A Frontline Worker’s Take on Hybrid Care Implementation in the Hospital Setting

Hybrid care in the hospital setting—combining in-person care with telehealth services—has increased dramatically since 2020 [1,2]. During the COVID-19 pandemic, frontline workers relied on remote access to care for patients from afar. In the succeeding years, hybrid care use has remained much higher than prepandemic levels [1]. At different points in my own practice as an intensive care nurse, depending on its implementation, hybrid care technology has been a distracting hindrance to patient care or has greatly supported my ability to treat patients in critical condition.

For other staff working at the bedside, reactions are similarly mixed: while some report safer patient care and more efficient workflows, others feel that hospitals now push telehealth technology as an ineffectual fix for staffing shortages and organizational issues.

Hybrid Care on the Ground

The day-to-day realities of in-hospital hybrid care use are varied. Location, patient demographics, and facility-to-facility differences in budgets and priorities play a part in determining the specific implementation, delivery models, and rate of adoption by both patients and staff for these modes of care [3].

Examples include using video calls to patch in specialty providers for emergencies and consultations, providing remote physician rounding for rural or underserved communities, and leveraging digital apps for patient communication and video visits.

Additional uses include monitoring confused or unstable patients via video; supporting nursing workflows with remote nurse assistance; facilitating admissions, discharges, and patient education; and offering a way for families to connect virtually with loved ones if they are unable to visit in person [1].

These tools represent a unique opportunity to augment patient care and improve safety measures. However, without collaborative implementation and ongoing support services, some frontline staff express concern that more technology simply adds to their already burdensome workload [4-6].

When Hybrid Care Saves the Day

At its best, hybrid care technology can save lives and ease stress for bedside staff, patients, and their loved ones.

Gwen*, a nurse in a postanesthesia care unit in Portland, Oregon, recalls a time when her patient experienced a stroke soon after surgery: “In that situation, we were able to use the telehealth neurologist during a code stroke. It worked really smoothly, and the other staff and I felt more confident in that emergency. That patient absolutely received better care because we were able to talk to a neurologist immediately.” Gwen’s experience demonstrates how faster access to specialty care via a remote provider can dramatically improve patient outcomes.

Avah*, a nurse who works in the postpartum unit of a hospital in Madison, Wisconsin, reported: “Our NICU [neonatal intensive care unit] has cameras that let parents see their baby from home.” She cites this use of telehealth technology as an important bonding tool for new parents of hospitalized infants.

Other benefits to hybrid care include fewer admissions and readmissions, reduced length of hospital stay, improved chronic disease management, enhanced patient safety, reduced health system costs, better integration of care services, better adherence to recommended best practices, and increased efficiency in provider workflows [4,5].

When Hybrid Care Gets in the Way

Nurses frequently become the point person for new in-hospital technology, including hybrid care tools. When patients struggle to log in to a phone app for a video appointment or the camera used for physician consults needs to be set up, it often falls to the nurse to first troubleshoot and then call for assistance if needed. They become the liaison for patient concerns and digital snafus, taking time away from patient care activities and adding to an already hectic workload.

Other concerns relayed by frontline health care workers regarding newly integrated hybrid care models include technical issues such as unstable Wi-Fi or poor equipment maintenance, patient and staff competency in adopting new technologies, and lack of ongoing support as uses for hybrid care modalities evolve [4,5]. Additional technology may also create interruptions in the workflow and degrade the quality of patient-nurse interactions [6].

Rhonda*, an intensive care unit charge nurse at a large Midwestern hospital, explains that her unit recently installed electronic intensive care unit (eICU) cameras in each patient room. These devices are meant to bring in ICU-trained registered nurses (RNs) via video to provide nursing support. “We rarely use them, and we never asked for this kind of device. Instead of being a help, they are a hindrance. The eICU staff call us to ask questions that are irrelevant to patient care. It wastes time. I’m sure [the cameras] were expensive, and they don’t help patient care in any way.”

She worries that this follows a recent trend at her facility of cutting staff and attempting to replace in-person RNs with nurses who can only watch from the other side of a screen.

These challenges and concerns suggest that additional technology is not a replacement for proper staffing or efficient organizational workflows.

Making the Most of Hybrid Care Tools

If in-hospital hybrid care models are to be effective, nurses and other frontline staff must be involved in the entire decision-making process, not brought in after adoption [5,6]. The choice of hybrid care technologies needs to be decided based on real-life clinical needs and centered around realistic patient behaviors. If patients struggle to use an app or cannot understand a provider on the other end of a video call, the technology becomes useless, burdensome to staff, or worse, an active impediment to the quality of patient care.

Designing for flexibility is crucial as technology develops, patient needs shift, and health care continues to see rapid change [7]. Ongoing and easily accessible tech support for both patients and staff should be included to increase use and reduce errors, work-arounds, and frustrating workflow disruptions [6]. While staff are often receptive to new technologies becoming part of their daily workflow, needs and perceptions vary by facility and department, highlighting the need for a tailored approach that includes bedside staff’s voices [8].

In-Hospital Hybrid Care Succeeds When Frontline Staff Are Involved

While hybrid care can be a powerful tool, everyday complications show gaps that hospital leadership and policymakers sometimes overlook. Without the involvement of these frontline workers, hospitals risk spending budget dollars on technology that simply does not serve its full purpose.

By continually seeking out and incorporating the input of frontline staff, health systems and hospital administrators can make realistic, informed, and effective decisions about which tools will increase safety, efficiency, staff retention, and patient experience in their facilities. Administrators should survey frontline staff about their daily challenges and perspectives on which models of hybrid care would best address staff and patient needs before purchasing, policy change, or implementation begins. Additionally, nursing focus groups may provide an opportunity for unit-specific representation so that hybrid care execution can be tailored to departmental needs.

Hybrid care tools cannot replace the human touch in health care, but they certainly have the power to create better outcomes for patients and lighten staff workloads. Hospital systems should invest in thorough research and open conversation with staff to generate flexible and human-centered hybrid care models that best serve the people under their care.

*Names changed to protect anonymity.