SEHAD Webinar: Implementation of Conversational AI in Home Hospitalisation Units - Tucuvi

In the last webinar organised by the Spanish Society of Home Hospitalisation, Dr. Manuel Mirón and Dr. Maikel Ayo shared how they introduced Lola in their respective units, as a support tool in their daily work.

Tucuvi’s virtual clinical assistant, Lola, has been implemented in the Home Hospitalisation Units (HHU) of both the University Hospital of Torrejón (Madrid) and the University Hospital of Vinalopó (Alicante).

In the last webinar of the cycle Experiences in telemedicine 2022, organised by the Spanish Society of Home Hospitalisation, Dr. Manuel Mirón (head of the HAD service at Torrejón Hospital) and Dr. Maikel Ayo (head of the HAD service at Vinalopó Hospital) shared how they introduced Lola in their respective units, as a support tool in their daily work.

Experiences: Virtual voice assistant as a support for Home Hospitalisation Units : Tucuvi Project.

Implementation of the virtual assistant in the HHU of Torrejón Hospital: monitoring of patients with COVID.

Just before the pandemic, the Home Hospitalisation Unit at Torrejón Hospital was staffed by 3 doctors and 5 nurses, and had 35 beds for daily home care. During the first wave of COVID, the volume of patients treated increased by 200%, and the staff had to be tripled in order to be able to care for this entire population.

However, during the second wave, Lola was introduced into the unit to make follow-up calls to COVID patients.  In implementing the tool, the project had different phases. The first step was to present the tool to management and the care team, along with an assessment of the resources required. The next phase was the adaptation of the protocol, in which the professionals personalised how the symptoms would be monitored, defined the alerts and established the periodicity of the calls. They then held a training session on the use of the Tucuvi platform, and began to use the virtual assistant. Throughout the project, some technical improvements have been incorporated and the platform has been adapted to the needs of professionals to help them provide the best possible care to patients.

The main challenge that the professionals encountered, and this is something that tends to happen whenever there is talk of Conversational Artificial Intelligence in healthcare, was the concern about dehumanising care. The key to avoiding this, which is exactly what the unit’s team agreed, is that Lola’s calls do not replace clinical activity, but rather serve to complement it. It is a support to be able to reach more patients more quickly and to discern where it is most urgent and urgent for professionals to spend their time. Thus, the established objective was to use the tool to better plan care, optimise the team’s time and prioritise those patients with more serious situations, while knowing that all patients have been monitored.

Thus, follow-up calls with Lola were made first thing in the morning, in order to know the health status of all patients on a daily basis. When any constant or parameter fell out of the range considered stable, Lola would alert the clinical team, providing support in the planning of care activities.

"It allowed us to plan our care and prioritise those patients who were in the worst condition."

Dr. Manuel Mirón

To analyse the results of the project, a comparative study was carried out between the follow-up with Tucuvi (241 patients from the second wave) and a standard non-face-to-face follow-up (SNFF) carried out on 348 patients from the first wave. Compared to the SNFF, patients included in the Tucuvi follow-up programme have reduced their ER visits by 55%, and 62% of hospital admissions have been avoided. In addition, monitoring with Lola was associated with a shorter hospital stay, as the average time in the ward decreased from 6.7 days (SNFF) to 5.2 (Tucuvi), i.e. 22% less. Finally, 30-day readmissions were also reduced by 55%.

Implementation of the virtual assistant in the HHU of the Vinalopó Hospital: monitoring of palliative care patients.

On the other hand, in the HHU of the Vinalopó Hospital, Lola is being used to monitor palliative patients. This unit consists of 5 doctors, 7 nurses, a nurse case manager and a psychologist, and 32% of the admissions correspond to patients in advanced palliative care.

This is a very complex patient profile, which requires continuous monitoring. The network of care that these patients receive is made up of three interconnected elements: the HHU itself, an Intrahospital Palliative Care Unit, and a Palliative Patient Follow-up Programme (PSPP). Tucuvi’s virtual assistant has been implemented within this programme, which is carried out through the nurse case manager.

Patients come to this HHU through the in-hospital setting, nursing homes and health centres, and are assessed for entry into the follow-up programme. When the patient is admitted to the unit, the clinical team explains the two agents involved in the follow-up: the nurse case manager and Lola, the latter always supported by the doctors.

"The concerns that initially existed on the part of the patient, being in such a delicate environment as palliative care, have completely disappeared. The reception has been phenomenal.
For us, from an organisational and care point of view, it has meant a before and after in terms of providing a quicker and more effective response to our patients".

Dr. Maikel Ayo.

In order to optimise the professionals’ time to the maximum, the operating dynamics established in the unit are as follows: all calls made by Lola are made first thing in the morning, so that the nurse manager has all the information necessary to prioritise and plan that day’s home visits.

Dr. Ayo explained that the main objectives of the follow-up include prioritising the home over the hospital as a therapeutic site, increasing continuity of care and obtaining regular information in real time on any signs of alarm.

In terms of the results obtained, patients monitored with Tucuvi have reduced their visits to the ER and Health Centres by 20% and 25%, respectively. In addition, thanks to the monitoring with Lola, the nursing staff has needed to make 70% fewer calls to patients, being able to prioritise their time to provide better healthcare coverage to the most urgent patients.

Final conclusions

The main conclusions of the healthcare professionals in these HHU is that monitoring with Tucuvi has allowed them to better plan their day-to-day work, optimise their work and save time in consultations. In addition, they feel that they have made better decisions about patients, as they were continuously monitored and this allowed them to act in advance to avoid decompensation.

In terms of the opinion of the patients who receive calls with Lola, the overall satisfaction rate in the two units is 4.7 out of 5. Patients have expressed feeling calmer and accompanied, and have perceived a good coordination between the clinical team and Lola, as well as a greater speed in the assistance received.

Tucuvi would like to thank Dr. Mirón and Dr. Ayo for sharing their experience, as well as the Spanish Society of Home Hospitalisation for organising this webinar. It is a great opportunity to make visible the impact that conversational technology is having on patients and clinical teams.

We continue to work to make healthcare more efficient and for all patients to have continuous monitoring at home, helping healthcare professionals to scale their capacity to care.

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