Generally speaking, there are two virtual nursing care models: the Admission, Discharge, and Transfer (ADT) model and the Care Partner Model. While both are helpful, they offer different strengths and solutions to a hybrid care model. Evaluating their structure, approach to patient care, and staffing models helps clarify their effectiveness and efficiency in healthcare. 

Admission, Discharge, and Transfer Model Features typically include:  

• Admission documentation with limited assessment: This involves collecting basic patient information and medical history at the time of admission but may not include comprehensive health assessments due to the virtual nurse’s remote nature.  
• Discharge documentation with medication reconciliation and discharge teaching: Ensures that patients receive instructions for care post-discharge and that their medication list is accurate and reconciled.  
• Transfer documentation: Focuses on the necessary documentation when a patient is transferred to another facility or unit, ensuring continuity of care. 

Staffing:  

• The Admission, Discharge, and Transfer Model is more of a transactional model in which one nurse is responsible for several patients. It emphasizes efficiency in admission, discharge, and transfer. When the “transaction” of documentation is completed, the virtual nurse moves on to the next task. Still, the broader scope of responsibility is assigned to the direct care nurse.

Care Partner Care Model Features may include:  

• Documentation assistance: Helps reduce the administrative burden on nurses, allowing them more time for direct patient care. However, this model will likely only offload some admission and discharge documentation due to the other patient care needs the care partner is involved in, even in a virtual capacity.  
• Patient education: Focuses on educating patients about their conditions, treatments, and the importance of follow-up care, aiming to empower patients and improve outcomes.  
• Dual nurse verifications: Enhance patient safety by requiring that critical tasks, such as high-risk medication and blood products, be verified by two nurses, one of whom is virtual in this scenario.  
• Call light triage: Efficiently manages patient needs and requests by prioritizing them based on urgency and importance.  
• Precepting on demand: Offers real-time training and support for new nurses, enhancing their skills and confidence while ensuring that they are providing safe patient care.  
• Pain reassessments: Utilizing virtual nurses to provide a pre- or post-pain medication assessment (reassessment) provides better care to the patient while helping to offload a critical yet often delayed follow-up.  
• Additional tasks: There are many more care activities that virtual nurses functioning as care partners can provide, such as quality and safety checks, safe word activations, patient/family education and pre-procedure teaching, safety rounds, expert clinician oversight, rapid response or code documentation, etc. 

Staffing:  

• This model features the nurse as part of individual care teams, allowing for a more personalized approach to patient care. It supports a collaborative environment where nurses work closely with patients and other healthcare professionals to provide comprehensive care. The staffing may differ, and a virtual nurse may be allowed to supplement a few nurses and share their patient load.  

Comparison  

Patient-Centeredness:  

• The Care Partner Model can feel more patient-centered. It focuses on education, safety, and personalized care. It aims to involve patients in their care and ensure their needs are met promptly and effectively.  
• While efficient, the ADT Model provides the same level of individualized care but focuses on offloading the more time-intensive administrative aspects of admissions, discharges, transfers, and perhaps other repetitive activities.  

Safety and Quality of Care:  

• The Care Partner Model potentially offers higher safety and quality of care through dual nurse verifications and hourly rounding, which can prevent errors and complications.  
• The ADT Model is beneficial because it impacts the transactional aspects of care transitions, which are critical but may only directly address some aspects of patient safety and quality. 

Efficiency and Staffing:  

• The ADT Model may be more efficient in managing large volumes of patients, especially in settings with high turnover rates, due to its streamlined focus on admissions, discharges, and transfers and can directly impact patient throughput.  
• The Care Partner Model may require more staff and resources to implement effectively. Still, it can improve outcomes by addressing a broader range of patient needs and reducing the potential for readmissions or complications through comprehensive care and education.  

Conclusion

The ADT vs. Care Partner model in virtual nursing is an ongoing discussion. Choosing between these models depends on the organization’s specific goals and constraints, including the patient population, available resources, and desired outcomes. 

The Care Partner Model 

This model offers a more comprehensive and patient-centered approach, potentially leading to better outcomes and patient satisfaction, but requires more resources and staffing. 

The ADT Model

This model focuses on efficiency in patient transitions, which might suit settings with high patient turnover and the need for improved throughput. 

Both models can be evaluated in a “supplemental” (potentially additive) or “net neutral” budget capacity. Either of these hybrid care models improves efficiency, outcomes, and experience (both patient and nurse) on med/-surg units over traditional inpatient nursing care delivery models.