Summary
Highlights
The Business of Healthcare podcast, hosted by Professor Daniel Carnuda, welcomes Dr. Teresa McDonald. Dr. McDonald is the Senior Vice President and Chief Nursing Officer at Duke University Health System, Vice Dean for clinical affairs and innovation at Duke University's School of Nursing, and a practicing nurse practitioner specializing in gastrointestinal oncology. The episode's focus is on how technology improves healthcare workflow, particularly in nursing, a continuation of the previous episode's theme on AI implementation.
Dr. McDonald describes Duke University Health System, located in North Carolina's Triangle region, serving 12% of the state's population with four acute care hospitals and 150 ambulatory clinics. The system employs 28,000 people, with 12,000 in nursing and patient care services. Her main challenges include retaining the shrinking workforce, caring for an aging population, and integrating technology to design future care models. She notes the significant challenge of retaining new nurses, with a 20% turnover rate for those in their first three years, compared to the pre-pandemic overall turnover of 14.9%.
Dr. McDonald explains how Duke uses technology to engage its predominantly young millennial to Gen Z nursing workforce. Communication is facilitated through podcasts, texts, and social media. In terms of workflow, ambient voice recognition technology is being adopted to reduce documentation burden in electronic health records, allowing nurses to spend more time on patient care. Duke is also establishing three 'innovation units' equipped with computer vision, electronic whiteboards, and advanced patient monitoring to shift from reactive to proactive care.
Dr. McDonald predicts that within five years, much of the innovative technology seen today will be standard. The limiting factor is retrofitting older facilities. The future of acute care will see more complex cases in hospitals, while general care shifts to homes or community settings, enabled by technologies like 'hospital at home' programs, remote patient monitoring, and real-time patient communication. She cites Singapore's use of wearables and real-time communication to reduce chronic diseases as an example of future possibilities.
The discussion moves to patient engagement with technology, and the increasing use of wearables like Aura rings and Apple Watches for data collection. Dr. McDonald foresees devices becoming smaller and more capable. For patients not comfortable with technology, Duke employs a hybrid approach, combining telephone engagement and in-home visits to help patients collect data and interact with remote clinicians, ensuring the 'human touch' is maintained alongside technological advancements.
Dr. McDonald explains that Duke uses AI for workforce logistics, managing diverse scheduling needs, and for decision support. AI-powered large language models provide medical professionals with quick access to validated research, aiding clinical decision-making. Duke, along with UCLA, has developed a model for the ethical use of AI, rigorously vetting new tools for efficacy, ethics, and appropriate usage. Training for AI integration is evolving, with efforts to embed AI and new technology utilization into nursing education.
Staff adoption of AI is evolving, with early adopters, a large middle group, and some skeptics. Dr. McDonald notes that as staff realize the benefits and trust the technology, adoption increases. Duke's virtual care center, established during the pandemic, has two main functions: remote safety observation, using algorithms and iPads to prevent patient falls, and a virtual nursing unit where experienced nurses augment on-site staff by handling patient education, admissions, discharges, and medication coordination remotely.
Duke Health received a $29 million Bloomberg grant to establish the Durham Early College High School program. This initiative, in partnership with Durham Public Schools and Durham Technical Community College, offers pathways in nursing, medical assistant, pharmacy tech, and research. Students, starting after eighth grade, will gain observation training and graduate with certifications or an LPN, ready for employment in the health system. This program addresses workforce shortages proactively, and there's been a recent increase in nursing school applications.
Professor Carnuda thanks Dr. McDonald for sharing Duke's innovative approaches, acknowledging Duke's leadership in addressing healthcare challenges. He highlights the importance of early intervention programs like the Durham Early College High School in building the future healthcare workforce.