Virtual nurse aims to reduce readmissions after discharge

"Are you a Red Sox fan?" nurse Elizabeth asked her patient with a curious look. "I would really like to see a game someday, but they don't allow computers at Fenway Park."

Elizabeth is a virtual nurse appearing on a screen. Starting a casual conversation, she can gradually explain discharge instructions to her patients, who converse by picking what they want to say in the chat boxes on the right side of the screen at each point of the conversation.

The virtual discharge nurse software is one example of how technology can help reduce 30-day readmissions in hospitals.

Readmission has long been a concern for healthcare providers because these rates impact patient outcomes and potentially reduce reimbursements from CMS. As a focus of inpatient clinical care, readmission comes out on top at 21.6% on the list of "areas most in need of improvement" concerning patient safety, according to a survey conducted by Health Catalyst, a data analytics and decision-support company.

To reduce avoidable return trips to the hospital, one factor to take into account is "effective communication and troubleshooting after the patient has gone home and try to head off problems that might cause complications and lead to readmission," said Timothy Bickmore, a professor at the College of Computer and Information Science at Northeastern University. Although hospitals can track patients' health conditions by text messages and phone calls, these may not be the most effective approaches.

Another effort hospitals could make is to ramp up patient education when they are discharged by employing automated software, in which case a virtual nurse can come into play. Bickmore developed the software behind Elizabeth the virtual nurse, and the program has been trialed at Boston Medical Center.

Elizabeth walks her patients through their discharge process by using sympathetic speech and animation. A typical interaction lasts about half an hour, much longer than the average eight minutes a human nurse spends with a patient on the same process, according to research conducted by Bickmore and Brian Jack, an associate professor at the School of Medicine at Boston University.

"Even for well-educated patients, [eight minutes] is probably not good enough," Bickmore said. "For the one-third of U.S. adults who have low health literacy and difficulty reading medical instructions, they really need a lot more time."

With Elizabeth, patients can choose "Excuse me?" or "Need more information" from the menu and let the virtual nurse repeat or elaborate information they don't understand. The explanation by the virtual nurse can be in great detail for the sake of patient education, which includes the time to take medicine and its dose, how to take it, scheduling follow-up appointments and advice on buying an over-the-counter medicine that could have two different names in a pharmacy.

Virtual nurse software is not only a boon to patients, but also a resolution to nurse burnout.

"[The virtual nurse] would cast the patients' comprehension and make sure they understood certain key information. And then it would print out a list of action items for the human discharge nurse to review afterwards and have more focused conversations with patients about their issues," Bickmore said.

According to Bickmore and Jack's trial of over 750 patients at Boston Medical Center, the software showed a high level of patient satisfaction. When asked whom they would rather receive discharge instructions from, most of the trial patients preferred getting it from a virtual nurse.

Virtual nurse software is not only a boon to patients, but also a resolution to nurse burnout. A randomized trial conducted by Jack in 2009 showed that to significantly reduce 30-day readmissions, a nurse needs to spend on average one hour with each patient explaining the discharge instructions. And shortly after discharge, nurses often need to call their patients to solve additional problems. If hospitals use automated discharge software, human nurses can focus on specific issues patients may have.

Regarding the possible improvements of the virtual nurse software, Bickmore would like to see it provide continuous services to patients at home.

"If we could put it on their smartphones, when they leave the hospital and have questions or problems, they can continue having the conversation. That is, of course, the ideal situation," he said.

Bickmore's software has not been produced commercially, although a couple of IT companies have pulled licenses to use the software.