Doling out healthcare over the phone
In a bunker-like former bank office near Tacoma’ Hilltop neighborhood, 200 doctors, nurses and medical-technology workers spend their days treating scores of hospital patients they never meet.
Their daily work is what CHI Franciscan calls a “virtual hospital” where a dizzying array of patients’ pulse-rate monitor data, webcam conversations with bedbound patients and complex medical charts flash by in real time from seven hospitals across the South Sound, from Silverdale to Enumclaw.
This, hospital officials said, adds vigilance to inpatient stays and other hospital care. It also removes waiting time from many kinds of consultations, from urgent care to prolonged treatments.
“We really envision a future where patients will be able to have the care they need, just exactly when they need it,” said Jessica Kennedy-Schlicher, a CHI Franciscan family-medicine doctor.
Not everyone loves the idea of augmenting regular hospital staffing with computers, cameras and remote operators. If you’re a patient at a CHI Franciscan hospital, critics note, the nurses and doctors you see might well be getting notes on your condition from medical staff members quite far away.
Over the last five years, the nonprofit has turned KeyBank’s former national call center on South State Street into a hub for close patient observation, from intensive-care scrutiny to simply making sure vital signs remain steady.
In a large central room in the Tacoma building, cardiac monitors for scores of patients pulsed on screens watched by a battery of observers who turn a warning signal on a vital-signs monitor into an instant dispatch to the hospital floor.
A few yards from that, “virtual companion” workers watch, listen and check in via two-way speakers with a half-dozen patients via hospital-room cameras. Consider this the high-tech version of the attention patients in decades past got from one-per-room hospital sitters.
Damaris Muita, one of the virtual care assistants, took a moment away from the screens to discuss her interaction with a patient who kept getting out of his bed, apparently aimlessly.
“He just wanted someone to talk to him,” Muita said.
This is the latest incarnation of the technology-aided “telemedicine” movement hospitals and clinics nationally use to check out a rash or converse with a specialist via a smartphone or laptop.
Although the region’s medical providers provide some form of remote medicine, the CHI Franciscan virtual hospital is unique locally for how it has moved inpatient monitoring away from existing hospital buildings.
It is among a few similar setups nationally, including a four-story suburban St. Louis facility built as “a hospital without beds” to support 34 hospitals, as well as in-home patients.
“Heck, you can rent an office in an office park somewhere,” said Doug Upson, Providence Health’s cardiovascular services director for southwestern Washington. “It’s all technology now. It takes connectivity, and that’s about it.”
Varying telemedicine programs are run at other area health-care providers.
Providence, which operates St. Peter Hospital in Olympia, has operated remote consultations among stroke victims at rural hospitals and centrally located neurologists for six years.
MultiCare in Tacoma has a range of telemedicine services, mostly for in-home patients, as well as remote diabetic and behavioral-health inpatient monitoring.
At Madigan Army Medical Center at Joint Base Lewis-McChord, pediatric cardiologists work remotely with pediatricans in far-flung Alaska and California base hospitals to give a heart screenings to infants a handful of times a month.
“We tell them if they need followups or everything looks normal,” said Matthew A. Studer, deputy pediatrics chief at Madigan, “and you don’t have to put that baby on an airplane and send them four hours away.”
The CHI Franciscan facility in Tacoma is unique for the region for consolidating inpatient medical facilities from hospitals with hundreds of patients into one spot. CHI Franciscan officials say the Tacoma center adds a layer of attentiveness to patients’ needs without reducing the number of nurses working hospital patient rooms.
The arrangement can mean quicker help than a nurse making rounds on a floor’s worth of hospital rooms can provide, said Laura Meacham, director of the CHI Franciscan facility. The technicians and nurses behind the monitors can cover for each other in breaks without pulling a nurse away from patients, she noted.
“We do have more eyes on them and can advocate for them a little bit more,” Meacham said.
A CHI Franciscan spokesman could not answer how much it cost to set up the virtual hospital. He said the movement of hospital nurses to the virtual hospital’s ICU doesn’t affect nurse staffing levels at any hospital.
The union that represents nurses and other caregivers at CHI Franciscan St. Joseph’s Medical Center in Tacoma took out a newspaper advertisement this month objecting to the substitution of remote monitoring for an in-room sitter.
“If you wake up in the hospital, what would you want next to you — a caregiver or a surveillance camera?” the ad says.
Suzi Powell, a certified nursing assistant at St. Joseph’s, said the “virtual companion” program could be disorienting to a patient who hears instructions over a speaker without anyone in the room. A sitter can also prevent a patient from pulling out tubes, she said.
“If I had a family member that was confused for some reason already, I wouldn’t want a weird voice telling them to get back to bed without seeing someone say the words,” Powell said.
Officials said it brings some efficiencies to the central operation. The doctor in charge of nighttime oversight of the chain’s intensive-care patients can check on all of them from the charts and monitors in central Tacoma instead of driving among hospitals, for example.
During the day, intensive-care nurses with hospital experience cycle through reviews of patient charts and talk with floor nurses to go over patients’ progress, lab results and other technical information.
On a recent afternoon, the virtual hospital’s intensive-care nurse Shannon Zawilski was looking in from her desk on 62 patients across CHI Franciscan’s system.
“They catch some things that the bedside nurses may miss,” said Lana Adzhigirey, CHI’s care transformation program manager, “just because they are taking care of more than one patient at a time.”