The Guthrie Clinic is a not-for-profit health system designed to provide patients in rural New York and Pennsylvania with a full range of healthcare services, including primary care, behavioral health services, surgical services, residential care and more. And it has implemented artificial intelligence to reduce nurse turnover and overtime, improve care quality, reduce costs and improve access to care.
THE PROBLEM
The Guthrie Clinic serves a predominantly rural community covering 9,000 square miles in parts of New York and Pennsylvania. Ensuring equal access to healthcare across such a large region can be difficult, and this challenge has been even greater during the COVID-19 pandemic. During this time, the healthcare system has suffered the loss of many workers and is in an area where it is already difficult to recruit.
“That’s why we decided to look for new models of care that would allow us to use technology to expand access to care, regardless of where staff or patients are located,” said Terri Couts, RN, senior vice President and Chief Digital Officer of Guthrie Clinic. “The idea behind this initiative was that no matter where the patient is, we have the ability to provide the right level of care at the right time where the patient needs it.
“This way, patients would not have to travel hours to receive care or be transferred to facilities outside of their community, which would require their families to travel to see them,” she continued. “The bottom line is that we needed to rethink our current models and innovate to maximize our resources through the use of technology and redesign of current processes.”
SUGGESTION
The Guthrie Clinic entered the AI space somewhat hesitantly, wanting to demonstrate return on investment. The choice was made with Artisight, provider of a platform that leverages ambient AI that sees, understands and augments clinical activity in real time by combining computer vision and sensor network technology.
“We started with telesitting,” recalls Couts. “During the pandemic, we have found it difficult to provide all of our patients with sitters, a safety measure for patients at high risk of falls. Traditional sitting involves putting a person in a room with a patient to get the patient to stay in bed, but that requires a lot of resources and takes the extra hands off of other bedside nurses.
“This technology really makes a difference for our organization.”
Terri Couts, RN, Guthrie Clinic
“During that time, we paid extra for staff to care for the patients, and even then we still didn’t have enough caregivers to go to all the patients,” she said. “The costs rose rapidly.”
Guthrie Clinic used AI technology to convert this 1-to-1 session into a virtual seating model to achieve the 1 to 14 ratio, meaning one sitter can now safely monitor 14 patients.
“This project wasn’t just about adding a camera and speaker to the room, but the hardware was also on the AI-driven platform,” she explained. “As a patient moves around the room, the AI technology in the camera alerts the telesitter of activity in the room that requires intervention. The telesitter can interact directly with the patient or ask an on-site nurse for assistance.”
“Overall, technology has allowed us to move those 1-on-1 sessions and allow those staff to be back at the bedside and providing direct care to patients,” she continued. “We document everything and place orders in the EHR so we understand who is caring for patients and other elements related to patient care.”
STAND UP TO THE CHALLENGE
The health system has expanded the program into what it calls a “virtual command center.” It is a central command center, not associated with any hospital, that allows staff to monitor the pulse of the organization.
The center features virtual sitting, a central transfer center, virtual telemetry monitoring, virtual nursing and an EICU component. This was founded last year and the organization plans to expand the services in the future.
“It will really be our virtual hub for the way we care for patients and manage resources, whether it’s beds, staffing or the ability to transfer patients,” Couts said. “The command center helps us coordinate everything to make virtual care models work alongside day-to-day operations and collaboration in the same space. We have also integrated the technology into our hands-free communication devices.”
RESULTS
The Guthrie Clinic has virtual critical care nurses supporting care in the facilities. After the pandemic, the average length of service in intensive care units was three to five years, which is critical.
“Nurses’ sense of caring for patients was lost because there was a large exodus of nurses,” she remembers. “With this technology, we were able to reduce our turnover rate from over 25% to around 13%. This reduction in turnover also results in cost savings in the form of contract bonuses that we would pay out to new employees.
“We were able to look at metrics on how much time nurses spend in the EHR system per shift,” she continued. “These administrative tasks increase caregiver burden and feelings of burnout. Using this technology, we were able to reduce the time spent in the system from approximately 160 minutes to 126 minutes, a saving of more than 30 minutes per shift. That’s a big difference that’s important to our caregivers.”
Such results illustrate why nursing staff satisfaction is enormous, she emphasized.
“In addition, we have reduced the number of care travelers by 82 for the 2023 financial year,” she reported. “That’s a significant cost savings of about $7 million. There are no more travelers in our intensive care units. Travelers serve a purpose, but are not a sustainable long-term model for two specific reasons: cost and commitment to the organization and the patients they serve.”
“We also measure things like the number of referrals we have accepted from outside organizations,” she noted. “We lost about 50 transfers a month because we didn’t have the right support. Thanks to this technology, we are now able to accommodate these patients, which also contributes to our bottom line.”
The other thing that the healthcare system measures is quality outcomes, such as metrics around sepsis and ensuring that the organization stays within the sepsis packages to ensure that it receives the reimbursement it deserves for the work it does earned.
“Our virtual nurses are like a conductor of an orchestra,” she explained. “They help ensure that documentation is timely and that impacts in the package are minimized by ensuring that timed tasks are completed.”
“This technology is truly making a difference to our company and we are receiving third-party validation of its importance,” she continued. “We are proud to have won ECRI 2023 Health Technology Excellence Award for the implementation of AI-controlled telesitting.”
ADVICE FOR OTHERS
“AI is a big buzzword right now and there are many vendors offering AI-like products,” Couts said. “Before you launch anything, it’s important to identify the problems you want to solve and understand whether the technology can help you address more than one use case.
“In a world where healthcare is facing financial challenges, health technology leaders launching AI products need a provider that will work with them to address all the challenges we face,” she continued.
Today, Guthrie Clinic is looking to add technology where its EHR has gaps, and one of those technologies is AI.
“So we’ve expanded the AI suite and it’s a real platform that allows us to scale the use cases we need,” she said. “In our case, we experienced such a significant workforce exodus that virtual care and sitting were the most pressing needs.
“We were able to implement that pretty seamlessly and then move on to other use cases, such as protecting staff from violence,” she concluded. “It’s very important to understand not only what your use case is today, but also where you want to go in the future so that you don’t get stuck on a platform that you can’t optimize. The system we have implemented is truly a comprehensive intelligent hospital platform.”
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