ambient’s Sepsis DART™ product has been accepted into the Patient Safety Movement’s Actionable Patient Safety Solutions (APSS) #9 for Sepsis. Ambient has achieved ISO 13485:2016 certification, an internationally recognized quality standard specific to the medical device industry. The ISO 13485 standard sets out the requirements for a quality management system specific to the medical device industry. Ambient’s remote patient monitoring, virtual-ICU, virtual acute care and patient surveillance platforms are ideal for any acute patient care setting from the ICU to the home. For more information, visit https://ambientclinical.com.
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