With the rise of virtual care, nursing teams are exploring innovative models that integrate remote support into technology-enabled patient care. Two prominent virtual nursing care models are the Admission, Discharge, and Transfer (ADT) and Care Partner models. While both bring unique strengths to hybrid care environments, their structure, approach, and staffing configurations differ. This article will examine how these models operate, compare their advantages, and explore their roles in patient-centered, quality-focused healthcare. 

Understanding the ADT Model 

The ADT model is primarily transactional, designed to streamline documentation-intensive tasks like admissions, discharges, and transfers. Offloading these time-consuming responsibilities allows direct care nurses to focus on bedside care, improving efficiency in busy hospital settings.  

1. Admission Documentation with Limited Assessment: In the ADT model, virtual nurses handle initial documentation tasks at admission. This typically involves collecting essential information, such as a patient’s medical history and medication list. However, comprehensive health assessments are not part of this role due to the virtual nature of the nurse-patient interaction. 

2. Discharge Documentation with Medication Reconciliation: Virtual nurses ensure patients receive clear post-discharge instructions and can reconcile their medication lists. This is critical for continuity of care and patient safety, particularly in avoiding readmissions due to medication errors or misunderstandings about aftercare.

3. Transfer Documentation: When patients transfer to a different unit or facility, virtual nurses complete the necessary paperwork, promoting seamless handoffs between care teams and maintaining continuity in patient care. 

ADT Model Staffing 

The ADT model operates as a “one-to-many” system where a single virtual nurse supports multiple patients across different units. The virtual nurse centers on completing documentation efficiently through an EHR-based or electronic queue before moving on to the next documentation task. While direct care nurses handle clinical tasks, the ADT model helps balance workloads by managing time-intensive essential but repetitive documentation requirements. This setup is often preferred in high-turnover settings, where patient throughput is a priority. 

Examining the Care Partner Model 

The Care Partner model offers a more integrated approach, embedding virtual nurses within individual care teams to provide a broader range of support services beyond just documentation. This model also reduces the administrative burden on nurses, enabling them to focus more on patient care. Here is a partial list of how a virtual nurse may function in a Care Partner Model.

1. Documentation Assistance: Virtual nurses assist with documentation across various aspects of patient care, including portions (or all) of admission and discharge paperwork. By lightening the load of direct care nurses, the Care Partner model promotes a more efficient workflow, allowing for more time spent at the bedside.

2. Patient Education: In the Care Partner model, virtual nurses play an active role in educating patients about their health conditions, treatments, and necessary follow-up care. This emphasis on education helps empower patients, supporting their involvement in their care and promoting long-term health.

3. Dual Nurse Verification: This model improves safety by incorporating dual nurse verification for high-risk tasks. For example, virtual nurses check high-risk medications and collaborate on admission skin assessments to minimize the risk of missing an existing skin concern, adding an extra layer of oversight.

4. Call Light Triage: Virtual nurses can manage call light requests, prioritizing patient needs based on urgency. This helps direct care nurses respond to critical situations faster, ensuring that non-urgent requests are attended to promptly. This task can also be delegated to non-licensed team members to ensure virtual nurses operate at the top of the license.

5. On-Demand Precepting: The Care Partner model provides real-time support for new nurses or nurses seeking a second opinion, offering guidance as needed. This approach fosters a collaborative learning environment, enhancing nurse confidence and patient care. 

6. Pain Reassessments: Virtual nurses are also involved in pre- and post-medication pain reassessments. This required task, often delayed in busy units, becomes more manageable, ensuring patients receive adequate pain management that is documented timely. 

Additional Care Partner Tasks 

Virtual nurses in the Care Partner model may undertake various other duties, such as conducting safety rounds, providing pre-procedure teaching, monitoring/preventing patient deterioration, assisting with rapid response documentation, and engaging in quality and safety checks. This flexible role promotes comprehensive patient care and improves team communication and patient safety. 

Care Partner Model Staffing 

The Care Partner model is more of a “one-to-few” configuration, where virtual nurses are embedded within a smaller number of care teams for a more cohesive approach to patient support. For example, working closely with a handful of direct care nurses, virtual nurses build solid relationships and contribute to a collaborative environment that prioritizes personalized care. 

Comparing the ADT and Care Partner Models 

Patient-Centeredness 

The Care Partner model is designed to be more patient-centered, focusing on patient education, safety, and immediate responsiveness to patient needs. This model aims to enhance patient satisfaction and involvement in their care by empowering patients through education and facilitating a collaborative approach. 

In contrast, the ADT model emphasizes efficiency. Its transactional nature is well-suited for high-volume settings and improves ED throughput by promptly handling admission, discharge, and transfer documentation. Although it may foster a different patient-centered focus, the ADT model contributes to a seamless care experience by efficiently managing administrative tasks. 

Safety and Quality of Care 

Both models support safety and quality, though in different ways. The Care Partner model can enhance patient safety with dual nurse verifications and regular rounding, addressing potential issues before they escalate. Its focus on education and reassessment also reduces the likelihood of complications, fostering better outcomes. 

The ADT model also plays a critical role in safety by documenting care transitions accurately and efficiently. While it may lack the direct impact on patient safety that hands-on care provides, it indirectly frees up direct care nurses to focus on clinical tasks. 

Efficiency and Staffing 

The ADT model is highly efficient, particularly in high-turnover environments where rapid admissions, discharges, and transfers are essential. Its streamlined structure allows one virtual nurse to support multiple patients, maximizing productivity and reducing the burden on direct care nurses. 

The Care Partner model requires a more resource-intensive setup involving embedding virtual nurses within individual care teams. Although it may support fewer patients per nurse, it offers a more personalized approach that may reduce readmissions and improve patient outcomes. 

Choosing the Right Model for Your Organization 

The choice between the ADT and Care Partner models depends on the specific goals, patient demographics, and resources available within a healthcare organization. Each model brings value in different settings:

• The ADT Model: Ideal for facilities with high patient turnover or those focused on improving throughput, the ADT model ensures efficiency and accuracy in documentation-heavy processes. It’s well-suited for hospitals that prioritize streamlined workflows and need to manage large volumes of patients effectively. Many hospitals start with the ADT model and mature into the Care Partner Model after proving the concept. 

• The Care Partner Model: Designed to deliver a more holistic, patient-centered experience, this model fits facilities aiming to improve patient satisfaction and outcomes. The Care Partner model aligns well with settings emphasizing individualized care and quality improvement by focusing on education, collaboration, and comprehensive care. 

Conclusion 

The ADT and Care Partner models offer unique benefits in hybrid virtual nursing environments. The ADT model enhances efficiency by handling documentation-heavy tasks, supporting high turnover rates, and allowing direct care nurses to concentrate on bedside care. Meanwhile, the Care Partner model promotes a more patient-centered approach, prioritizing safety, education, and a supportive team environment. 

Selecting the optimal model depends on an organization’s patient population, staffing resources, and care objectives. Whether supplementing current workflows or serving as a core component of patient care, each model can enhance the quality, efficiency, and experience of nursing care in med-surg units.