Located only one hour outside of New York City, The Valley Hospital was hit hard by COVID-19 early on. Hear how they used predictive analytics to reduce nurse burnout and support staff during times of extreme stress.
Title: Improving Safety and Efficiency with Predictive Analytics
Alicia Brubaker, RN and Director of Clinical Informatics, The Valley Hospital
Chris Neumann, Clinical Analyst for Surveillance, The Valley Hospital
Host: Christine Parent, Associate Vice President, MEDITECH
Alicia: I’m going on a personal crusade to really try to cut back on the documentation for clinicians, and do it in a more effective way. Try to cut back where we can because I truly think that if they have less to document they're really going to have more time at the bedside.
Christine: Welcome to another episode of MEDITECH podcast, the leader in healthcare technology empowering you to be a more informed healthcare consumer and provider. Hear the latest from our friends and colleagues on topics we think you should know about.
Today, I'm joined by two clinical IT leaders at Valley Hospital in Ridgewood, New Jersey, Alicia Brubaker RN and Director of Clinical Informatics, and Chris Newman, Clinical Analyst for Surveillance. When COVID-19 hit their community, information technology was front and center as caregivers leveraged surveillance boards as an early detection tool to protect their patients and staff.
When people think of the epicenter of COVID-19 they think about New York City but you're just on the outskirts, only one hour away. What was the response at Valley when you saw the wave of cases inevitably coming your way?
Alicia: So at Valley, we saw that things were happening, we saw that in New York the numbers were going up and I think there were a few patients trickling in. They might have had one or two patients coming in the ER. What really happened was we really had no way to truly prepare because we went from having a few patients one day to almost 200 patients three days later. So many of the things that we did we had to do on the fly very quickly between IS and Informatics to really change everything that we were doing, get areas prepared. We had to create new locations as the patient load went up and all of this happened rather quickly. I would say over the course of two weeks as far as the nursing staff I think they started off not really knowing what was happening and just doing what they always do every day. Then as they started to see their colleagues getting sick they became very terrified because we'd never seen this before. You'd never seen your co-workers get sick like this and so it was definitely challenging for the nursing staff.
I think for Informatics and for IS that we really went right ahead, we built new order sets, we built new care plans for these patients, we actually cut back the nursing documentation to help with that burden while they had such a high acuity load and there were a lot of locations that popped up.
Chris: A lot of our staff were working, especially from IS, overnight. March 21st was actually the first weekend we had 35 of our staff working that entire weekend to build different units and care plans and be prepared for the possible surge.
Christine: During this time you built out a very robust and sophisticated tool with surveillance and was able to pivot and use this to monitor COVID-19 ventilators and eventually evolved to patient status. Can you explain this evolution and how this tool supported you?
Chris: We originally started by tracking ventilator usage. We were worried that we may have run out and our respiratory department had asked me to keep track of basically the population that was on ventilators and it would show which patients were on a ventilator that had COVID, which ones were on a ventilator didn't have COVID and that was the original goal of the surveillance board. As things progressed we started to then track positive test results for the nursing staff so they could see where their patients were either positive, negative, or had a pending test, and then as that continued we started to track using special indicators as well as infection control started to put patients on isolation protocols. So if they had a test that was from another facility or if they came in and wasn't done by us or if they had been here before and came back so we definitely rewrote the profile almost every two weeks to adjust to what was happening at that time.
Alicia: For the testing, specifically to the nurses, instead of having them have to go to a separate surveillance board to see this information we created an indicator on their status boards that they could actually see right in their status board was their patient positive, negative, or pending a test. Then also for infection control using that special indicator we've actually leveraged to create a lot of our reports that they're still using to track our in-house COVID patients.
Christine: Where else are you using surveillance at this time and what impact does it have on your nurses and quality staff?
Alicia: We use surveillance for many different things. A lot of the typical things that you would think of like CLABSI and CAUTI and Sepsis and COPD, we also track restraints. There's many different quality indicators that we're tracking but we also use surveillance for many out-of-the-box things. Some of the things we also use it for is a funny option of a copay in the ED to make sure that we know that a patient's had a copay. We also are leveraging it as well as some outside logic to automatically qualify patients on status boards. We use this for some of our bundle patients so that the case managers are able to keep track of who are our bundle patients that we currently have in-house and it's really been a helpful tool for them versus having to dig through every patient's chart, they quickly can see this right away and track it.
Another thing that is really interesting that we just did is we took our fall risk which is usually a tool that nurses as you know manually go through at least once a shift on their patient and we decided to see if we could use surveillance logic to not only take the objectivity out of filling out this scale but also take some of the documentation workload off of the nurse. So by doing this it actually uses surveillance in the background to pick up all the pieces needed for the fall risk assessment and then it actually qualifies the patient for either the low, moderate, or high category and it populates that information right on their status board. So as far as documentation all they really have to do is document some very minimal things in their documentation versus having to do an entire scale each shift.
Christine: It seems like your ability to be flexible and make changes on the fly was a big factor in your success. Can you walk us through some of the ways Valley works collaboratively between clinicians and IT to drive meaningful change?
Alicia: So the clinical team, as well as informatics and IT, were in constant communication and I think for informatics and some of the IT staff we did a lot of things that we never thought we would actually be doing because clinical staff were so overwhelmed with what they were doing they couldn't step aside and really tell us how exactly this should go.
Part of our implementation of crisis standards of care one of the components was cutting back documentation for nursing and this was a huge thing we sat down and decided with some of the clinical leaders what we were going to cut back and how much we were going to cut back. We created a brief admission assessment which cut our real admission assessment down to probably a third of what it normally is to really expedite the process of documentation and give the staff a lot more time at the bedside.
So in doing all of this we updated a policy, we made all these changes and we actually made the changes to existing patients. We're actually updating patient frequencies on interventions on the worklist in real-time because we knew the nurses would not have the time to stop and do this for their patients. So it was something that I don't think we ever thought we would be put in a place having to do but again we just all worked very closely together and I think one thing to point out about Valley is that for us it wasn't a big change because organically we always work so closely together.
Christine: So one of the things we observed about Valley was how active you were on social media during this time disseminating information to your community constantly. Can you step us through your strategy and any feedback you received back from your community?
Chris: The focus was on transparency and frequency. We wanted to make sure that we were giving the community accurate and timely information as best that we could. We also wanted to reassure the community that it was still safe to come to the hospital for non-COVID-related issues. We were concerned that people were going to stay away and that was a worry for us because we wanted to make sure that we were still a fully functional community hospital. We also used it as a platform to ask for help from the community and the response was overwhelming. We had PPE donations, we had people sewing masks, they would come to our facility and they would pick up the materials, and then they would come back with sewn masks for us. We had a lot of the local businesses donating food.
As we started to thank people on social media it encouraged more people to reach out and help us and I think we really needed that at that point. It was also an excellent way to bring the community together and kind of just show that gratitude and tell stories to motivate people to continue to follow the guidelines, to make sure they were staying healthy, staying safe, and one of the things that we actually did was we would show the videos from when we had the drive-bys. We would publish those or when we had clap-outs for certain patients.
Alicia: There was a COVID hotline that was started by Valley to again help the community and it was publicized that you could call with any COVID questions, we would help you out and so myself and my team included would take turns staffing this hotline as well as other nurses from other areas that were able to be pulled to do this. And what we would do is if a patient called we'd answer their questions and especially if they had certain symptoms we'd be able to do a nice warm handoff with our access team that could actually set them up with a telehealth visit to be seen and potentially tested and treated. So it was a really nice interesting experience to be part of. I never thought that I would be triaging patients on a COVID hotline but it's just one of the many things that you know Valley really felt it was important for the community to feel supported through the entire thing.
Christine: You know, that's great! With the COVID hotline and specifically during this time there was a lot of disinformation. What did you introduce to support staff morale at the height of the pandemic to alleviate the stress that you were probably experiencing?
Chris: So we had started what was called a resilience lounge and this was done by the pastoral care department and some of the social workers to kind of give the staff the ability to voice their concerns and just talk about what was going on. We also had a couple of our physicians do different presentations, we had one that was doing meditation. So they would do recorded meditation for the staff that they could either do, she had them live or you could watch them after if you didn't have that time. We had our CNO and our infection control group do a few live events for the staff to kind of give them information about what was going on, where we were, again the transparency, and also to let them know that we were all in this together. How things were going good or bad and I think that was also important for the staff to kind of hear that from the executives.
Alicia: In addition to those resilience lounges, there were programs that you could sign up for. Valley gave us actual resilience PTO time so it was hours of PTO time that you could take just to take off if you needed a break. We actually have two designated holistic nurses and they pretty much went around on the units and just did whatever they possibly could to try to alleviate some of the stress.
In addition to these resilience lounges, they also would do an overhead every morning of a quote or some kind of mindful passage to really just start off the day in a good place. One thing that when I would round in the hospital as well myself one thing is that the nurses also felt extremely isolated because especially in these units nobody wanted to go into the units. So these nurses really didn't see people, it was just the staff and the patients. The patients had no families. So it was also very isolating so a lot of the leadership at Valley really took an initiative to get out there and go on the units. How are you doing? What can we do for you? What should we do differently? And just get all of that feedback which I think is a huge deal which I don't know if other areas were doing that.
Christine: I love the fact that your administrative team came out and that's leadership, that's showing that you're in the trenches along with your front line workers. So now that the vaccine has arrived how are you handling the demand?
Alicia: We have daily calls and there's teams daily that discuss the vaccines infrastructure as far as administering 4,000 per day so we're really only limited by the supply. We're really trying to be a mega center for the community and getting all these vaccines out there. One of our food service areas in the beginning called Kurth Cottage was actually converted into an area to administer the vaccine. We started off using it for our employees and staff and then it kind of grew into a clinic for a while until everything shifted more to our mega site at our 599 building.
Christine: So what are you going to carry forward into the future work-related?
Alicia: I would say that we cut back documentation and I think that if anybody is aware of what's going on right now there is a huge focus on burnout and studies have shown that documentation burden is a direct indicator of clinician burnout and it's a huge problem.
For me, I'm going on a personal crusade to really try to cut back on the documentation for clinicians, do it in a more effective way, try to cut back where we can because I truly think that if they have less to document they're really going to have more time at the bedside. It's going to make them feel better because really you didn't get into nursing, you didn't become a physician to document on the computer, you did it to take care of patients.
So I think if that's one thing to take away is that listen, we could function on less documentation. So why do we need to put it all back in the future? That's definitely one thing I think that you know we've taken out of the process plus, we can do things a lot faster than we thought we could. And personally, I'm just thankful that I had a job through all of this and I had meaning and I felt that I was really trying to help as much as possible the clinician’s so that they could take care of the patients.
Christine: It's great to hear you will both be presenting at the MEDITECH Nurse Forum in June. I think we've all found value in collaborating and learning from one another during these times. What are you most looking forward to at the Nurse Forum and what do you hope others will take away from your presentation?
Alicia: I think that in the Nurse Forum I'm always excited to see what everyone else is doing because we all have the same challenges or even different challenges and we all sometimes tackle it a little bit differently with all the same functionality that we have. So it's always nice to see what others are doing that might help us out. That's usually what I'm excited to see or anything that's brand new that's coming out that somebody's tried to see how they're doing with it.
As far as takeaways, I think that the biggest thing that I would like everyone to take out of it is that you can use this or try to use this for other tools. It's not just a fall risk tool, try to apply it to any of those other clinical tools where you know a lot of this data is already living in the record. Try to use this not only to get things probably more accurate sometimes than the documentation but it also might help to decrease documentation burden. It definitely was something that helped decrease even if it was just a little, little bit. The documentation burden for the nurses at least on one assessment but if you do this for multiple tools eventually it's going to add up.
Chris: I've adapted a lot of the stuff that I've learned from other sites. It's good to see what other people are doing. Are we on the right path? Is everybody having the same issue?
Christine: Well, we're looking forward to seeing you virtually and I have to say we've actually grown our numbers by having it available virtually. I always end our podcast with a unique question that I pose to you. So Alicia I'm going to start with you. What is the first vacation you're planning to take once you have a bit of downtime and can step away?
Alicia: I think the first thing that we're planning to do is probably near the end of August, usually every year we go to the beach for a week and it's all of my family. We all come down, we get a condo everybody's there and it's great. We couldn't do it last year, just trying to get out because I don't know about you but I haven't gone or done anything for over a year now.
Christine: Well, there's been family members I haven't seen for a year so I’m sure that's going to be very special for you. So, Chris, I'm going to change it up on you. I’m not a big reality tv show fan these days but I love Hell's Kitchen and yes I could never work for Gordon Ramsay. I want to ask you what is the tv show that you're hooked on that you can't get enough of?
Chris: So I'm also not a big reality tv show fan but I’ve also been watching Hell's Kitchen and Kitchen Nightmares. Actually, I’ve been watching both of his shows kind of back and forth because they came up on my recommendation and I figured why not? And from watching that yeah, I could never work for him but also I am fairly certain that I do not know how to cook. I thought I did! I thought I knew how to cook at the very least a little bit but then from watching this apparently not! Apparently not!
Christine: Same here! I'm still trying to work on that plating.
Oh, this was fantastic! So thank you very much for joining us, Chris and Alicia. This was a great discussion and you should be proud of your staff at Valley Hospital for beating this extraordinary challenge. We look forward to continuing this conversation and hearing even more about your surveillance strategy at next month's nurse forum.
Thanks for listening next time we'll talk with Ontario Shores Center for Mental Health Sciences in Canada to hear how they are supporting mental health initiatives. Stay informed and subscribe to MEDITECH Podcasts and be sure to check out our resource page for links from this episode. We'll talk to you next time!