Building A Virtual Nursing Team: Implementation of the Advance Alert Monitor


Laure E Lisk, RN, MS, CPHQ, CPHRM; Elizabeth Scruth, RN, PhD, MPH, CCNS, CCRN, FCCM; Vanessa Martinez, MSN, MPH, RN; Bronwyn Cox, MSN, RN; Kris Wilson, RN, MSN, CPHQ

Abstracts from the Kaiser Permanente 2019 National Quality Conference

From Northern California

Background: Implementation of the Advance Alert Monitor (AAM) program has allowed us to create and to operationalize a virtual nursing care team that provides 24/7 support and consultation for inpatient adult medical/surgical population. The program comprised more than 30 critical care-experienced registered nurses with postgraduate education and leadership skills. Regionwide adoption of the AAM program resulted in the need to develop the infrastructure to manage a series of complicated workflows that ensure systematic implementation and feedback mechanisms for the virtual team.
Methods: Virtual team development began in July 2016 concurrently with the AAM pilot implementation at a single medical center. A small nursing team was formed to provide oversight up to 16 hours per day. Additional AAM implementation occurred throughout 2017. Significant staffing increases supported 24/7 monitoring beginning in October 2017. Full implementation to all 21 facilities will be completed by December of 2018. The virtual team developed structured work processes and communication techniques to build best practices and enhance their relationship with the hospital-based team, composed of the hospital-based specialist, rapid response team nurse, and leadership; this was paramount to the success of our team.
Results: Recent data released by Gabriel Escobar, MD, and the Department of Research revealed a statistically significant reduction in hospital and 30-day mortality rates for the patients who triggered the early-warning alert relative to a similar patient population at hospitals without the intervention. AAM has proved its ability to predict patients who may decompensate within a 12-hour time frame since 2017. Creation and continual evaluation of a sustainable workflow, virtual team growth to accommodate 24/7 coverage, and meeting rigorous timelines have been significant milestones throughout 2017 and 2018. We also simultaneously transitioned our program from a Web-based application to a dashboard built within our own electronic medical record system (Kaiser Permanente HealthConnect).
Discussion: Some key identified areas for successful team engagement include developing clear communication techniques, a rhythm within the team including regularly scheduled meetings, and leveraging available technologies. A shared leadership model, which creates opportunities to involve others, has been shown to increase engagement. When creating a clinical virtual nursing team, professional experience is essential, and the ability to use critical thinking skills and independent decision making is paramount. Specific competencies required for these nurses include technical training, critical thinking, and problem-solving skills, additionally, interest in looking to future opportunities, willingness to change, and a passion for providing safe care for our members.

Abstracts from the Kaiser Permanente 2019 National Quality Conference


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