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We explore the evolving landscape of health care data management with nurse executive Betsy Castillo. Drawing on her decades of experience, Betsy discusses the importance of timely registry data, the critical role of nurses, and how AI-driven automation can transform clinical tasks, reduce workload, and enhance patient outcomes. She shares insights on how health systems can better support their staff amidst growing shortages, highlighting the value of listening to frontline nurses and integrating advanced technologies for sustainable care delivery.
Betsy Castillo is a nurse executive.
She discusses the KevinMD article, “How automation helps nurses return to the bedside.”
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome Betsy Castillo. She’s a nurse executive. Today’s KevinMD article is “How Automation Helps Nurses Return to the Bedside.” Betsy, welcome to the show.
Betsy Castillo: Thank you very much for having me. I’m looking forward to discussing the article today and sharing some insights on how automation can impact the nursing profession.
Kevin Pho: All right, let’s start by briefly sharing your story and journey in nursing.
Betsy Castillo: Well, I’ve been a nurse for over 30 years. I started my career in critical care, specifically the CVICU, and then transitioned into ER and trauma care. These were foundational experiences that taught me a lot about fast-paced decision-making, patient advocacy, and how to manage complex cases under pressure.
In the past decade, I’ve shifted into the field of quality and data collection. My primary focus has been collecting data points that can improve patient outcomes. However, what I’ve realized is that it’s not enough to simply gather data. My goal has been to make these data points actionable and timely. Data is only useful if it helps improve care delivery, secure appropriate staffing levels, and identify trends that can guide better decision-making. That’s the core of what drives me—to ensure nurses can use this data to make meaningful changes in patient care.
Kevin Pho: Your KevinMD article, “How Automation Helps Nurses Return to the Bedside,” explores this very issue. Can you tell us more about the article and what inspired you to write it?
Betsy Castillo: Absolutely. This article came from years of observing the challenges that nurses face on the front lines, especially with staffing shortages and administrative burdens. Nurses have been talking about the current nursing shortage for years, but what many people don’t realize is that the problem is projected to get much worse in the coming decades. By the 2030s, we’re anticipating an even more severe nursing shortage, which could have devastating consequences for patient care.
One study I referenced in the article really stood out to me. It found that a 10 percent reduction in bedside RN staffing increases the odds of in-hospital deaths, readmissions, longer lengths of stay, and lower patient satisfaction. What struck me most was the impact on mortality rates. This wasn’t about reducing the total hours worked by nurses; it was specifically about a reduction in RN staffing. The clinical expertise that nurses bring to bedside care is irreplaceable. When you remove that expertise, patient outcomes suffer.
The article explores how automation and digital technologies can alleviate some of the burdens nurses face, such as excessive charting and other administrative tasks. By reducing these barriers, we can free nurses to spend more time at the bedside, where their skills and judgment are most needed.
Kevin Pho: For those unfamiliar with the nursing profession, can you describe some of the bureaucratic challenges that prevent nurses from spending more time with patients?
Betsy Castillo: Certainly. One of the biggest challenges is the sheer volume of documentation required. Studies have shown that for every hour nurses spend on direct patient care, they spend an additional one and a half to two hours on charting. This means that during a typical 12-hour shift, a nurse could spend up to eight hours just documenting their work. It’s overwhelming and contributes significantly to burnout.
Everything nurses do—administering medications, performing assessments, documenting procedures—must be meticulously recorded. While documentation is essential for continuity of care, the current processes are cumbersome and time-consuming. Nurses often find themselves staying late to complete their charting, which takes away from time they could spend recovering from a long shift or preparing for the next one.
Another issue is redundancy. For example, when patients are admitted, they are often asked to repeat their medication list and medical history multiple times. If we could automate this process and make the information readily available to nurses, it would save valuable time during intakes, shift changes, and discharges. This would allow nurses to focus more on patient care and less on repetitive tasks.
Kevin Pho: You mentioned automation as a potential solution. How does registry data factor into this, and what role does it play in improving care?
Betsy Castillo: Registry data is a powerful tool for improving patient care and supporting nurses. Across the U.S., there are over 200 different registry bodies, with even more internationally. These registries collect comprehensive information about patients’ hospital courses, from pre-op to post-op, and analyze it to provide actionable insights.
For example, registries like the NCDR and STS capture data on morbidity, mortality, discharge medications, and adherence to best practices. This data is analyzed and returned to hospitals in the form of reports that highlight areas for improvement. By using this information, we can identify gaps in care, streamline workflows, and ensure that nurses and physicians have access to accurate, timely data.
Kevin Pho: Can you share a specific example or case study where digital technologies helped alleviate some of the burdens nurses face?
Betsy Castillo: Sure. One example involves the use of real-time data integration in the registry world. Traditionally, registry data is collected and analyzed retrospectively, which means that by the time the data is reviewed, it may no longer be relevant for current decision-making. Emerging technologies, however, are changing this dynamic.
Imagine a patient arriving in the ER unconscious and unable to communicate. With automated systems that pull data from registries, the nurse can instantly access the patient’s medical history, medication list, and previous diagnoses. This eliminates guesswork and ensures that critical information is available when it’s needed most. For conscious patients, this system reduces the likelihood of important details being overlooked, especially during high-stress situations.
Kevin Pho: There’s often a concern that automation could be seen as a way to replace nurses. How do you see automation fitting into the future of nursing?
Betsy Castillo: I don’t see automation as a replacement for nurses. Instead, I see it as a tool to enhance their capabilities. Automation can take over repetitive and time-consuming administrative tasks, such as charting and data entry, allowing nurses to focus on what they do best—providing hands-on care and building relationships with their patients.
For example, if automation can achieve 80 percent accuracy in charting, it could significantly reduce the time nurses spend on documentation. This not only improves efficiency but also enhances job satisfaction. Nurses are more likely to feel fulfilled when they can devote their time and energy to patient care rather than paperwork.
Kevin Pho: Are these solutions primarily for hospitals, or can they also be applied in outpatient settings?
Betsy Castillo: These technologies can absolutely be applied in outpatient settings. For instance, many registries collect data from outpatient testing, such as lab results and echo reports. Automating these processes allows outpatient clinics to benefit from the same efficiencies as hospitals, ensuring that patients receive seamless, high-quality care across all settings.
Kevin Pho: Can you provide a before-and-after success story to illustrate the impact of these technologies?
Betsy Castillo: Of course. When I first started in the CVICU, I worked with a CT surgeon who told me something that stuck with me. He said, “If I had access to this data six months ago, I might have changed the way I practice.” That comment underscored the importance of timely data in driving improvements in care.
With digital technologies, we can collect and analyze data much faster. For example, if we notice a trend in post-op complications and address it promptly, we can change processes to improve patient outcomes. This not only saves time but also enhances the quality of care and supports better decision-making for both nurses and physicians.
Kevin Pho: How do you see these solutions addressing the nursing shortage, especially in light of the burnout that many nurses experienced during the pandemic?
Betsy Castillo: These technologies won’t replace the human touch that nurses bring to patient care. What they will do is take over the administrative tasks that contribute to burnout. By improving efficiency, automation can help nurses focus on their patients and reduce the stress of completing paperwork long after their shift ends. This, in turn, can improve job satisfaction and retention.
It’s similar to how tools like ChatGPT help people in their daily lives. Whether it’s finding directions or researching a topic, technology can make tasks more manageable. For nurses, having access to trustworthy, accurate information at the bedside can make a world of difference.
Kevin Pho: What do you see as the next steps for this technology in the foreseeable future?
Betsy Castillo: I believe the next steps involve building trust in the technology. Once we’ve established accuracy and reliability in registry data, we can expand its applications to include outpatient charting, pharmacy processes, and more. Imagine a pharmacist being able to access a patient’s complete medication history without making a single phone call. That’s the kind of efficiency we’re working toward.
Kevin Pho: What are the obstacles to implementing these solutions more widely?
Betsy Castillo: The biggest challenge is gaining the trust of clinicians. We need to demonstrate that the data is accurate and actionable. Once that trust is established, adoption will follow.
Kevin Pho: For systems that don’t use this technology, what’s the current situation like?
Betsy Castillo: Most systems are essentially electronic versions of paper charts. They don’t integrate information across different settings, such as outpatient offices and pharmacies. By overlaying a system that pulls data from multiple sources, we can create a cohesive picture without requiring costly system replacements.
Kevin Pho: We’re talking to Betsy Castillo, a nurse executive. Today’s KevinMD article is “How Automation Helps Nurses Return to the Bedside.” Betsy, let’s end with your take-home thoughts for the KevinMD audience.
Betsy Castillo: Trust the information and do your own research. With AI and digital tools evolving so quickly, it’s important for clinicians to stay informed. Talk to your nurse leaders and use data to demonstrate how these solutions can save time and improve care. The rapid advancements in technology and the decreasing costs are going to have a massive impact.
Kevin Pho: Betsy, thank you so much for sharing your perspective and insights. Thanks again for coming on the show.
Betsy Castillo: Thank you very much. It was a pleasure.
