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      Remote telemonitoring is associated with improved patient safety and decreased workload of nurses

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          Abstract

          Objective

          There is significant interest in exploring new technologies to improve efficiency and work-life quality for nurses. We aimed to evaluate the impact of a remote video monitoring (RVM) solution that provides continuous in-hospital patient audio-video (AV) monitoring by technicians.

          Methods

          The RVM system that we developed, consisting of 2-way AV communication and a continuous O 2 saturation monitoring device, has been deployed in all inpatient units within our hospital network, including 3 acute care hospitals and 2 rehabilitation facilities. Data were collected before and after implementation on safety measures including fall rates and adverse events, along with device utilization and number of escalation events requiring nursing intervention. Nurse job satisfaction was assessed with surveys.

          Results

          Data were collected from April 2020 to May 2022. A total of 2087 patients were monitored at 5 hospital sites. The technicians identified 54,716 safety concerns that required them to intervene remotely and address with the patient. Of these, 46,289 required escalation of nursing staff, who were called to the bedside through the RVM alerting technology. Importantly, 8427 safety concerns were managed solely by the technicians without the need for nursing intervention, resulting in 8427 avoided nursing visits to the bedside. The surveyed nurses reported that the RVM technology provided reassurance that additional support was available to assist them in managing their patients. Patients and their families also expressed high degree of satisfaction. Since implementation, the rates of falls and other adverse events have been reduced, with the greatest impact in patients on high-flow oxygen. Code blue and mortality rates decreased from 7% to 1%.

          Conclusions

          The use of RVM has proven to be a successful innovation at our hospital and has led to improved patient safety. RVM was able to reduce 8427 individual nurse visits to the bedside, allowing nurses to manage the care of patients more effectively while improving both patient and staff satisfaction.

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          Most cited references12

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          The association of registered nurse staffing levels and patient outcomes: systematic review and meta-analysis.

          To examine the association between registered nurse (RN) staffing and patient outcomes in acute care hospitals. Twenty-eight studies reported adjusted odds ratios of patient outcomes in categories of RN-to-patient ratio, and met inclusion criteria. Information was abstracted using a standardized protocol. Random effects models assessed heterogeneity and pooled data from individual studies. Increased RN staffing was associated with lower hospital related mortality in intensive care units (ICUs) [odds ratios (OR), 0.91; 95% confidence interval (CI), 0.86-0.96], in surgical (OR, 0.84; 95% CI, 0.80-0.89), and in medical patients (OR, 0.94; 95% CI, 0.94-0.95) per additional full time equivalent per patient day. An increase by 1 RN per patient day was associated with a decreased odds ratio of hospital acquired pneumonia (OR, 0.70; 95% CI, 0.56-0.88), unplanned extubation (OR, 0.49; 95% CI, 0.36-0.67), respiratory failure (OR, 0.40; 95% CI, 0.27-0.59), and cardiac arrest (OR, 0.72; 95% CI, 0.62-0.84) in ICUs, with a lower risk of failure to rescue (OR, 0.84; 95% CI, 0.79-0.90) in surgical patients. Length of stay was shorter by 24% in ICUs (OR, 0.76; 95% CI, 0.62-0.94) and by 31% in surgical patients (OR, 0.69; 95% CI, 0.55-0.86). Studies with different design show associations between increased RN staffing and lower odds of hospital related mortality and adverse patient events. Patient and hospital characteristics, including hospitals' commitment to quality of medical care, likely contribute to the actual causal pathway.
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            Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction.

            The worsening hospital nurse shortage and recent California legislation mandating minimum hospital patient-to-nurse ratios demand an understanding of how nurse staffing levels affect patient outcomes and nurse retention in hospital practice. To determine the association between the patient-to-nurse ratio and patient mortality, failure-to-rescue (deaths following complications) among surgical patients, and factors related to nurse retention. Cross-sectional analyses of linked data from 10 184 staff nurses surveyed, 232 342 general, orthopedic, and vascular surgery patients discharged from the hospital between April 1, 1998, and November 30, 1999, and administrative data from 168 nonfederal adult general hospitals in Pennsylvania. Risk-adjusted patient mortality and failure-to-rescue within 30 days of admission, and nurse-reported job dissatisfaction and job-related burnout. After adjusting for patient and hospital characteristics (size, teaching status, and technology), each additional patient per nurse was associated with a 7% (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.03-1.12) increase in the likelihood of dying within 30 days of admission and a 7% (OR, 1.07; 95% CI, 1.02-1.11) increase in the odds of failure-to-rescue. After adjusting for nurse and hospital characteristics, each additional patient per nurse was associated with a 23% (OR, 1.23; 95% CI, 1.13-1.34) increase in the odds of burnout and a 15% (OR, 1.15; 95% CI, 1.07-1.25) increase in the odds of job dissatisfaction. In hospitals with high patient-to-nurse ratios, surgical patients experience higher risk-adjusted 30-day mortality and failure-to-rescue rates, and nurses are more likely to experience burnout and job dissatisfaction.
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              The effect of nurse-to-patient ratios on nurse-sensitive patient outcomes in acute specialist units: a systematic review and meta-analysis

              Nurses are pivotal in the provision of high quality care in acute hospitals. However, the optimal dosing of the number of nurses caring for patients remains elusive. In light of this, an updated review of the evidence on the effect of nurse staffing levels on patient outcomes is required.
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                Author and article information

                Contributors
                Journal
                JTCVS Open
                JTCVS Open
                JTCVS Open
                Elsevier
                2666-2736
                20 September 2023
                December 2023
                20 September 2023
                : 16
                : 493-497
                Affiliations
                [a ]Division of Thoracic Surgery, Sprott Department of Surgery, Toronto General Hospital, Toronto, Ontario, Canada
                [b ]Trinity College, Dublin, Ireland
                [c ]Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
                Author notes
                []Address for reprints: Marijana Zubrinic, RN, NP, Division of Thoracic Surgery, Sprott Department of Surgery, Toronto General Hospital, 200 Elizabeth St, 9N-946, Toronto, Ontario, Canada. marijana.zubrinic@ 123456uhn.ca
                Article
                S2666-2736(23)00282-6
                10.1016/j.xjon.2023.09.014
                10775035
                300af067-73d0-4b1b-ae60-9bd01a0a6d18
                © 2023 The Author(s)

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 25 May 2023
                : 30 August 2023
                : 5 September 2023
                Categories
                Adult: Perioperative Management

                healthcare efficiency,job satisfaction,nurse workload,patient safety,perioperative management,remote monitoring

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