How St. Luke’s Improved Patient Safety and Reduced Staffing Costs with Virtual Sitting

Background

St. Luke’s is a Duluth, Minnesota-based health system that serves the communities of northeastern Minnesota, northwestern Wisconsin, and the Upper Peninsula of Michigan. Its services include primary and specialty care, a level II regional trauma center, the only DNV orthopedic center of excellence in the state, a nationally recognized regional heart and vascular center, as well as a regional cancer center accredited by the American College of Surgeons’ Commission on Cancer. The hospital’s mission is to put the patient above all else, and its more than 3,000 employees endeavor to demonstrate compassion, quality, teamwork, and safety in everything they do.

Problem

Like many health systems across the country, St. Luke’s faced challenges associated with staffing such as a tightening labor market, increasing competition for experienced healthcare workers, and rising costs. Many of these challenges were exacerbated by the COVID-19 pandemic, prompting St. Luke’s nursing leaders to seek out new ways to provide additional resources and support to its patient care staff. To overcome these barriers, St. Luke’s decided to implement a virtual sitting solution, which would enable it to decrease the use of costly one-to-one sitters to monitor at-risk patients and achieve a quick ROI. After a competitive review of vendors, St. Luke’s decided to partner with AvaSure, due to feedback that nursing leaders received from peer institutions regarding AvaSure’s excellent customer service, quick implementation and continued program support post-launch.

Solution

Due to the costs and general unfeasibility of employing one-to-one sitters, many leading health systems have explored alternative means of preventing patient falls. One method that has proven effective is virtual sitting, which enables a single trained employee to monitor multiple patients simultaneously via AI-enabled mobile video-and-audio connection, preventing falls, elopement, violence against caregivers, and other adverse events. AvaSure’s two-way video and versatile configurations of room devices enable a wide range of virtual care advances.

For its virtual sitting program, St. Luke’s uses a two-person model: one staff member provides sitting and rounding services for patients and staff, while the other specialist observes patients via video monitors. Nursing leaders have found that this approach enhances patient and staff safety and helps support sitting staff by providing adequate breaks to avoid monitor fatigue. Promoting a team approach to safety has helped build trust and goodwill between departments which, in turn, has increased program utilization.

By adding a rounding specialist, the hospital has provided nursing staff with a valuable resource for patient safety, which allows them to concentrate on direct patient care needs. Here’s how the process works:

• Once an order is received, one specialist transports the camera to the patient room, completes audio and visual checks, and introduces the monitor observer to the patient.
• During rounds, the rounding specialist obtains face-to-face reports from nursing staff, provides patient updates, and rounds on one-to-one patients and staff while ensuring their welfare and conducting room safety checks.
• Additionally, the specialist facilitates the triage process, attends staffing huddles, and cleans and transports camera and audio devices to storage.
• Finally, the monitor observer and rounding specialist switch places at least every four hours, depending on patient acuity, to avoid monitor fatigue.

In addition to using virtual sitting for patients at risk of falls and elopement, St. Luke’s Hospital has expanded to virtual sitting for monitoring vital signs, monitoring seizure patients, communicating with patients requiring frequent interactions, and connecting with patients who have high call light usage. Its monitor specialists are currently being trained in empathetic communication, by their Mental Health Department, in order to provide additional support to patients experiencing anxiety, depression and other mental health issues.

Results

Since initiating the virtual sitting program at St. Luke’s Hospital in November of 2021, they have had more than 164,842 hours of patient observation. The program utilizes 16 devices throughout the hospital. Virtual monitoring of patients has improved patient safety through fall reduction and prevention, boosted staff efficiency, and decreased staffing costs by reducing one-to-one sitters.

St. Luke’s primary use of virtual sitting is for fall reduction and prevention. Fifty four percent of patients are admitted to the program for heightened fall risk. The program is estimated to prevent 529 falls per month.

Virtual monitoring has allowed patient care teams to become more efficient by reserving their time for skills, activities and clinical tasks appropriate to their experience, education, and licensure; thus, relieving them of duties that could be safely done by someone else with an alternative skill set. To optimize nursing licensure, St. Luke’s implemented innovative methods of deploying its virtual sitter technology. One example is utilizing monitor staff to check in with patients receiving continuous bladder irrigation, instead of the nurse being required to check in with the patient every 15-20 minutes. Another example is using the virtual monitor assistant to encourage patients to drink their bowel prep solution every 15 minutes, again preventing a nurse from having to do this task.

The cost-effectiveness of the virtual sitter technology compared to traditional methods of one-to-one sitters has been incredibly impactful to St. Luke’s Hospital. In 2023, virtual sitter hours accounted for 39.7 FTEs hospital-wide, while staffed one-to-one sitters amounted to 8.8 FTEs. For 2023, the annual cost savings from its virtual sitting program was over 1.5 million dollars. From 2022-2023, some units in St. Luke’s Hospital saw a decrease in the number of one-to-one sitters by 73% due to the utilization of the virtual sitter program. Looking back to 2018, prior to implementing the virtual sitter program, St. Luke’s Hospital averaged 15.9 FTE of one-to-one sitters. Since 2018, they have decreased one-to-one sitter FTE by about half, which allows those staff members to return to providing bedside care on the unit in addition to adding the support of the virtual sitter program. Virtual sitting improved staffing ratios from one-to-one to one-to-12, sometimes even as high as one-to-16, depending on patient acuity.

Another noteworthy result includes the number of verbal interventions monitor staff perform and their level of patient engagement. St. Luke’s virtual monitor staff consistently performs twice the national average of verbal interventions than others, with more than 20 verbal interactions per patient, per day. The results of the frequent verbal exchanges are that the average number of stat alarms applied monthly at St. Luke’s Hospital ranges between 0.2 – 0.5 per day. The accumulative comparison average of other organizations is 2.0 stat alarms applied each day. Additionally, in 2023, St. Luke’s Hospital bedside care staff reduced alarm response time to 9 seconds, 46% better than the average national response time of 17 seconds in 2023.

Over the course of the two-year project, St. Luke’s nursing leaders have identified three key elements essential to the success of the virtual sitting program: consistent and clear communication; ease of implementation; and patient and staff safety.

Next steps/Lessons learned

As the program continues to mature, St. Luke’s plans to expand virtual sitting for other uses. For example, they recently extended the use of virtual sitting to their discharge lounge, which is designed to accommodate patients who are alert and can walk independently. To provide care for these patients, the rounding specialist welcomes patients to the lounge and performs safety checks, while the virtual safety attendant watches over patients and alerts staff when potential patient safety events occur. The health system is in the process of implementing a hub-and-spoke model, where patients in other facilities can be monitored from one centralized and remote location at St. Luke’s Hospital in Duluth, MN.

They plan to leverage the software program’s AI capabilities to enable them to enhance efficiency and time-savings while also improving the quality of care. Initial applications will help amplify a virtual safety attendant’s capacity for reducing elopement and preventing falls. Safety attendants will remain the “human in the loop” with support from AI, which will alert virtual safety attendants when an at-risk patient tries to stand up or attempts to leave their room. Virtual team members can then intervene before an adverse event occurs. AI will also help with predictive fall risk identification, improving the accuracy of identifying patients at risk of falling, which in turn alleviates the nursing workload associated with fall risk assessments. AI-driven alerts will be delivered directly within the platform, guiding observer attention precisely where it’s most needed.

The integration of virtual sitter technology represents a significant step towards enhancing patient care and streamlining healthcare operations. By considering these key factors, healthcare providers can make informed decisions that contribute to a safer, more efficient, and patient-centric healthcare environment.