Getting the Full Picture: Nurses Find Ways to Incorporate Telehealth Video Visits to Enhance Telephone Triage to Homebound Patients

Research purpose: To utilize office-based nursing staff at a home-based primary care program to pilot use of video visits to enhance telephone triage for homebound patients.
Background: Office-based nursing staff are the initial responders to urgent clinical calls coming into the practice at a large home-based primary care program in New York City. Despite thorough telephone triage, sometimes the clinical picture isn’t fully clear. In order to gather the pertinent clinical information necessary for care planning, the MSVD nursing team initiated the use of video visits into their practice, with the objective of enhancing telephone triage with visualization of the patient. Grant funding was received for a telehealth project in 2020, which included over 100 tablets with 4G connectivity given to patients and introduced two community health workers (CHW) to the program. CHWs made home visits with tablets to facilitate video visits. In response to this new resource, our office-based nursing staff decided to launch a pilot project with the goal of completing same-day video visits for patients who called in with clinical changes where telephone triage alone was not sufficient.
Methods: Retrospective chart reviewed (n=97) analyzing six months of data from January 2022- June 2022 of the patients who received a video visit by the nurse. Quantitative and qualitative data was obtained. Interdisciplinary staff huddles were performed to discuss reasons and triggers for visits and resulting outcomes and benefits.
Results/findings: The most common reason for visits was wound or skin lesion assessment (39.6%), but nurses also performed visits for respiratory assessment (16.8%), heart failure (3.1%), blood pressure monitoring (7.3%), post-fall assessment (1.0%), medication reconciliation (2.1%), and transitional care (19.8%). 61% of the video visits were completed on the same day as the urgent clinical call came in. Nurses noted a broader usefulness of video visits beyond physical assessment including medication reconciliation and transitional care calls. The CHWs were able to assist with technological support, obtaining vital signs, photographing wounds, reconciling medications, and assisting with home environment assessments.
Conclusion/implications: Facilitating video visits may be part of the expanding role of CHWs. Nurses’ innovative use of technology has enhanced the quality of nursing assessment and could be applied to a variety of nursing settings. Telephone triage nursing is a growing field, and adding video visit capability when appropriate could be beneficial for patient care. In this project, nurses intended to address clinical calls with rapid deployment of video visits for timely treatment planning and optimization of care, but we found that video visits can have a broad usefulness in nursing practice including patient education, assessment of home environment, and transitional care management.