The Importance of Having a Licensed Nurse at the Other End of the Line

December 14, 2023 - Amid the workforce shortage in healthcare, nurses are in high demand.

Technology has helped bridge the gap, allowing nurses to serve patients remotely using virtual care nursing or sitting platforms and virtual care supplemental staff. However, these tools still need a person at the other end of the line, and that might be a good thing since many patients still have a preference for in-person care over virtual care, depending on the circumstances.

The question remains: what role should technology play in nursing? Dusti Browning, vice president of growth and client solutions for Conduit Health Partners, addresses this and similar questions in this episode of Industry Perspectives.

Dusti Browning: Nurses most trusted profession. We have a lot of technology, just wonderful things happening, but at the end of the day, they want to speak to someone. They want to have that relationship.

Kelsey Waddill: Welcome to Healthcare Strategies | Industry Perspectives where we dive into several of the conversations that we had with leaders in healthcare technology at the Health 2023 conference in Las Vegas. In January 2023 a Gallup poll found that nurses were the number one most trusted profession in the US...for the 21st year in a row. Technology has ensured that patients have better access to care, but it can never replace the trusted individuals who give that care, often registered nurses. In today's episode, our VP of editorial, Kyle Murphy, chatted with Dusti Browning, vice president of growth and client solutions for Conduit Health Partners, about how to use technology to enhance nurses' capabilities without trying to replace or complicate their roles. Let's listen in.

Kyle Murphy: All right. Well, Dusti, welcome to Healthcare Strategies. Thank you for joining us. Before we get into things, tell me a little bit about your background in healthcare. What's your healthcare story?

Dusti Browning: Certainly, and thank you for having me. I've been a registered nurse for more than 30 years.

Kyle Murphy: Bless you.

Dusti Browning: Started my career in oncology and solid organ transplant. Then moved to transplant specifically for several years before going into leadership roles. So I stayed with the same organization for more than 25 years.

Kyle Murphy: That's commitment.

Dusti Browning: Yes. Before coming to Bon Secours Mercy Health to lead the blood cancer center there. And then joined the Conduit team in 2017 to start the nurse triage program.

Kyle Murphy: So tell us about the triage program and what are some of the basics? What are the people process, technology components that are integral to your success?

Dusti Browning: Absolutely. So people, process. So registered nurses at the start of every call. So one of the things that we pride ourselves that's really a differentiator in the market is when we answer the phone, it's a registered nurse answering the phone. It's not an unlicensed person who's leaving a message or putting something in the queue for the patient to be called back. So our nurses answer the call. We utilize Schmidt Thompson decision support tools to help guide the conversation, to do a telephonic assessment to help the individual calling understand the most appropriate level and location for care.

Kyle Murphy: I guess considering what we know about healthcare literacy, how important is it having a trusted healthcare worker, the clinician, the nurse there to really steer the individual to the right place?

Dusti Browning: Absolutely. So I'm glad that you mentioned that. Nurses: most trusted profession. And individuals have a comfort with speaking to people. We have a lot of technology. This conference is a testament of all the technology out there, just wonderful things happening. But at the end of the day, they want to speak to someone, they want to have that relationship to really help them understand what they need to do.

Kyle Murphy: How do you guys--I guess, when you look at the areas where triaging is most needed, are there certain use cases, are there certain events, episodes in a patient's life that this becomes even more valuable service?

Dusti Browning: Certainly. When you think about the period of time--and I'm going to refer to it as a transitional period--patients who've been discharged from the hospital, they're at high risk for being readmitted if they have certain diagnoses in their history. So having access to a nurse triage line just to help recognize symptoms and give guidance for self-care, very well may prevent an individual from having to return to the hospital.

Also, when you think about new moms, just being able to have that lifeline to run a baby's cry by a registered nurse who can give that reassurance or help them dose a baby with Tylenol. Something as simple as that. It's really full spectrum, triage is very symptom-based. So it's "why are you calling" and "let me help find a solution for why you're calling."

Kyle Murphy: It's amazing to me because transitions of care were something that federal initiatives were really looking at them, but more from a technology standpoint. But when you think about it from the human standpoint, it's an overwhelming experience.

Dusti Browning: Absolutely.

Kyle Murphy: When you move from A to B, and we know, with the older population, sometimes it's to a skilled nursing facility then home or someplace else. There's a lot of information for a human being to try to process and with their care team, family members. I guess just how important is the human element really? I know we talk a lot about tech, obviously, who are here.

Dusti Browning: It's very important. I don't know if you've ever seen what's referred to as an "after-visit summary" or discharge paperwork for-

Kyle Murphy: I get them for my children.

Dusti Browning: So you've seen that?

Kyle Murphy: Yes.

Dusti Browning: There are multiple pages.

Kyle Murphy: Yes.

Dusti Browning: There's sometimes information in there that is--from a regulatory standpoint that has to be there. So that's confusing in and of itself. The medications, ensuring that the medications are listed by the name that the patient knows them as. So there's so many components just to helping an individual understand how to take care of themselves. We overload them with information. It's stressful already. They're coming from a stressful situation of being hospitalized, and then they are either put into a different situation that's equally as stressful or they're at home with all of a sudden all the resources that they've had in the hospital setting aren't there.

And they have three or four physicians to follow up with, trouble getting scheduled, not really understanding... "Before I went to the hospital I had this dose of medication and now I have this dose, which one do I follow? Because my doctor told me to do this, but the hospital doctor told me to do something..." So it's all of that that's really confusing to individuals. So having a nurse line like what Conduit offers is really a safety net from having a negative event because of a, say, inadvertent medication error or something like that, that can happen at the home.

Kyle Murphy: It is interesting because so much is on the patient to adhere to their medications, their care plan, but they're not the licensed professionals.

Dusti Browning: Absolutely.

Kyle Murphy: So it seems like a bizarre pressure.

Dusti Browning: And you have to prepare them. And when you look at all of the stressors inside the hospital, they're focused on length of stay. They're focused on ensuring that they are treating what the patient's there for. Maybe other things go unaddressed. So when the patient goes home, there's still a lot of questions and, unfortunately, the stressors that are put on the frontline staff in the hospitals often lead to inefficiencies or inadequate preparation for the patient once they're home.

Kyle Murphy: How are you guys measuring success? Obviously, there's those quality metrics. If someone's not being readmitted, they don't return to the hospital, that's a win right there. And that's been one of those longstanding measures. But I have to imagine member experience, satisfaction scores?

Dusti Browning: Absolutely. But one of the things that we focus on too is ED utilization. Our clients are really concerned about inappropriate ED utilization. So we share data with them regarding our referrals, and I don't want to give the impression that our team refer inappropriately, because that's not the case. We have high quality standards. Our team is URAC accredited, and we review cases not only to ensure that we're doing what we're supposed to be doing, but also making sure that we take opportunities to incorporate best practice. So, ED utilization, we look at that and then, of course, we gain customer feedback or consumer feedback as well as our client feedback

Kyle Murphy: I'm also curious about are you guys able to identify other potential care gaps? One of the things that we were hearing the past couple of days were just, there's still a large proportion of individuals who don't have a PCP, who don't have have a regular...

Dusti Browning: Absolutely.

Kyle Murphy: ...relationship with a provider. Are you also able to create that feedback loop so that they're not ending in the ED, they're actually reaching out to...

Dusti Browning: Absolutely. When individuals have access to our line, we serve a variety of different clients. Sometimes provider groups, sometimes hospital networks, sometimes communities. So it's not uncommon for a patient to reach out and have X, Y, Z concerns and they don't have a PCP. So we work with our clients to understand points of access as well as providers accepting new clients. If we're working with a payer, we want to understand their networks we're assured to give appropriate information to callers.

Kyle Murphy: That was actually a question I want to ask you in terms of how you communicate with the different stakeholders. Obviously, there's providers you're dealing with--got to help complement what they're doing--but then you've got payers who are getting increasingly involved in care management and they want to see their members being served in the most appropriate way based on how they like to be communicated with. What has your organization learned about best practices for getting all these stakeholders aligned and ultimately serving the needs of the patient?

Dusti Browning: Yeah, so we try to understand what our stakeholders need from a data and reporting standpoint. And of course we also have to consider patient privacy too. So certain types of clients won't get the same type of data that, say, a provider will get. So really understanding what they need in order to fulfill their work and the roles that we're contracted to do, and so we can ensure that we're sharing the appropriate information.

Kyle Murphy: And then, last question, a conference like this--what are the things that are interesting to you from a professional standpoint? And then also from a business standpoint, are there certain technologies or company services that you're really curious about?

Dusti Browning: So, very curious about generative AI, and I bet anyone that you spoke to is going to say the same thing, but I want to understand how it's going to help the nurse do their role. So when we look at nursing shortage in general, even though we have a substantial pipeline waiting to come into Conduit and we're able to be very selective, still that workforce is dwindling. So if we're able to utilize technologies to augment what our nurses are doing--perhaps we can hear what the patients say and it's being documented for them as opposed to the nurses having to document, or using those AI components to understand things more intricately before they're connected to the nurse. I think that that would be very helpful in the space.

And then again, looking at ease. So, all too often, we have this great technology, it's so cool, but we don't really understand the end user's experience or the patient's experience. So wanting to ensure that we are putting the end user or the patient at the forefront and looking backwards. What do they need? What do they want? What's their experience going to be like if we do this?

Kyle Murphy: Awesome. Well, thank you for taking the time to chat with us.

Dusti Browning: Absolutely.

Kyle Murphy: Really appreciate it. Hope you enjoy the show.

Dusti Browning: Certainly. Thank you.

Kelsey Waddill: Listeners, thank you for joining us on Healthcare Strategies Industry Perspectives. When you get a chance, subscribe to our channels on Spotify and Apple, and leave us a review to let us know what you think of this new series. More Industry Perspectives are on the way, so stay tuned.