Updated: Apr 23
The Nurses at Mary Washington Hospital in Fredericksburg, Virginia, have been given an extra assistant for their shifts: Moxi, a nearly six-foot-tall robot that carries medications, supplies, lab samples and personal items through the hallways and from floor to floor. After two years of fighting COVID-19 and the burnout it caused, this is a welcome relief for the nurses.
"There are two types of burnout: there's the 'we are short this weekend' burnout, and then there's the pandemic burnout that our nursing teams are experiencing right now," says Abigail Hamilton, a former ICU and ER nurse who leads nursing support programmes at the hospital.
Moxi is one of several specialised delivery robots that have been developed in recent years to ease the burden on health workers. Even before the pandemic, nearly half of nurses in the US felt that their jobs did not offer an adequate work-life balance.
The emotional toll of watching patients die and infecting colleagues on such a scale - and the fear of bringing COVID-19 home to families - added to feelings of burnout.
Studies have also found that burnout can have long-term consequences for nurses, including cognitive impairment and insomnia for years after exhaustion in their early careers. There was already a shortage of nurses worldwide when the pandemic began.
According to a National Nurses United union survey, about two out of three nurses in the US have considered leaving the profession.
The shortage leads to higher wages for permanent staff and temporary travelling nurses. In countries like Finland, nurses demand better pay and go on strike. But it has also paved the way for more robots in healthcare.
At the forefront of this trend is Moxi, which had rolled through the hallways of some of the country's largest hospitals during the pandemic to bring emergency room patients items like a smartphone or a beloved teddy bear when COVID-19 protocol kept family members away from the bedside.
Diligent Robotics developed Moxi; a company co-founded in 2017 by Vivian Chu, a former Google X researcher, and Andrea Thomaz. They developed Moxi while she was an associate professor at the University of Texas at Austin. The two roboticists met when the Chu was advising Thomaz at Georgia Tech's Socially Intelligent Machines Lab.
Moxi's first commercial deployment came months after the outbreak of the pandemic. About 15 Moxi robots are now used in US hospitals, with another 60 to follow this year.
"In 2018, every hospital thinking about working with us was a special project for the CFO or an innovation project about the future hospital," says Andrea Thomaz, CEO of Diligent Robotics. "We have seen over the last two years that almost every health system is thinking about robotics and automation or has robotics and automation on its strategic agenda."
Several robots have been developed to perform healthcare tasks such as disinfecting hospital wards or assisting physiotherapists in recent years. Robots that touch humans - such as the Robear, which lifts older adults out of bed in Japan - remain primarily experimental due to liability and regulatory requirements. More widespread are specialised delivery robots.
Moxi is equipped with a robotic arm and can greet passers-by with cooing sounds and heart eyes on a digital face. However, Moxi is less of a caregiver and more like Tug, another delivery robot for hospitals, or Burro, a robot that helps farmworkers in Californian vineyards. A camera on the front and a lidar sensor on the back help Moxi map hospital floors and recognise people and objects it should avoid.
Nurses can summon Moxi robots from kiosks in nursing stations or send the robot a task via text message. Moxi could be used to transport items that are too large to fit in a tube system, such as IV pumps, laboratory samples and other fragile goods, or special items such as a piece of birthday cake.
A survey of nurses who have worked with Moxi-like delivery robots in a hospital in Cyprus found that about half felt that robots posed a threat to their work. Moxi still needs help with basic tasks. For example, Moxi has to ask a human to press a lift button for a particular floor.
More worryingly, the cybersecurity risks that hospital robots pose are not yet well understood. Last week, security firm Cynerio revealed that hackers could take remote control of Tug robots or violate patient privacy by exploiting a vulnerability. (No similar flaws were found in the Moxi robots, and the company says it is taking steps to ensure its "security posture").
Around the time of Moxi's first commercial deployment in 2020, a case study supported by the American Nurses Association evaluated Moxi trials in hospitals in Dallas, Houston and Galveston, Texas.
The researchers pointed out that using such robots requires more careful care management by hospital staff. The robots cannot read expiration dates, and expired dressings can increase the risk of infections.
The majority of the 21 nurses interviewed for the study said Moxi gives them more time to talk to patients discharged from the hospital. Numerous nurses said Moxi saved them energy, brought joy to patients and their families, and ensured that patients always had water when it was time to take their medication.
"I could do it faster, but it is better when Moxi does it so I can do something else more meaningful," said one of the nurses interviewed.
Nurses complained that Moxi had difficulty navigating the narrow hallways during the morning rush or anticipating needs by accessing electronic health records in less positive feedback. Another said some patients were wary of "the eyes of the robot recording them". This case study concluded that Moxi cannot provide skilled nursing care and is best focused on low-risk, repetitive tasks that can save nurses time.
These types of tasks can represent big business. In addition to its recent expansion into new hospitals, Diligent Robotics announced the closing of a $30 million funding round last week. The company will use the funds to, among other things, more closely link Moxi's software with electronic health records to perform tasks without a nurse or doctor has to make a request.
Abigail Hamilton of Mary Washington Hospital has found that burnout can force people into early retirement, push them into temporary work as travel nurses, affect relationships with loved ones or cause them to leave the industry altogether.
Yet, she says, the simple things Moxi does can make a difference. It can save nurses the 30 minutes it might take to walk from the fifth floor to the basement to pick up medications from the pharmacy that can not be transported through the tube system.
And picking up meals for patients after hours is one of Moxi's most popular tasks. Since two Moxi robots were put into operation in the corridors of Mary Washington Hospital in February, they have given back about 600 hours of staff time.
"As a society, we are not who we were in February 2020," Hamilton explained why her hospital uses robots. "We need to think of new ways to support nurses at the bedside.
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