In the United States, over 80,000 people die from opioid overdoses each year; this is an exponential increase from the 20,000 opioid-related deaths reported in 2010.1 It is estimated that more than 2.1 million people had an opioid use disorder as of 2017, and that number is expected to grow.2 Even more concerning, opioid-related deaths and opioid use disorders are estimated to cost the US over $1.2 trillion.2 Almost $35 billion of costs are related to healthcare and opioid disorder treatment every year.2 Thus, in addition to treating opioid addiction, prevention of opioid misuse has become a focus of public health.  Hospitals are at the forefront of this battle against opioid addiction. For many people with substance abuse disorders, their first use of an opioid occurs in a hospital or clinical setting. Opioids are initially prescribed to assist with pain from an injury or other medical condition. Initially, high doses of opioids may be necessary due to critical pain; however, the reduction of pain medication may not occur in an effective manner or at all. Further, many physicians who prescribe opioids for the initial injury are not pain management specialists, and they may not be aware of multimodal pain management strategies.3...

You may have heard of virtual nursing, and it is a rapidly growing field that offers many benefits for patients, nurses, and healthcare systems. Today’s nursing workforce needs to provide a higher level of care to a more significant number of patients. This increased workload has resulted in higher levels of burnout and staff turnover. As healthcare demand continues to rise, virtual nursing is a tool to expand the reach and capacity of the healthcare system. Importantly, telemedicine itself is not new to nursing. The first telenursing standards were published in 2001 (American Academy of Ambulatory Care Nursing).1 By leveraging the advantages of advanced software and communication technology, virtual nurses can help increase access to medical care, reduce costs, and improve patient and healthcare provider satisfaction. Increased Access to Care Those living in rural or underserved areas have limited access to essential care services. Since the pandemic, telemedicine use has exponentially increased, and healthcare access in rural communities has improved. As the adoption of digital technology grows, the number of patients wanting or needing virtual care has also increased. Today, virtual nursing is used for both remote medicine as well as in-hospital monitoring and consults. Virtual nurses can assist with initial visits,...

Improving patient outcomes and reducing healthcare costs are key goals of any healthcare organization. Critical condition monitoring (CCM) and clinical intelligence (CI) are two essential tools that can contribute to an organization’s quality improvement efforts. CCM involves the continuous monitoring of patients' vital signs and other physiological parameters to assess the risk level of patients. CI refers to the use of advanced analytics and machine learning to identify patterns and alert clinical teams as soon as a patient is at risk. By combining CCM and CI, clinicians are better able to care for a larger number of patients, focus their attention on at-risk patients and make evidence-based decisions in real time. To embrace the true potential of this technology, hospital systems should take five critical steps. Implement Real-Time Monitoring:CCM technology uses advanced algorithms to analyze real-time data from the EHR and other medical devices, and alert teams when subtle changes are detected. CCM assists the clinical team (including the Rapid Response Teams[1] [2] ) with access to real-time, actionable information in multiple clinical settings including emergency departments, intensive care units (ICU), and general hospital floors, etc.The use of real-time monitoring can help reduce the risk of complications, thereby reducing the need for more...

In 2009, the Health Information Technology for Economic and Clinical Health Act (HITECH) was passed by the United States Congress to “promote the adoption and meaningful use of health information technology.”1 The legislation incentivized providers and institutions to adopt the use of electronic health records that provided advantages, such as increased availability and transferability of information and legibility.2 However, like most technology, medical software has exponentially grown in capability and application. While not all systems are equal, the increased adoption of healthcare information technology has been universal, and most advanced health care teams now use clinical decision support (CDS) systems. Broadly defined, CDS systems use technology, clinical evidence, and real-time patient data to support health care team decisions. The system integrates relevant patient information from multiple sources of patient data and provides real-time outputs to the clinical team. Integration of CDS with the clinical workflow can improve the quality and safety of patient care. A CDS system can also incorporate predictive analytics and machine learning algorithms to help providers identify potential risks and make more informed decisions. They can provide alerts, reminders, and suggestions for clinical decision-making, such as recommended medications, dosages, or diagnostic tests. In fact, multiple studies have shown...

Hospital or clinic visits can inspire anxiety, fear, or dread in many people. A clinical environment can provide an unsettling atmosphere as many do not have extensive knowledge or experience with medical situations. In fact, many people suffer from white-coat syndrome wherein individuals experience a temporary rise in blood pressure in clinical settings. Often, patients and family caregivers are overwhelmed by the stress of the situation, which can make understanding and processing massive amounts of complex medical information extremely difficult. Thus, clear communication between the clinical team, patient, and family caregivers is at the core of the ideal patient experience and outcome.  It is critical that medical communication is family-centered. Family members of patients often wish for up-to date information and details regarding their potential roles in care plans during and after hospital visits.1,2 To avoid misunderstandings concerning treatment, follow-up instructions or the severity of a patient's condition, clinical teams must prioritize effective communication strategies that educate the entire family.3 Counseling patients and families on current care and postcare plans cultivates open communication and transparency, which can be fundamental to a full recovery.4  Involving family members also allows the counseling to be more reflective of a patient’s current life situation. This...

Treating patients virtually is an increasingly effective and cost-saving trend in the healthcare world. In particular, remote patient monitoring (RPM) is transforming preventive healthcare and certain outpatient services. RPM uses digital technologies to monitor and collect medical data from patients outside of a hospital setting.1 This data is relayed to healthcare providers who will assess and implement further action if needed. Multiple devices are often used with RPM systems, such as blood glucose and blood pressure monitors, pulse oximeters, and other specialized tools for recording health data.  During the COVID-19 pandemic, significant updates on how providers and institutions can be reimbursed for RPM services were enacted. As a result, more institutions can now utilize remote care options.2 By using RPM, patients and providers reduce their disease exposure risks by limiting direct contact. RPM services also ensures a reliable method of contact when travel is restricted, such as what was seen during lockdown periods. Further, an advantage is gained by using RPM, because the patient is continuously monitored as compared to the traditional method of office visits, where health data are only spot-checked. As a result of the success of RPM programs during the pandemic, coverage of RPM through the Centers for...

The pandemic served as a catalyst for change and innovation in the digital health world and at-home care. The combination of telehealth and hospital-at-home (HaH) services will have lasting positive effects but requires comprehensive and proactive remote technology to provide quality care to patients. With the advancement of technology, more hospitals and physician teams are adopting the HaH model. However, many may ask if it is safe and effective. Thus, we seek to review the latest research on the impact of this healthcare model on patients and policy.  What does acute health care at home look like?  The HaH model can take a variety of forms. It has been primarily used for older patients who meet specific clinical and nonclinical eligibility criteria.1 These patients typically are at low risk of requiring complex technical procedures in a hospital setting but require continuous care and/or monitoring for certain conditions, including pneumonia, congestive heart failure, emphysema, pulmonary embolism, and other treatable conditions.1  Effective HaH models include face-to-face clinical care from nurses and physicians, diagnostic testing, continuous monitoring, and specific treatments, such as administering intravenous medication. The care plan for home-based patients typically includes visits by care providers and is driven by telehealth technologies. Digital platforms allow...

The effects of treatment and recovery in a hospital setting can seem like a cruel paradox. Admission to the hospital is often necessary for certain treatments; however, hospital stays can come with additional risks. It has long been known that hospitalization is associated with adverse outcomes, hospital-acquired infection, and mortality risk.1 Thus, many patients would prefer to receive treatment and recover in the comfort and safety of their own homes. As a response to these risks, hospital-at-home (HaH) programs have been created to allow for necessary treatments for acute conditions to be done in patient homes. Such a model demonstrates a patient-centered approach to care and has been increasingly adopted in multiple fields of medicine. In fact, implementing at-home hospital services is one of the most extensively-researched reforms in health care, demonstrating safer, cheaper, and more effective care options for some acute conditions.2 The concept of HaH dates back to the 1970s when clinical trials in the United Kingdom determined that there were no specific benefits of hospitalization over home-based care for patients experiencing myocardial infarctions.3 Hospital-at-home programs have since been implemented in several countries, including the United Kingdom, Canada, Israel, and Australia.4 The United States has previously been slow to adopt...

Today, Rapid Response Teams (RRTs) are a crucial component of many hospitals.  Implementing a RRT was one of the six strategies that defined the Institute for Healthcare Improvement (IHI) 100,000 Lives campaign.  Most RRTs consist of critical care nurses, but they can also include respiratory therapists, pharmacists, and physicians. Research consistently shows that patients exhibit signs and symptoms of deterioration for several hours prior to a code.  These symptoms include changes in vital signs, mental status, and lab markers. The goal of a RRT is to intervene upstream from a potential code.  They reach the patient before deterioration turns into crisis.  This is different than a code blue team that typically responds to a patient that has already decompensated to cardiac arrest. Historically, most hospitals relied on busy bedside nurses to identify crashing patients and call for rapid response.  With most states having no limits on the number of patients assigned per nurse, many medical-surgical ward nurses are caring for 6 or more patients per shift.  Placing this additional responsibility on their already over-flowing plate is challenging at best.  Providing a RRT empowers bedside nurses to trigger an escalation of care earlier and faster.  Measurable Improvement in Patient Outcomes Hospitals using RRTs typically observe...

In medicine, every second counts. A patient can be stable one minute and crash during the next moment. Early detection, timeliness, and competency of clinical response are a triad of determinants that impact clinical outcomes of people with acute illness. Results from observational studies confirm that patients often show signs of clinical deterioration during the 24 hours before a severe event requiring clinical intervention.1  Timely detection of those subtle clinical warning signs has its own set of challenges. When those clinical values (especially vital signs) cross a critical threshold, they usually alert the bedside staff via beeping monitors. Because of the volume of alerts and the mountain of tasks that bedside staff manage, many alarms are simply silenced in seemingly stable patients. Thus, a critical value is often lost and not documented in the EMR system. Documentation of an alert is another task that can be triaged and forgotten. In some cases, especially in non-critical care settings, critical (outlier/severe) values may not trigger an alert, or the vital signs may not be taken as frequently.  Automated capture of vital signs and real-time alerts could reduce the burden on bedside staff while increasing data capture. However, the intense amount and frequency of data...