How technology can free up nurses for better care [PODCAST]

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We explore the evolving landscape of health care data management with nurse executive Betsy Castillo. Drawing on her decades of experience, Betsy discusses the importance of timely registry data, the critical role of nurses, and how AI-driven automation can transform clinical tasks, reduce workload, and enhance patient outcomes. She shares insights on how health systems can better support their staff amidst growing shortages, highlighting the value of listening to frontline nurses and integrating advanced technologies for sustainable care delivery.

Betsy Castillo is a nurse executive.

She discusses the KevinMD article, “How automation helps nurses return to the bedside.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Betsy Castillo. She’s a nurse executive. Today’s KevinMD article is “How automation helps nurses return to the bedside.” Betsy, welcome to the show.

Betsy Castillo: Thank you very much for having me. I’m looking forward to discussing the article today.

Kevin Pho: All right, so let’s start by briefly sharing your story and journey.

Betsy Castillo: Well, I have been a nurse for over thirty years. I started out in the CVICU, ER, and trauma. I have now worked in quality for the past ten years, collecting data points, and my whole goal is to make these data points actionable as we move forward. It’s great that we sit in an office for eight hours a day and collect data, but if we cannot make them actionable and they’re not timely, what use are they? So that’s where I’d like to make sure that we as nurses use that data to our advantage, to make sure that we’re getting enough staffing, to make sure that we are looking at our trends, to make sure that we’re improving patient care.

Kevin Pho: All right, and you’re going to talk about, of course, one application of that data in your KevinMD article, “How automation helps nurses return to the bedside.” Tell us about that article for those of you who get a chance to read it.

Betsy Castillo: So a while back, I read an article that was put out by the AACN, which talks about the nursing shortage. We all on the front lines know that there is a nursing shortage, but we also are not looking into the future, in the 2030s, that they’re anticipating such a great shortage, and how we can use what we have right now to get those nurses back to the bedside.

There are also some interesting statistics that came out that talk about even a 10 percent reduction in the nursing staff at the bedside increases your chances, not only the associated odds of in-hospital deaths, but readmission, increased length of stay, and lower patient satisfaction. What really impacted me was the increase in the odds of inpatient death. And what they did in this article is they also examined that. That didn’t have anything to do with the decrease in the nursing personnel hours; that was all kept the same. It was a decrease in the RN staffing. So that shows that the clinical expertise of them taking and looking at the patient was taken away. Looking and using our clinical assessment skills and reporting that back to the physicians is first line. We need to get that information back.

So if we take away that burden of all of the charting, all of the extras that we have, and replace that with automation, replace that with trustworthy, timely information, we can get back to that bedside and relay that information back correctly.

Kevin Pho: So for those who aren’t immersed in the nursing world, just give us a taste of some of the bureaucracy, some of the obstacles that prevent nurses from spending as much time as they would like at the bedside.

Betsy Castillo: So if you look at it, there are some studies out there that say for every hour of patient care, you have an hour and a half to two hours of charting. So that’s overwhelming, and that’s taken throughout your whole 12-hour shift. Everything you do, everything you’re doing as you’re assessing the patient, has to be documented. We want to make sure that we are giving you those tools to be able to do that a lot faster. I know that there’s been some evolution in the physician area, but in nursing, it’s really been stagnant. So we want to make sure that that charting is, number one, accurate. You want to paint the exact picture of what you have done throughout the day, but you also want to make sure that it’s not taking you six hours at the end of the day to complete those tasks.

So looking at it: Every time you give a medication, we’ve started to, a little bit, with automation. Every time you do a procedure, we are trying to figure out how to do that. We also are looking at when you do intake, when you’re doing an assessment, when you’re repeating yourself, from the patient’s level. Every time the patient comes in, they have to repeat their medication list. They have to repeat their history. If we have a way to automate that and be able to pull that in front of the nurse, they’re just able to review that. Change of shift would go faster, intake would go faster, and discharge goes faster, if you look at and take away those huge chunks.

We also look at the way that we convey information back to the physicians. If you think about it, and I know all physicians can relate to this, when I was orienting new nurses, I would say, “Make sure you’re painting the picture of the patient. Give them all of the good data points, not just say, ‘the appendectomy down in bed 12.’ Give them the history. Tell them everything.” We also want to chart that same way, making sure that we’re doing that. So if we have that information, we’re able to document that. The physician can pull that open, see all that information, and be aware of what’s going on with the patient, just as the nurse standing there is, before she or he even makes that phone call.

Kevin Pho: So Betsy, when you talk about registry data, give us a little bit of context in terms of what exactly we’re talking about here.

Betsy Castillo: There are over two hundred different registry bodies across the nation right now, and more internationally. They’re a little bit different than research. What they do is they capture the patient picture. For instance, the NCDR or the STS, they bring information in and capture the picture of the patient as they went through their hospital course, from pre-op to post-op, and make sure that we’re collecting that information. We send that off to the registries on a quarterly basis, and they analyze that information and send you back reports.

Kevin Pho: And what are some of these reports saying? Just give us an example.

Betsy Castillo: They talk about morbidity and mortality. They talk about best practices in discharge medications, best practices for pre-diagnosis and pre-op testing, and making sure that they’re meeting all of the guidelines.

Kevin Pho: So give us an example of how these emerging digital technologies can take some of those obstacles off the nurse’s plate. Tell us a story, a case study, of what that would look like.

Betsy Castillo: For example, just to lead to the registry world. Why we started with the registry world is we want to make sure that the clinicians trust the information. The registry world uses post-documented information that we can prove, that we analyze, that we audit to make sure that we’re giving the correct information.

But as we see it advancing, we can see it as a patient comes into the ER; they’re unable to communicate with you. You’re able to pull up their information and have that right then and there. You’d have their history. You’d have their information, their medications, all right within, so that when you go in to see the patient, you have all that information. Same with any other patient, because if they’re in an area of stress, that’s the last thing that they might, and they may leave out such very important pieces of information that are critical to their care.

Kevin Pho: And when administration looks at some of these technological solutions, do they ever chart a scenario where some of these solutions, whether it’s AI or other digital technologies, can replace nurses because they are more cost-effective? Does that scenario ever play out?

Betsy Castillo: I don’t think it’s replacement. I think it’s enhancing that they look at, and where you can show the improvements. If we show an 80 percent accuracy on some of the charting that we’re pulling in, then we can show a decrease in the time spent on that charting.

Kevin Pho: And are we looking primarily in a hospital setting? Can this also be applied at the bedside in a clinic?

Betsy Castillo: It also can be applied at the clinic level. We pull information in for the registries that is outpatient testing. For instance, for some of our registries, for the thoracic surgery, we look at some of the outpatient testing, including labs, including echo reports, and we’re able to scan through that and bring that to the forefront.

Kevin Pho: And in terms of success stories, tell us a before-and-after picture where you may have implemented some of these digital and technological solutions and really improved the lives of the nurses that were affected. Give us a before-and-after success story.

Betsy Castillo: So as we’re looking at and going through all of the day-to-day operations, you have registry bodies that want that information, and the way that we can enact the information is to get it back in a timely manner.

I go back to when I first started in the CVICU. I had a CT surgeon that said to me, “You know, if I would have had some of this information from the data collection six months ago, three months ago, I may have changed the way that I practiced. I may have changed the way that I wanted to look at things.” That way, it actually proves what we were conveying to the physicians with those data points. We can always say, “Oh, this happens to all of your patients after surgery. How about if we work on it this way?” But if we have that data at that time, everybody’s more likely to say, “Hey, yeah, you’re right.” Not that they didn’t believe us, but we just want to make sure that people understand that we have the data to back it up.

If we have that a lot faster, in any kind of research world, it can become actionable and make those process improvements. For example, especially with the nursing care, if you’re seeing this happens to all the patients at this point in time, and we have the data to back it up in a timely manner, we’re able to change our processes. We’re able to save time. We’re able to say, “This is what we’re going to do, and this is how we’re going to do this,” to make sure that the patient gets the adequate care.

Kevin Pho: And do you see some of these solutions improve the nursing shortage? Because during the pandemic, as you know, a lot of nurses left because of burnout and reasons associated with that. How can these solutions eventually improve the nursing shortages that we’re seeing nationwide?

Betsy Castillo: So it’s not going to take over the human-touch tasks. It’s going to take over the paperwork tasks, and that’s where I see that it’s really overwhelming. That’s what causes the burnout in nurses that I’ve talked to, in my own experience: spending all that time afterwards and trying to capture what we’ve done. And it’s going to improve the efficiency, which is going to give you better job satisfaction too, if you have the tools out there.

I mean, I look at it as, many, many people use ChatGPT, as one example, going through their day-to-day lives anymore, if they’re looking for directions, if they’re looking for a recommendation for a restaurant. We need to use that technology to help us through our day at the bedside: What is this medication? What can we do? But the key with that is we have to make sure it’s trustworthy. So that’s where we come in, to make sure that we’re giving trustworthy information and prove the accuracy so that clinicians will use it.

Kevin Pho: So where do you see this technology evolving over the foreseeable future? What are some of the next steps that you’re seeing?

Betsy Castillo: I see that once we have this groundbreaking with the registry world, and we’re able to work on that and prove that the accuracy is there as we’re honing through charts, that will also decrease and enhance everything across the clinical, not just in charting, not just in in-hospital charting, but in outpatient charting, in pharmacy reports. As we’re looking through, can you imagine if the pharmacists, you know, they’re able to just pull that information directly across their whole hospital stay, instead of calling you up and saying, “Hey, I don’t know about this medication”? It’s going to save a lot of time. It’s going to improve and decrease the frustration of the patients also.

Kevin Pho: And any obstacles that you see in terms of implementing this more widely?

Betsy Castillo: I think we need to get the buy-in, and the way that we do that is gain the clinician trust by showing and proving that these data points are being pulled in accurately.

Kevin Pho: So tell us, systems that don’t use their technology, what’s the current situation like?

Betsy Castillo: I think it’s just an electronic version of the paper chart that most systems are using right now. They’re not pulling any information in. The systems aren’t talking to each other. There are, you know, great EMRs out there, but then when you attach the outpatient offices, you attach the pharmacies, they’re not interacting with each other. The way that we were able to overlay and pull the information out of separate systems is also going to align them. So it doesn’t mean that you have to replace your systems, which is a huge cost. It means you can use one system to make them conjoined.

Kevin Pho: We’re talking to Betsy Castillo. She’s a nurse executive. Today’s KevinMD article is “How automation helps nurses return to the bedside.” Betsy, we’ll end with some of your take-home thoughts to the KevinMD audience.

Betsy Castillo: Trust the information. Do your own research. As a clinician, do your own research when you’re looking at the different AI forms that are coming out. Things are moving very fast right now. We’ve seen drastic improvements in the past six months and a drastic decrease in pricing, so that’s going to make a huge impact. Talk with your nurse leaders, get that information back to them, and prove with the data points from the registries, or from your own research, that it’s going to decrease your time.

Kevin Pho: Betsy, thank you so much for sharing your perspective and insight. Thanks again for coming on the show.

Betsy Castillo: Thank you very much. It was a pleasure.

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