Rise of the Virtual Nurse.

As the process of providing health care becomes increasingly complex and the foundation of the nursing profession changes, nursing leaders will need to think differently about how to support their colleagues more efficiently and effectively. The role of the virtual nurse is expanding as part of the effort to address these complexities and develop innovative solutions. Although more work is necessary to define best practices in the variations of virtual nursing, current examples have had a positive impact on nursing and patient care. This article describes the ways in which virtual nursing has grown over the years and how it continues to adapt to support the nursing profession.

TeleICU Interdisciplinary Care Teams.

Telehealth in intensive care units (TeleICU) is the provision of critical care using audio-visual communication and health information systems across varying clinical and geographically dispersed settings. The optimal structure of a TeleICU team is one that leverages expert clinical knowledge to address the needs of critical care patients, regardless of hospital location or availability of an onsite intensivist. Information related to the optimal TeleICU team structure is lacking. This article examines the optimal TeleICU team composition, which is one that incorporates the use of an interdisciplinary approach, leverages technology, and is cognizant of varying geographic locations.

TeleICU Interdisciplinary Care Teams.

Telehealth in intensive care units (TeleICU) is the provision of critical care using audio-visual communication and health information systems across varying clinical and geographically dispersed settings. The optimal structure of a TeleICU team is one that leverages expert clinical knowledge to address the needs of critical care patients, regardless of hospital location or availability of an onsite intensivist. Information related to the optimal TeleICU team structure is lacking. This article examines the optimal TeleICU team composition, which is one that incorporates the use of an interdisciplinary approach, leverages technology, and is cognizant of varying geographic locations.

Improved asthma outcomes using a coordinated care approach in a large medical group.

The objective of this study was to review the development of a multidisciplinary asthma disease management program in a large medical group practice in an urban area, and evaluate the impact of the program on processes of care and health care utilization for adults and children with asthma. The disease management intervention included the development of a patient registry, a systematic approach to assessment of asthma control using the Asthma Therapy Assessment Questionnaire (ATAQ), case management, and physician education. An administrative database was used to examine hospital admissions and emergency department (ED) visits. A medical record audit was conducted to examine recorded compliance with asthma guidelines and documentation practices. The baseline study population included 3486 adults and children with asthma. The ATAQ suggested that, at baseline, control problems were frequent, with 34% of adult respondents missing work because of asthma. ATAQ also revealed several areas for care improvement. For example, only 20% of adult respondents reported having a written treatment plan. The chart review and administrative claims analyses showed that the program had beneficial results in several areas. Medical record documentation improved for asthma diagnosis (83.3% vs. 98.6%; p < 0.001) and patient education (15.7% vs. 26.1%; p < 0.001). No improvements were seen in documentation of peak flow ownership/use, smoking cessation advice, or influenza vaccination. ED visits related to asthma decreased from 148 per 1000 to 88 per 1000 (p < 0.001), and hospitalizations related to asthma decreased from 81 per 1000 to 37 per 1000 (p < 0.001). The outcomes suggest that this program was associated with a marked reduction in rates of hospitalization and ED usage for asthma, as well as significant improvement in several essential processes of care.

Process improvement for asthma. An integrated approach.

At least 18 million people in the United States have asthma. Despite the publication of national guidelines, the delivery of care has not substantially changed. This article describes a program at Chicago city sites to improve the delivery of care to adults and children with asthma. Using consistent comprehensive patient education materials, innovative provider education, and a variety of continuous quality improvement interventions including creation of a designated practitioner, this project enhances partnership between patients and health care providers.