How to Use Technology to Turn Around Staff Turnover

“No. 1, it is the patient volume,” Campbell says. “No. 2, it is the patient acuity—the severe illness that we are seeing in our hospitals. No. 3, it is the rigor around the documentation, which is increasingly about what we must do to support a bill or authorization versus using documentation for communication in the record.”

Virtual nursing has been the primary strategy to address nurse turnover at Ardent, Campbell explains.

“In one of our markets, we put telehealth technology in 400 rooms,” Campbell says. “This allowed for a new breed of nurses—virtual nurses.”

Virtual nurses at Ardent are rounding on patients, and completing intakes, admissions, and discharges, and they can come into the room at any time. The work that the virtual nurses are doing is cerebral, according to Campbell.

“They are usually seasoned nurses, and they are not getting interrupted,” Campbell says. “That allows the nurses that are on-site to have a greater opportunity to handle complex tasks that are taking place, have a greater opportunity to be aware of the acuity of the patients in their panel, and have greater oversight of patient care technicians.”

Virtual nursing is having a positive impact at Ardent, Campbell explains.

“Where we have virtual nursing, turnover has decreased sharply, and we have seen a reduction in the cost of care,” Campbell says. “What is most important to us is we are trying to create a situation where nurses want to work for us and not leave.”

Automated patient monitoring that helps to identify deteriorating patients is also addressing nurse turnover. According to Campbell, Ardent is partnering with FDA-approved BioIntelliSense, which provides a sensor that can be put on the patient to monitor things such as respiratory rate, heart rate, and body temperature.

As is the case with virtual nursing, automated patient monitoring has achieved positive results, according to Campbell.

“On the units where we have automated patient monitoring, we have seen a 15% reduction in mortality,” Campbell says. “For the nurses in those hospitals, we have hospitals that are watching their back. They are less afraid to be at work. That impacts burnout.”

Addressing physician turnover

In recent years, documentation burden has been a primary driver of physician turnover, Campbell explains.

“Electronic medical records have not been making significant inroads in reducing documentation burden, including the most advanced EMRs,” Campbell says.

To rise to this challenge, Ardent has adopted Ambience, an artificial intelligence scribe tool.

“A clinician starts an encounter with a patient by saying the conversation is going to be recorded, then they have a conversation with the patient,” Campbell says. “The clinician can look at the patient the whole time. The clinician then walks out of the room, and in less than a minute a clinical note is completed.”

Ambience features the latest generation of AI scribe technology, according to Campbell.

“Early generations of AI scribes were good at dictation,” Campbell says. “But the newest generations of AI scribes do a much better job of summarizing and linking to key elements that are going to communicate the acuity of the patient and affect the coding and the subtleties of what is in the clinical note overall.”

“It has improved coding,” Campbell says. “Patients are commenting that the clinicians are talking with them directly the whole time of an encounter.”

Virtual attending is another technological approach to addressing physician turnover at Ardent. There are clinicians such as cardiologists, neurologists, and nephrologists who are willing to truncate their practice so long as they can have access to patients through video encounters, according to Campbell.

“They do not go into clinics or hospitals any longer,” Campbell says. “In many cases, they take a lesser level of compensation. They see patients for consultations via telemedicine.”

Ardent has had video consultation for stroke patients for years, but the new virtual rounding strategy is different, according to Campbell.

“You don’t have a cart come into the room as you would for a stroke patient,” Campbell says. “This is seeing a patient in a setting such as the emergency department, where there is audio-visual equipment in every room. Clinicians can round on many patients virtually.”

For physicians, virtual rounding reduces travel time and cognitive burden, Campbell explains.

“I have cardiologists who have been rounding on patients in certain hospitals, and they have not entered those hospitals for months,” Campell says. “I have neurologists in our East Texas market who will never go into those hospitals. These are individuals who are basically moving beyond the traditional confines of having an office practice and going to hospitals for consultations.”