Nursing Workflow Change in a COVID-19 Inpatient Unit Following the Deployment of Inpatient Telehealth: Observational...

Area of Science:

• Healthcare technology and workflow analysis
• Infectious disease management and patient safety
• Nursing practice and patient care delivery

Background:

• The COVID-19 pandemic accelerated telehealth adoption in hospitals to reduce pathogen exposure and personal protective equipment (PPE) use.
• Nursing workflow adaptations are critical for patient safety, as bedside time is associated with outcomes.
• Understanding telehealth's impact on nurse-patient encounters is vital for assessing patient safety and resource utilization.

Purpose of the Study:

• To evaluate changes in nursing workflow, specifically nurse-patient encounters and time spent, following inpatient telehealth implementation.
• To compare workflow changes on a COVID-19 unit with in-room telehealth to comparison units using mobile telehealth carts.
• To assess the impact of telehealth on nursing time at the bedside relative to prepandemic levels.

Main Methods:

• A real-time locating system (RTLS) tracked nurse movement before and during five pandemic stages (January-December 2020).
• Data analyzed changes in encounter frequency, duration, and total bedside time on a COVID-19 unit versus comparison units.
• Generalized linear models were used to assess differences-in-differences in outcomes between unit types.

Main Results:

• Encounter frequency decreased significantly more on the COVID-19 unit (-6.6 to -14.1 encounters) compared to controls.
• Encounter duration increased significantly more on the COVID-19 unit (1.8 to 6.2 minutes) compared to controls.
• Total nursing time in patient rooms per shift did not significantly differ between the COVID-19 and comparison units.

Conclusions:

• Inpatient telehealth deployment on a COVID-19 unit led to fewer, longer nurse-patient encounters, indicating work redistribution.
• Virtual care appeared to complement, not replace, in-person nursing care, maintaining overall bedside time.
• Further research is needed to establish causal links between telehealth, workflow changes, and downstream effects on patient safety and resource use.