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By LISA EISENHAUER

The robots maneuvering through the corridors of Mercy Hospital Jefferson don't even turn many heads anymore.

For five years, the 3-foot-tall autonomous devices have been beeping their way down the halls at the 251-bed hospital in Festus, Missouri. They deliver meals to units, pick up and drop off laundry, tow trash to an outdoor dumpster, and shuttle medications and supplies. The hospital's six robots together logged 5,500 miles last year.

In January, Chesterfield, Missouri-based Mercy began a phased expansion of the robots to seven of its other acute care hospitals in Missouri, Arkansas and Oklahoma. The TUG robots are made by Pittsburgh-based Aethon. The company does the mapping and programing required before the robots go live and it monitors their operation remotely once they are in service.

Jackee Bauch, executive director of support services at Mercy Jefferson and Mercy Hospital South in St. Louis County, Missouri, has helped oversee the robot pilot project. She says while patients and visitors still sometimes do a double take when the machines roll past, co-workers have become accustomed to the robotic couriers.

Bauch says the machines have improved the work environment by unburdening co-workers of some tasks in order to open up more time for other duties. The robots push meal carts to patient floors where nonmedical aides pass out the food trays to patients. Robots cart medications and supplies to medical units to recapture time pharmacy and clinical staff can devote to patient care. They assist housekeeping staff by hauling loads of dirty linen to the laundry.

Bauch says robots have not replaced any co-workers, just taken over some of the more mundane tasks. "We want to treat our co-workers with dignity and this is one way to do it because it allows them to spend more time with patient care," she says. "That's why they come here to work, to take care of patients and serve them."

Rise of robotic technology
Robotic technology factors into clinical care too. Many surgeons use robotic tools to increase surgical precision. Rehabilitation robots assist in reconditioning patients. Robotic exoskeletons allow wheelchair users to stand and walk.

Saint Joseph Hospital in Denver, part of Intermountain Health, opened in 2014 with what it called the nation's first robotic pharmacy.

In 2020, the American Nurses Association published an 84-page case study on the use of autonomous service robots in hospitals. The white paper notes that the technology appears to be on the rise and is likely to have profound impacts on the profession.

"Regardless of the speed with which this transition will occur, robotics associated with patient care will very likely transform and revolutionize the way we support, augment, and deliver care," the case study says.

Two hospitals within Trinity Health are piloting the use of Moxis made by Diligent Robotics for the hospital system. One is MacNeal Hospital in suburban Chicago, part of Loyola Medicine. The other is Trinity Health Oakland Hospital in Pontiac, Michigan.

Diligent Robotics, an Austin, Texas-based company founded in 2017, designs robots specifically for use in health care settings. Diligent says the number of hospitals using its Moxi robots increased from two at the start of 2022 to 14 by year's end. Moxis logged a total of 160,000 deliveries in those facilities last year.

Jennifer Moore, nurse manager of cardiac telemetry at MacNeal Hospital, calls the two Moxis that began making rounds there in August "a great addition to our staff."

In her unit, Moore says the Moxis cart the cardiac telemetry boxes between patient rooms and the central telemetry hub. The robots also ferry goods from central supply and medications from the pharmacy. Moore says Moxis usually deliver requested supplies within 10 minutes.

"This is a solution to a problem I don't think we realized we had," she says. "I think it has been great for our staff overall because they appreciate the time Moxi has given them to stay at the bedside."

No replacement for the human touch
Unlike TUG robots, which from the front resemble a washing machine-sized appliance, Moxi robots have a more humanlike appearance. They are 4½ feet in height and weigh in at about 300 pounds. They have what looks like a torso with a bendable arm attached. They are topped with a rounded block about the size of a human head, complete with eye-like lights that can flash red hearts when people are around.

MacNeal staff summon and direct the Moxis via iPad kiosks at central locations in the hospital. The robots are programed for routes within and between the hospital's two towers. Each robot has three secure drawers in its base. Access to the drawers is programed into individual workers' electronic ID badges.

While they can't carry on a conversation, Moxis can announce themselves with simple statements like "I'm here for a pickup." When they're not on a task, the devices park themselves at recharging stations.

Diligent Robotics contracts out the Moxis in packages that include programing and service. Gregg Springan, head of clinical informatics at Diligent Robotics, says the company is continually updating the Moxi software. The programing incorporates machine-learning algorithms that fine-tune the robots' ability to navigate in their environments.

Springan says while the Moxis somewhat resemble humans, the company's intent is not to replace flesh and blood workers. "In fact, I would argue that robots can't replace the human touch," Springan says.

What they can do is give workers more time to do essential tasks and bolster the efficiency of a workforce that is increasingly spread thin, he says.

Optimism and concern
The American Nurses Association case study includes input from Diligent and three hospitals piloting service robot use. The white paper reflects optimism that the devices will in the long run prove to be a blessing for nurses, as well as concerns.

"If nursing is to remain relevant, we must use our superpower of innovation and become proactively involved in charting the path for the adoption of this emerging technology, provide direction into what skills robots provide and help determine how robots are incorporated into the patient care ecosystem," the paper says.

Springan is onboard with the notion that nurses should have input into how Moxis and other robots impact their profession. He's a former intensive care nurse and part of a team of clinicians at Diligent who he says are "representing the voice of the medical profession" as the company continues to evolve its technology.

Proof of concept
At Mercy Hospital Jefferson, pharmacist Rachel Handrahan had reservations when the TUG robots were introduced. "I was kind of like, eh, I don't know how that's actually gonna work," she recalls.

Now her pharmacy keeps two of the robots busy with deliveries day and night. One of the TUGs has multiple drawers. Handrahan can schedule a specific drop spot for each drawer. Staff at the receiving end have to use a unique ID and their fingerprints to open the drawer. At each scheduled stop, the robot will wait up to 10 minutes before automatically moving on to the next stop and then returning to their base. The robot's runs can take more than an hour.

The other pharmacy robot has one large locked cabinet. Handrahan sends it out with deliveries that require more space, such as bags of intravenous fluids.

When the TUGs are on the units, Handrahan can monitor from her desktop their whereabouts and progress as well as who has accessed each compartment. She can even switch to a view from the cameras on the robots to see their surroundings.

Now that she's had the robotic helpers for several years, Handrahan admits, "I do like them way more than I ever thought I would."