Author: SuperScoutTrooper

Addressing workforce challenges and keeping patients safer: How CHS is deploying virtual patient monitoring

Posted on November 13, 2023 by - Uncategorized

Explore their journey of virtual patient monitoring from evaluation to implementation to outcomes, including a significant reduction in falls, zero patient falls with injuries in 2022, and improved staffing efficiencies.

Challenge: Reducing patient falls

CHS, one of the largest provider organizations in the United States, operates across 43 distinct markets in 15 states. Their decade-long commitment to high reliability, safety, and harm reduction aligned perfectly with the need to reduce falls during the pandemic in 2021. Hospitals across the nation have been grappling with staffing shortages, leading to nurse burnout and a rise in adverse patient events. As the personnel issue worsened, many healthcare systems asked: How can hospitals create a care system that reduces the need for 1:1 patient sitters while allowing nurses to focus on critical patient care?

Evaluating solutions: Evidence and scalability

In their quest for the right solution, CHS employs a rigorous evaluation process. Their primary criteria encompass two crucial elements: evidence-based effectiveness and scalability. First and foremost, CHS seeks evidence-backed solutions, emphasizing clinical outcomes and operational impacts. This commitment to data-driven decision-making ensures that any chosen solution delivers tangible benefits across both patient care and operational efficiency.

The second key criterion is scalability. Given CHS’s size, the ability to initially implement a solution at a few select hospitals and then scale it elsewhere across the organization is paramount. In this regard, AvaSure’s TeleSitter solution met these criteria for virtual patient monitoring, making it a natural choice to address their needs.

Phase 1 deployment: Keys to success

CHS’s journey with the AvaSure TeleSitter solution commenced with a pilot deployment at three hospitals and then scaled to 17. This pivotal phase yielded notable success, attributed to several critical factors:

  • Intentionality: The deployment of virtual patient monitoring was marked by a deliberate and well-thought-out strategy. Every step was carefully considered, from initial planning to execution, ensuring a seamless integration of the TeleSitter solution into their healthcare ecosystem.
  • Metrics that matter: A key driver of success was CHS’s dedication to data-driven decision-making. They recognized the importance of collecting precise and relevant data to assess the impact of the TeleSitter solution accurately. This commitment to meaningful metrics allowed them to track progress, identify areas for improvement, and ultimately optimize patient care outcomes.
  • Leadership and oversight: Strong leadership and dedicated oversight were pivotal throughout the deployment process. Key leaders within CHS played a central role in driving the virtual patient monitoring initiative forward. Their unwavering commitment and guidance ensured that the program remained aligned with the organization’s broader goals and objectives.
  • Buy-in and Teamwork: CHS understood that achieving the desired results required a collaborative effort. Encouraging buy-in and utilization among staff was essential. Through effective communication, collaboration, and trust, the healthcare team worked together to maximize the benefits of the TeleSitter solution. It became a team effort, with everyone playing a crucial role in its success.
  • Strategic Patient Selection: CHS recognized the importance of strategic patient selection in applying the technology where it would be most effective. Careful consideration was given to identifying patients who would benefit most from the TeleSitter solution, further optimizing its impact on patient safety and care quality.

This comprehensive approach to the Phase 1 deployment set the stage for CHS’s journey implementing virtual patient monitoring, paving the way for positive clinical and operational results.

Outcomes: Reduction in falls and positive operational and financial impact

Following the completion of the pilot program, CHS embarked on a thorough analysis, which unveiled some significant outcomes.

  • A Meaningful decrease in falls: While CHS has worked effectively to reduce falls for years, implementation of the TeleSitter solution led to an even greater reduction in falls, including a 76% reduction in one hospital.
  • Zero patient falls with injuries in 2022: In 2022, CHS reported zero patient falls with injuries at facilities using virtual patient monitoring. This milestone reflects a profound commitment to patient safety.
  • Savings through injury avoidance: The solution translated into meaningful savings through the avoidance of costs related to patient injuries. In an environment where litigation looms, AvaSure can help mitigate potential liability claims when it comes to falls with injury.
  • Staffing dfficiencies of 16 to 1: The introduction of virtual sitters had a strong effect on staffing efficiency. With each virtual sitter capable of monitoring up to 16 patients simultaneously, CHS achieved staffing efficiencies of 16 to 1. This efficiency not only optimized staffing allocation but also enabled caregivers in CHS hospitals to work at the top of their licenses and provide more attentive care to a broader patient population.

These outcomes are a testament to CHS’s commitment to excellence, safety, and innovation. AvaSure delivered quantifiable operational benefit and helped reinforce the high standard of patient care and safety across CHS.

Quality and patient care lead to next steps

Today, CHS is poised to expand virtual patient monitoring services. With 87 devices currently in place, CHS plans to add 78 more across 12 more hospitals by the end of 2023.

CHS’s innovative approach helps ensure that more patients are kept safe, more healthcare professionals are supported, and the future of healthcare is brighter than ever.

Watch the webinar replay to hear firsthand from CHS about how they expanded their virtual patient monitoring program to enhance patient safety and optimize resource utilization.

Today, CHS is poised to expand virtual patient monitoring services. With 87 devices currently in place, CHS plans to add 78 more across 12 more hospitals by the end of 2023.

Best practices for behavioral health monitoring: Virtual monitoring of patients at risk of suicide

Posted on August 15, 2023 by - Uncategorized

AI patient monitoring on screen illustration

The ins and outs of behavioral health monitoring, including regulatory standards, device selection, patient consent, and evaluation tools in utilizing virtual monitoring for patients at risk of suicide.

FPO Image

Mental health conditions are on the rise in all age groups, affecting millions of Americans. Providing safe care for patients with behavioral health needs can be especially difficult when they are in emergency departments or acute-care settings that are not designed for their needs. Too often, hospitals resort to using costly 1:1 sitters to monitor patients with low-to-moderate suicide risk, and providing this sitter often means pulling a much-needed care staff member from the floor. In a world where hospitals are pressed to “do more with less” this can exacerbate already stretched staffing levels, which is why hospitals are looking for more scalable ways to keep their at-risk patients safe.
There is a perception that virtual sitting solutions aren’t allowed or suitable for these patients – in reality, while policies may have to be adjusted, most governing bodies allow for the virtual monitoring of patients that are assessed to be at low and moderate risk of suicide. Using a TeleSitter® program for these behavioral health monitoring can help reduce placing additional staffing constraints on your system while empowering patients on their journey to well-being.

Discover how 8 hospitals are using virtual sitting for their low-to-moderate suicide risk population

What are the regulatory standards for behavioral health monitoring?

With virtual sitting proven as a reliable solution for preventing falls, the question has naturally risen whether it is a suitable method for monitoring other vulnerable patients, including those at risk of suicide. Research led by David Kroll, MD, of Brigham and Women’s Hospital in Boston, showed that having a 1:1 sitter in the room of a suicidal risk patient is unproven in preventing self-harm. By contrast, use of the TeleSitter® solution on suicide risk patients resulted in zero adverse events.1 This study paved the way for the Joint Commission to deem the use of video monitoring for patients who are not at high risk for suicide up to the discretion of the organization in 2019.

Hospitals in 45 states across the U.S. are using AvaSure to virtually monitor over 75,000 patients for low-to-moderate risk of suicide.2

Do patients need to complete an informed consent form before they can be monitored?

Patient consent is not necessary for non-recorded video monitoring when it is solely employed for the purpose of ensuring patient safety, allowing healthcare providers to promptly implement essential monitoring systems that prioritize patient welfare, and fostering a safer and more secure healthcare environment. AvaSure’s platform does not record videos of patients.

What devices are best for behavioral health monitoring?

Selecting the right device is key to ensuring patient safety. You will need a robust device that offers 360-degree pan/tilt/zoom functionality for a comprehensive view of the surroundings. The device should feature infrared viewing to ensure visibility during both the day and night. High-resolution capability is essential to enable effective risk assessment, such as identifying potential hazards like trash bags, lines, or hidden items.  

Two-way communication capabilities are a must for verbal redirection, especially in situations where a patient may attempt to go into the bathroom alone. And finally, any alerts from the device must be loud so staff can quickly respond to potential safety concerns.

AvaSure offers robust device options suited to meet the needs of behavioral health monitoring, such as patients at risk of suicide, including ligature-free ceiling options.

What tools are used to evaluate patients for suicide risk?

It is up to the discretion of the care team to determine if a patient is appropriate for virtual monitoring based on the hospital’s protocols and clinical judgment.

It’s critical to have an adequate, evidence-based screening tool in place to conduct suicide risk assessments. The Columbia Suicide Severity Risk Scale (C-SSRS) is the most commonly used tool to assess suicide risk, and we highly recommend it. However, if you’re interested in exploring other options, The Suicide Prevention Resource Center provides a variety of resources for different risk stratification tools.

To keep everyone on the same page, it’s important to review and address any existing hospital policies around suicide risk assessments. Depending on the state and other regulatory factors, there may be additional compliance considerations to keep in mind.

At the end of the day, our goal is to work collaboratively with hospitals and providers to ensure that every patient receives the appropriate level of monitoring to keep them safe and healthy. AvaSure’s Customer Success team will advise and help your team develop policies and risk stratification that work best for your hospital and patient population.   

How do you overcome adoption challenges in behavioral health monitoring?

Change management is key. It’s common for staff to initially feel hesitant to use a virtual monitoring solution in place of a 1:1 sitter. First and foremost, ensure your staff understands the inclusion and exclusion criteria for patients and the screening process. You’ll want to keep everyone in the loop so they can feel confident about the new system. To make everyone feel even more comfortable, many facilities run pilots where a virtual monitor is used alongside an in-person sitter, who is just outside of the room. This safety net not only eases minds but also proves the efficacy of the system.

And don’t forget to celebrate the good catches! Sharing your successes with hospital leadership, nurse managers, and front-line staff is crucial to building goodwill around your new behavioral health monitoring program and gaining support. AvaSure provides a toolkit for our customers to easily share the good news with their hospital.

Are the staff monitoring for suicide risk required to be clinical or specially trained in any way differently from those monitoring for falls, elopement, etc.?

While there are no formal requirements for specialized training, we highly encourage you to invest in additional training to ensure your staff is fully prepared for their role. We recommend annual education and competency validation for Virtual Safety Attendants (VSAs) along with education on the risk of suicide to ensure that your team’s skills remain sharp while monitoring this vulnerable patient population.

But it doesn’t stop there – it’s equally important to train your bedside staff. By sharing stories and experiences that highlight the potential consequences when things go wrong, you can drive home the need for compliance and create a sense of urgency around proper training.

At AvaSure, we provide specialized training and competency evaluation resources that equip your VSAs with the knowledge and skills needed to effectively monitor patients at risk of suicide. From screening the room for potential safety risks to redirecting patients who may attempt to use the bathroom alone, our training ensures that your VSAs are well-prepared for any situation.

By investing in comprehensive training for your virtual safety attendants and bedside staff, you can enhance the overall safety and well-being of your patients. Together, we can ensure that everyone is equipped with the necessary knowledge and skills to provide the highest level of care.

AvaSure’s Customer Success team is comprised of nurses and change management experts who are ready to guide you through best practices and provide clarity, policy templates, training, and resources about using behavioral health monitoring to keep patients safe. Schedule a discovery session with our team today.

Resource Center

Discover best practices from 8 hospitals using AvaSure for virtually monitoring patients at risk of suicide

Hear how St. Peters’ Health, Ascension Michigan, and HCA Methodist keep suicidal patients safe, virtually

Hear how HCA Kingwood and Froedtert use behavioral health monitoring

Learn about AvaSure’s ligature-free ceiling device

Suicide Prevention Resource Center

The Columbia Suicide Severity Risk Scale

Guidance from The Joint Commission on video monitoring of patients at high risk for suicide

References:

  1. Kroll, D. S. et al., (2020). Virtual monitoring of suicide risk in the general hospital and emergency department. General hospital psychiatry, 63, 33-38. https://doi.org/10.1016/j.genhosppsych.2019.01.002
  2. Insights from AvaSure’s national database on virtual monitoring (ORNA®)

4 Key insights from AvaSure’s first digital summit

Posted on August 2, 2023 by - Uncategorized

AvaSure Symposium ft. Lisbeth Votruba on stage

Last week AvaSure hosted our 1st Annual Digital Summit: Start, Scale & Succeed with Virtual Sitting. During this one-day educational event, we featured over 10 current AvaSure customers to share their best practices & learnings from deploying virtual sitting programs.  Read on to hear how they were able to improve outcomes, optimize their labor force and protect staff all while helping to reduce costs.

There were so many exceptional discussions centered around today’s challenges – staffing being front and center. We know that hospitals across the U.S. are struggling to find enough nurses and support staff to run efficiently, so technology is helping to bridge the gap. With the AvaSure TeleSitter® Solution, hospitals are replacing the need for traditional 1:1 sitters by using Virtual Safety Attendants (VSAs) to monitor up to 12 patients remotely while reducing adverse events. Seem too good to be true? The results just may be.

How Valley Health Reduced the Use of 1:1 Sitters While Decreasing Falls

Valley Health System shared their story of starting a TeleSitter program four years ago that has gone on to help:

  • Reduce falls with injury by 50%
  • Save over $1 million dollars from combined fall reduction and sitter cost reduction
  • Achieve an 80% device utilization across the system

When discussing why they chose to work with AvaSure, they said, “We wanted to work with the experts to show us how this has worked at other organizations. Other organizations have made mistakes, had those mistakes corrected and so we are the beneficiaries of that. We wanted to focus on what we are good at. What we aren’t good at is setting up our own sitter program. But, what we are good at is knowing our needs, selecting the best partner out there and picking someone who could address our needs today & help us go beyond that in the future.” AvaSure has helped over 1,000 customers just like Valley Health start their programs and we have the clinical expertise to help make it as turnkey as possible for your staff.

Use Cases for TeleSitter solutions extend beyond just falls

Success of virtual sitting extends beyond just the acute care setting, Gaylord Specialty Healthcare gave a sneak preview of yet-to-be published results of how AvaSure helped optimize their LTACH program.

While virtual sitting programs may be best known for helping reduce falls, their use extends far beyond that one use case. We heard from Rachel Krajnovich, MSN, RN-BC, Director of Clinical Operations at HCA Kingwood on utilizing virtual monitoring for suicide risk & behavioral health patients.

  • Suicide is the 12th leading cause of death in the U.S. across all age groups and the number of patients requiring suicide monitoring in acute care has increased 165% since 2019
  • 45% of hospitals that utilize AvaSure have monitored over 75,000 suicide risk patients across 45 states

This lesser-known use case can be extremely effective in helping to monitor low and moderate suicide risk patients, and is proven to be equally effective to in-person sitters for this population(1). These customers shared best practices regarding how they evaluate patients to be placed in the program, how they helped to get physicians and staff on board with utilizing virtual monitoring for this high-risk population and how it has helped them extend access of needed yet scarce mental health resources in ERs today.

Expanding to other use cases is just one example of scaling your program, you can also help to extend the reach of your program across various facilities in your system, helping you to achieve greater scale and efficiency. Providence Oregon Region shared how they built a ‘hub and spoke’ model – which involves having devices across multiple facilities with monitor staff at one, centralized hub watching patients across the system. This can help create a highly effective staff that is able to protect patients across the system and optimize your device utilization. Hear how they were able to achieve an average stat alarm response time of 12-15 seconds, well below the national average of 17 seconds.

Virtual Safety Attendants are Key to Program Success

 As always, one of our most popular sessions was best practices from Virtual Safety Attendants – sharing how they’ve built teams of heroes that work 24/7 to connect with patients, keep them safe, keep them calm & help assist them on their recovery journey. We heard from a VSA, Tom Dezell from Froedtert, who shared when thinking back on advice he’d give himself on his first day:

 “That I cannot let my fear of something happening to the patient interfere with my taking care of the patient. In other words, I can’t respond out of fear, I have to respond out of patient advocacy and confidence.”

His demonstrated commitment to his patients brought emotions to all who listened as he spoke so passionately and eloquently about the time he spends helping patients.


What Does the Future of Virtual Care Look Like?

We closed the day with Claire Zangerle, DNP, MBA, RN, NEA-BC, FAONL, FAAN, Nurse Executive with CMZ Strategies, LLC discussing the future of virtual care with AvaSure Chief Clinical Officer, Lisbeth Votruba, MSN, RN. In discussing her hopes for the future of nursing in this new virtual care environment she said,

“It’s our time as nurses to step up and make sure we’re listened to. We have to tell people how great it is to be a nurse and what it means to be a nurse. We’re in danger of people saying that the job is too hard to do. Everyone wants to work remote now, you can’t be hands on and work remote. You have to promote the value of human interaction, it’s so important. We know we don’t have enough staff and enough people to do human interaction whether it’s in a hospital, ASC, community health center, we know we don’t have enough people. We need to meet patients where they are, and we need to think of new ways to meet patients. We aren’t thinking about this because we don’t have enough staff, it’s also because that’s what patients want. We are looking at ways to make sure they get what they want.”

Nursing has always been and will always be an essential and noble profession that relies on hands-on patient care, clinical expertise & empathizers who care deeply about the lives of their patients. AvaSure believes that nurses should always be central to care, which is why we featured nurses throughout our summit – as moderators, hosts & panelists to demonstrate the vital role they play in the shifting care model moving forward.

We look forward to sharing more insights, recaps and full session replays of Digital Summit for those who have missed it, and we look forward to seeing you IN-PERSON at our upcoming Annual Symposium October 25th – 26th in Grand Rapids, Michigan – learn more here.

1 Kroll, D. S. et al., (2020). Virtual monitoring of suicide risk in the general hospital and emergency department. General hospital psychiatry, 63, 33–38. https://doi.org/10.1016/j.genhosppsych.2019.01.002

Struggling with maintaining your Virtual Safety Team? You’re not alone.

Posted on April 18, 2023 by - Uncategorized

nurse looking at clipboard, holding head

Struggling with maintaining your Virtual Safety Team? You’re not alone.

Here are best practices for recruiting and retaining virtual safety attendants for your TeleSitter® program.

AvaSure monitor staff at computers

It’s no secret that healthcare is impacted by staffing shortages and turnover. During the past year, hospital turnover increased by 6.4% and currently stands at 25.9%. Recruiting and retaining virtual safety attendants is more challenging than ever. The “secret sauce” to maintaining a successful video monitoring program is in the details. We recently sat down with the experts to discuss how they created the sought-after role of a virtual safety attendant. Watch the webinar and see below for best practices for hiring, onboarding, and maintaining a program that keeps your virtual safety attendants engaged. Thought leaders:

  • Lori Colineri, DNP, RN, NEA-BC, Chief Nursing Officer, Hackensack Meridian Health
  • Tiffany Villamin, MSN, RN, CRRN, Nurse Manager, Patient Flow Support Services, VA North Texas Health Care System
  • Lisbeth Votruba, MSN, RN, Chief Clinical Officer, AvaSure

“When you hire right, you will have staff committed to the mission and to keep the program sustainable”

– Tiffany Villamin, MSN, RN, CRRN, Nurse Manager, Patient Flow Support Services, VA North Texas Health Care System

Finding the Right Talent is Critical to Success

It all starts with hiring. Virtual safety attendants are the lynchpin of a successful video monitoring program. A dedicated monitor staff member is one who makes patient care their top priority.

Proven tips:

  • Use AvaSure’s job roles & responsibilities and job description templates to kickstart your search
  • Look for candidates with at least one year of healthcare experience in rehab, acute care, and psychology settings
  • Beyond their resume, look for candidates who embody accountability, empathy, courage, and reliability.
  • If there is a labor shortage, partner with a staffing organization, like Equum Medical, to augment your team.
  • Work with local schools to create a pipeline program for nursing or allied health students.

BEST PRACTICE: Hackensack Meridian Health developed an “earn while you learn” program that helps learners get familiar with monitoring systems, work in the hospital setting, and communicate with patients. This program creates a pipeline of talent ready to take on new roles in the organization as they graduate. As an added bonus, those who went through the program are advocates for your virtual monitoring program throughout their careers.

Onboarding and Education Sets the Right Tone 

Your onboarding strategy is the first impression of your monitoring program and sets the tone for the attendant’s experience. A robust training program helps to build staff confidence, and better engagement with their patients. 

Proven tips: 

  • Use AvaSure’s education modules in your regular Learning Management System (LMS) for virtual safety attendants, nursing staff, nursing leaders, and non-nursing leaders. 
  • Hold an in-person or virtual open house to introduce your bedside nurses and virtual safety attendants. 
  • Have monitor staff spend the first 2-3 months monitoring full-time to get comfortable with the skillset required for TeleSitter® and then train them at the bedside, expanding their skillset. 
  • Use AvaSure’s competencies and skills checklists to prepare virtual safety attendants to confidently fly solo. 

BEST PRACTICE: Hackensack Meridian Health recognized that everyone plays a role in their monitoring program. They use AvaSure’s learning modules in their LMS for nursing and non-nursing roles so that when a STAT alarm goes off, everyone knows what to do without question. Those investments are worthwhile. Hackensack Meridian Health outperforms industry benchmarks on verbal interventions and STAT alarm response time.   

Recognition and Career Planning Keeps Staff Engaged

The best way to keep your video monitoring program strong is to retain your core talent. The program hinges on the reputation of your virtual safety attendants as trusted partners to the nursing staff.  

Proven tips: 

  • Ensure managers consistently check in on their team’s well-being, guaranteeing they are getting the breaks and support needed to remain focused on patient safety. 
  • Create a career path for roles like medical assistant, clerk, registered nurse, and phlebotomist to encourage positive turnover. 
  • Build a “great catch” program to recognize virtual safety attendants’ impact on patient safety as critical members of the team. 

BEST PRACTICE: VA North Texas Healthcare System designated a nurse responsible for administrative duties that ease the burden on the virtual safety attendant staff. This person is responsible for clinical coordination, data review, staff relief, education, and collaboration with the nursing staff. This role improved the partnership with nursing and raised the number of patients enrolled in the program. 

A successful virtual monitoring program improves patient safety while giving back to bedside nurses, and the strength of your program relies on the dedicated people behind the screen. More than technology, AvaSure is committed to the success of your TeleSitter® or TeleNurse™ programs. Pulling from our experience building virtual care strategies in over 1,000 hospitals and health systems, AvaSure’s clinical team partners with hospitals to ensure that their virtual safety attendants are confident, engaged, and seen as valued members of the team.

A Business Case for Centralizing TeleSitting: Clinical and Financial ROI at Ochsner Health

Posted on March 23, 2023 by - Uncategorized

virtual staff monitoring patient

Many leading healthcare organizations are turning to centralized audiovisual monitoring models as an alternative to 1:1 sitting for high-risk patients

Because one-to-one sitter staffing isn’t effective for high-risk patients, many leading healthcare organizations are turning to centralized audiovisual monitoring models as an alternative.

During a virtual featured session sponsored by AvaSure as part of Becker’s Hospital Review 11th Annual Meeting in May, two telemedicine leaders from New Orleans-based Ochsner Health joined AvaSure’s Chief Clinical Innovation Officer to discuss how a TeleSitter program in a hub and spoke format can deliver clinical and financial benefits to health systems.

Presenters:

  • Jennifer Humbert, MSN, RN, AVP of Telemedicine at Ochsner Health
  • Rachelle Longo, BSN, RN, AVP of Telemedicine Strategic Partnership Solutions at Ochsner Health
  • Lisbeth Votruba, MSN, RN, Chief Clinical Innovation Officer at AvaSure

Read the full article to learn more.

In Today’s Impatient Care Environment, the Nurse Call Light Falls Short

Posted on March 20, 2023 by - Uncategorized

nurse call light illustration

U.S. nurses have relied on the same technology, the nurse call light, to care for a growing, aging, more demanding patient population

It’s time for a more interactive patient room

The truth is that the call light technology used in thousands of patient rooms is rarely updated and increasingly deficient in detecting and alerting staff to life-threatening scenarios.

Amazing advancements like virtual visits, patient portals and remote patient monitoring for disease management are improving communication and quality of care. But how about technology that optimizes inpatient and caregiver safety against violence and “sentinel”[1] or patient safety events?

It’s time to overhaul the call light.

As AI, virtual care, and telehealth take center stage in healthcare delivery, there is an opportunity to embrace a more interactive patient room where:

  • Patients are protected from self-harm and adverse events in real time
  • Clinicians and caregivers can safely and effectively interact with patients before events escalate
  • The spread of viruses like COVID-19 is mitigated
  • The care team is reserved for the highest, most effective level of bedside care

Call lights, unsecured mobile devices (think baby monitors), and the questionable practice of using 1:1 sitters placed with patients presenting infectious disease or violent tendencies are neither safe nor sustainable ways to improve patient safety, experience or outcomes. As healthcare workers sometimes feel compelled to adapt unsecure workarounds to monitor potentially dangerous scenarios, it is imperative that health systems consider secure technology for optimal care and safety for every patient and every caregiver.

Thankfully, this is not a futurist mindset. A solution – remote inpatient video monitoring – does exist in most major hospitals around the country. Has it made its way into your holistic telehealth strategy?

What exactly is remote safety monitoring?

Remote safety monitoring technology provides a continuous live feed from a patient’s room, allowing hospital staff to monitor a patient while reducing exposure risks to infectious disease or violence. It improves communication, provides peace of mind and reduces stress among caregivers, patients and families. It allows healthcare workers to keep an eye on patients who are at risk or in isolation and enables clinicians to communicate with their patients any time, remotely, from a monitor at the nursing station.

Remote video monitoring, in conjunction with other safety measures, can:

  • Help monitoring staff prevent falls, self-harm attempts, and manage other adverse events, such as elopement or wandering and interfering with medical devices.
  • Alert nursing staff to potentially abusive visitors
  • Help staff immediately identify clinical deterioration and notify nurses
  • Protect bedside staff from potentially violent patients
  • Enable remote monitoring staff to calm the most vulnerable patients

In addition, a paper[2] published in the Journal of Nursing Measurement shared a more personal benefit of the technology, in which a dying, nonverbal patient began humming along with a TeleSitter monitor who initiated humming the song the patient’s daughter hummed every time she visited, pre-COVID. This touching gesture created calm and familiarity in this patient’s final days.

A Holistic Telehealth Strategy Can Address Staffing Shortages, Hospital Falls, and Isolation

Even before the COVID-19 pandemic, nursing shortages, patient falls and patient violence were trending concerns in healthcare. Healthcare workers are four times more likely to suffer violence than workers in other industries.[3] These issues have been exacerbated in healthcare environments where staffing is limited, infectious disease management is critical, and at-risk inpatients continue to be isolated due to tighter visitor restrictions. AvaSure’s TeleSitter® Solution has been deployed in 75 percent of major health systems in 48 states. The secured audiovisual monitoring technology allows one tech to monitor up to 16 patients at a time. In an over-burdened health system – the implications of the COVID-19 pandemic notwithstanding – we must consider telehealth technology that protects the patient and the caregiver in today’s precarious healthcare environment. And technology that allows a nurse to serve at their highest calling can only elevate the nursing profession, improve staff engagement and, ultimately, optimize each patient’s recovery.

As chief clinical innovation officer of AvaSure, Lisbeth Votruba, MSN, RN, demonstrates her vision for innovative inpatient telehealth care delivery through her compassionate leadership, activism for the nursing profession, and advocacy for the dignity, safety and quality of care for patients, families and healthcare professionals. As a third-generation nurse, she understands how important it is to keep patients and frontline medical workers safe in clinical environments.

[1] Joint Commission /20200101 [2] Remote Visual Monitoring During a Pandemic by Keeling, Eva, MSN, RN, NE-BC | Cudjoe, Joycelyn, PhD, RN | Hawksworth, Lisa, MSN, RN, NEA-BC | Drake, Jennifer, DNP, RN, NPD-BC, ONC |Davis, Theresa, PhD, RN, NE-BC, FAAN Journal of Nursing Measurement, Vol 28 Issue 3, DOI: 10.1891/JNM-D-20-00100 [3] https://pubmed.ncbi.nlm.nih.gov/32433143/

Virtual nursing: 7 step roadmap for getting started

Posted on February 28, 2023 by - Featured

virtual nurse illustration

Including Virtual Nursing Best Practices from AvaSure’s Experienced Clinical Support Team

Hospitals across the U.S. are challenged with nursing shortages, a rise in patient complexity and unprecedented cost challenges. Nurses are being stretched too thin, constantly asked to do more with less. This environment is causing 52% of nurses to consider leaving the bedside at a time when labor is already a challenge. Hospital leadership is being forced to think differently about how technology can help create a new model of care delivery.

89% of hospital leaders say they’re considering some form of virtual nursing, but only 2% have implemented a program – why the gap? Many don’t know where to start.

Are you in the 2% that have already started their virtual nursing journey? We can help no matter what phase you’re at! Schedule a complementary on-site assessment to get started with AvaSure.

For those still concepting, with our extensive experience helping over 1,000 hospitals across the U.S. with their virtual sitting and virtual nursing programs – we’ve put together a 7-step roadmap for starting your virtual nursing program.

1. Identify your facilities unique pain points

It’s important to identify your biggest challenges within your organization. What’s unique about your facility and where should you focus efforts?

To help identify the top pain points, gather a group of cross-functional stakeholders including bedside staff. Ask them to provide feedback on what they are struggling with day-to-day.

Expect to hear things like:

  1. Retirement vacancies causing a lack of highly experienced staff
  2. Burnout & exhaustion of staff members of all types – from nurses to CNAs to physicians
  3. Novice nurses feeling overwhelmed and unsure if they’re doing a good job
  4. A rise in patient complexity
  5. Quality metric declines across key areas
  6. Patient throughput challenges & bottlenecks

Once you’ve cataloged what your staff is dealing with, you can get to prioritizing.

2. Prioritize the challenges with the greatest impact

Once you understand challenges across the facility, work to identify which is creating the biggest drain on the system.

We see two models of virtual nursing that customers are starting with first to address their top challenges – based on ease and the biggest impact:

  1. Clinical Resource TeleNurse™ Model: a virtual nurse offloads documentation burden, giving bedside teams more time for direct, hands-on patient care
    • Admission & discharge support
    • Medication reconciliation
    • Patient & family education
    • 2-nurse sign-off
    • Expert consultation
  2. Expert Oversight TeleNurse™ Model: a virtual nurse oversees a cohort of complex patients providing clinical insight & nurse mentorship
    • Review & respond to clinical triggers from EHR and/or physiological monitoring
    • Expert nurses provide guidance and mentorship to novice nurses on the unit
    • Proactive patient rounding
    • Support satellite facilities with expert interventionists/specialists

We are confident one of these virtual nurse models would be a great place to start and to solve your greatest challenges.

3. Build your business case

Building a business case to sell your organization on starting a virtual nursing program is essential to ongoing success. The collaboration between clinical and IT leadership is key in this stage and to document how an IT infrastructure can help support clinical needs, not just today but for the future.

Once you’ve identified the model of virtual nursing with the most impact for your facility, begin to identify goals and benchmarks for your program. 

Examples include:

  • HCAHPS Patient Experience Scores
  • 30-day readmission rates
  • Staff satisfaction
  • Rapid response & code blue rates
  • Time to discharge

Still not sure where to start? You’re not alone. Hear from our customers who’ve kicked off their programs and have already seen early results to help get you thinking.

Best practice from AvaSure’s clinical team: Be sure to include feedback from front line staff and managers, bringing them along in the process. Their buy in will be essential long-term. Make sure your care teams understand this program is designed to help them, not add more work to their plate or eliminate jobs.

4. Select a vendor partner

The final piece of your business case will be to choose a virtual care partner that can help you achieve your long-term goals. It’s important to select a partner that has both clinical & technical expertise and will help grow your program over time.

When evaluating vendors, be sure to consider:

  1. Platform ease of use
    • Be sure to select a vendor that offers a platform that supports multiple clinical use cases that is easy for nurses to use.
  2. Support
    • There is a lot of clinical change & workflow management when implementing a change to the care model, select a vendor with expertise who will partner with your clinical teams throughout this process.
    • IT teams also have a lot on their plates and shouldn’t be overburdened with implementing a new platform. Consider a vendor who provides robust technical support including project management and 24/7 support – not just at the time of deployment, but throughout the partnership.
  3. Demonstrated outcomes
    • In any emerging area, a lot a new solutions will become available with little experience. In the clinical space, it’s more important than ever to select a partner with demonstrated experience in delivering outcomes for our patients.
  4. Current technology
    • Vendor consolidation is key for maximizing the impact of current spend and reducing technology duplicity. Before adding a new vendor, consider if any current solutions – such as your TeleSitter® solution – also offer virtual nursing solutions before investing in additional technology.

5. Roll out your first use case

Now that you’ve identified the challenges, started formulating a business case with IT and have leadership on board it’s time to start building your program. You can start with a single unit or department if you’d like.

It’s good to start small, helping to demonstrate early success. Consider perhaps starting with peak hours – such as only between 9 a.m. – 9 p.m. to help ease staff into the program and staff the virtual team successfully.

But be flexible, consider that you may identify in real time that this isn’t the most impactful area to be addressed. Be willing to adapt and change quickly. It’s imperative that you get some quick wins under your belt to gain buy in from front line staff and garner continued support from leadership, so an agile approach can help.

When deciding what unit to start on, think about the following:

  • Highest churn unit for admission & discharges – may be a high need for offload of documentation
  • Unit with highest amount of novice nursing staff – may benefit from expert oversight & mentorship
  • Unit with highest percentage of travel nurses – may benefit from expert oversight or clinical resource
  • Considering using virtual nursing for specialists that low staffed – nutritionists, diabetic management, wound care, social workers/case managers & more
  • Assist with morning rounds on units with residents using virtual nurse to facilitate documentation to communicate with family
  • Units with high complexity patients allowing virtual nurse to do purposeful rounding being a second set of eyes on patients
  • In conjunction with units that have deterioration or sepsis protocols and/or wearable monitoring to help reduce false alarms and identify early signs of adverse events

Be sure to build in a feedback loop to hear directly from front line staff on how the program is going and have a way to share wins across the facility and with leadership. This positive word of mouth is what will really sell the program.

6. Share results with stakeholders and spread the word

After a few weeks or months, ensure you hold a forum with leadership and the cross functional teams involved in the early discussions to update them on your progress. Show how the pilot has driven change against your key goals or metrics. AvaSure’s clinical team will help you pull your data and showcase your progress.

Tip from AvaSure’s Customer Success Team: it’s important to have a baseline before starting so you can demonstrate change, be sure to log all metrics before implementation in addition to any financials.

Best practice from AvaSure’s clinical team: Include great catches & stories from front line leaders. While metric moving is great, it’s the stories that will win the hearts of your teams.

7. Scale up your program – you’re really doing it

Now that you’ve demonstrated success (and it was easy!) identify additional units to cover or consider expanding to a second model of virtual nursing. But be reasonable about what your team can take on at once. Go slowly & deliberately, making sure your teams have a venue to speak up if it’s too much.

Worried about staffing your virtual nurse program? Learn about hosted options if you don’t have adequate talent to pull from in your area.

A successful virtual nursing program can not only help with labor challenges, helping to optimize the productivity of your staff but it can also help to drive nurse satisfaction & retention. Nurses will feel more supported, get more time at the bedside, and leave feeling accomplished. AvaSure can help support you through every step of scoping, implementing, and scaling a virtual nursing program. With 15% of our staff being RNs, we understand the unique challenges of care systems today and have a robust clinical team to help from business case development through implementation, metric tracking, expansion.

The Importance of Centralized Monitoring in a Health System’s Patient Safety Program

Posted on December 22, 2022 by - Uncategorized

illustration of patient being monitored by virtual staff

Key insights and takeaways from successful patient safety programs.

Two Virtual Safety Attendants sitting at computers & monitoring patients

Historically, health systems and hospitals have used ‘patient-sitters’ to provide direct and one-on-one monitoring support to their patients. But this method is expensive and inefficient. Many healthcare systems have identified the importance of a centralized patient safety program for labor optimization and providing value-based care and  have scaled to hub and spoke model systems, increasing their coverage through a centralized monitoring model. Read on to learn more on how hub and spoke models are becoming the norm for virtual care. 

Streamlining patient care with a hub and spoke model 

  • When an administrator at Baptist Health Medicine spotted a sitter in full PPE in a room when doing rounds on a COVID floor, she came up with the idea to introduce the TeleSitter® solution. She got the parties from all six campuses as well as the leaders in the fields of executive, nursing, financial leadership, social work, and case management. Within 18 months, the project went from piloting with 16 cameras to centralized, off-site operation covering multiple facilities. Implementation of the centralized system involved 100 team members!
  • To make sure that a workforce would be available, Loyola Medicine looked at the location of the hub while monitoring all four time zones. Cost of sitters, fall rates, and present-day costs associated with falls were examined. The estimated number of patients requiring monitoring at each facility was used to decide how many cameras per hospital to install.
  • A best practice for budgeting hub & spoke – each facility receiving monitoring in the hub & spoke model pays for 60% of the program. This budget then supports virtual safety attendants (VSAs), regardless of utilization. It’s important to keep the FTE level of virtual safety attendant staff adequate so you can monitor the requested number of patients at any given time. Cox Health uses a similar model to support their patient safety program. In year 1, they reduced the requirement for 30 FTE sitters, saving $1.3M. Since remote hospitals lack sitter reserves, cameras have been helpful in preventing staff from being called away from the floor.

Data collections across health systems

  • Many healthcare systems run extremely differently from one another (even when part of the same IDN) and efforts to harmonize data collecting are still a work in progress at many systems. At Baptist Health Medicine, falls have been identified as a core metric to measure results of the TeleSitter system. The system’s fall committee tracks “falls” and “falls with injury” using an incident reporting system. YoY comparisons are made to ensure that as they reduce sitter counts, they see reduction in falls as well. Prior to AvaSure, there was no reliable statistic for tracking sitter impact.
  • Sharing data throughout the system can help to garner buy in for your patient safety program. Once a month, Loyola Medicine holds a hub & spoke meeting where data is presented at the hub level, but also broken down by each spoke so that everyone can see their individual results. This makes it easier to benchmark each facilities effectiveness by looking at important indicators such as stat alarm reduction time & utilization. Asking leaders to bring information to the meeting such as falls data (not collected in ORNA®) can help make it a productive time to share other results as well. The dashboard in ORNA helps them be accountable to how VSAs are performing and quantify the value they’re bringing to the hospital. This meeting helps collect results to hold staff accountable and demonstrate program effectiveness to leadership.

Building support: How to get your patient safety programs off the ground

  • Facilities have different approaches on staff background required to become a virtual monitor team member; some require entry-level staff to have a general understanding of healthcare. PCTs or CNAs are also great candidates as they have all worked and gained hospital experience. Given medical expertise, the learning curve is lowered, and this can help to build a team of more experienced VSAs to balance out anyone who may be new to the industry.
  • To give virtual safety attendants a perspective for what RNs are dealing with, Loyola Medicine implemented “reverse shadowing” with new hires helping to overcome the obstacle of how each side views “what you truly do all day.” Cox Health has specific qualifications they look for in a VSA, including a positive attitude and demeanor to help foster positive interactions with patients. They are hired as an in-person sitter first, and then after 30 days may permanently place them in a VSA role depending on their understanding of the healthcare space intimately and their technological abilities.
  • Cox Health prioritizes education for both groups. To keep personnel accountable, discuss the necessity for vocal intervention. If calling the nurse, verbally intervene first to ensure it’s documented. Also, make sure that bedside staff knows when monitors are and are not monitoring the patient to ensure no moment is missed. Education and communication are key to bridging the gap between the two groups and will be a continual work in progress.
  • For VSAs to recognize the importance of their position, they must feel connected with patients, family members, and team members in the hospital. A best practice at some facilities is to have a nurse manager or ANM from one of the spokes round at the departments they’re monitoring to help foster relationships with the bedside. Virtual safety attendants are more likely to find success when they have these relationships with the bedside teams they’re supporting. Presenting at nurse leadership meetings across the spoke facilities help identify new and emerging problems and pain points, helping to continue to optimize the focus of your patient safety program.

 Build a strong team – Hire, train & retain staff

  • Maintaining a strong team is another key to long-term patient safety program success. Having a house-wide partnership council where all nursing staff are welcome to participate to enhance processes can help with this. This council allows participation from virtual monitors, connecting them to the bedside staff and allowing them to develop process changes, introduce initiatives to the whole company, and bounce ideas off different roles. Each unit has a council that any staff member may join as a subset.
  • Loyola Medicine has struggled with retention, so they try to get creative and create more flexibility beyond 12-hour shifts when it comes to scheduling, trying to ensure that they get enough rest and adequate breaks but also considering work/life balance expectations of people interested in this role. When hiring, consider their chances for advancement and where they want to go next; many who start as VSAs are then interested in opportunities to apply to CNA programs, etc., providing a talent pipeline for your organization. At Loyola Medicine, this is so common that they are developing a virtual monitor attendant/CNA program so they can perform both roles in a more flexible program.
  • Creating a fun and interactive environment has helped multiple facilities keep staff satisfied and retain them long term. Office items such as sit-to-stand desk or stationary exercise equipment can help to break up the day for workers pulling long shifts. Some offices take it further with “fun Friday” including activities like potlucks, PJ parties, karaoke, or a hot chocolate bar. Because the office is not on site at the hospital, their office setting is more accommodating to these types of work activities. It has created such a great culture at Loyola Medicine that there is a waiting list for VSA roles when many other departments are struggling for staff.
  • Having a lead virtual safety attendant who isn’t assigned to specific patients can also help when centralized monitoring increases the number of patients being monitored. What is the lead’s role?
    • Be the resource relief for team
    • Relieve them for breaks & be a second pair of eyes
    • Lead the majority of communication with hospital – troubleshooting, tracking down numbers, etc.
    • Do all the admissions & discharges into the TeleSitter system so they can focus on patient care
    • Balance workloads, manage patient assignments, and manage VSA’s patient mix between “busy” and “less busy” patients, optimizing their efficiency
    • Ensure that the virtual safety attendants are doing their work properly by conducting accountability tracking
  • The importance of recognition:
    • Emailing virtual safety teams and bedside workers with great catches and highlighting the work of the combined teams every few weeks can help to boost moral of the teams and generate buy-in.
    • Use team or staff meetings, orientation, or any time in front of facility staff as an opportunity to highlight the work of the patient safety programs/teams.
    • Encourage the use of “kudos” in HR systems to celebrate great catches, but overall, make sure both VSAs and nurses see the good they’re doing in keeping patients safe and make them feel like invaluable assets of the team.

Insights and takeaways to get you started

  • When getting started, involve more stakeholders than less. Think about departments likes security, biomed, and all nursing units – ensure everyone who may have a hand in the patient safety program has a voice.
  • Consider a steering committee to develop and implement required policies and procedures. This steering committee can also help to guide the program, facilitating communication between departments and driving growth over time. Especially when working with pediatrics, behavior health, or higher risk patients, it’s important to collaborate and communicate regularly to keep the patient safety program running smoothly.
  • Don’t stop at falls! Many say they started their patient safety programs focusing only on falls, but over time saw value with a number of other use cases and many wish they had expanded sooner to things like:
  • Establish bonds with your spokes, including facility leadership and bedside staff. The ones where leaders are engaged with and have a relationship with the TeleSitter teams have better performance than other units.
  • Help your staff recognize the delicate balance between keeping an eye on patient safety vs. being big brother. It’s not their focus to judge nursing jobs, i.e., document “not rounding enough” or commenting on nurse performance. This can help drive trust between nursing and VSAs.
  • Early involvement in system falls teams, committees, etc. is important. If you don’t make yourself top of mind, people may forget you are there. Getting involved early is key.

Centralized monitoring is a great way for a patient safety program to create efficiency while delivering improved patient outcomes. Virtual safety teams bridge the gap between patients and nurses, being a true part of the team helping to ensure patient safety and improved outcomes. With the staffing shortage continuing to increase, it is more difficult than ever to find patient sitters without further exacerbating staffing challenges. Virtual sitting is proven to be a safe and reliable way to monitor a variety of patients, while reducing labor costs, driving improved patient safety, and quality outcomes. At AvaSure, we have a best-in-class team that helps establish the goals of your health system while maintaining high-reliability, expertise, quality, and safety. To learn more about how we can help you streamline and increase quality patient care, contact us and get a free complimentary on-site assessment.

Watch the recorded session with Loyola Medicine, Baptist Health Medicine, and Cox Health or download the guide for more best practices.

Tips, Tricks, and Tales from Monitor Staff Superstars

Posted on December 5, 2022 by - Uncategorized

speaker headshots

Many conversations surrounding AvaSure TeleSitter® or TeleNurse® programs focus on the burden removed from the bedside care team & the benefits to patient.

Transforming the Industry: Avasure Virtual Symposium Recap

Many conversations surrounding AvaSure TeleSitter® or TeleNurse® programs focus on the burden removed from the bedside care team & the benefits to patient outcomes, but the forgotten superstar is often the care provider on the other side of the device. In this session, we had the opportunity to speak with two phenomenal monitor staff managers who lead effective teams that work tirelessly to keep patients & staff safe. As Juliet said, “it’s not just about the patient alone – it’s also about protecting staff while they work tirelessly to provide care.” Read on to learn more about their tips, best practices & experiences as monitor staff, program leaders & facilitators of great patient care.

Panelists:
Kearston Winder, Ascension Via Christi
Juliet Aninye, LVN, VA North Texas Health Care System

Q: What Was It Like Verbally Redirecting Patients For The First Time?

  • Kearston was excited to be able to help the floor staff & help in managing the patient. She felt apart of the care team and during her first intervention, was trying to get a patient to keep their oxygen on. She felt great when the floor staff immediately recognized her work reaching out to say thank you & share their gratitude, she was watching their patient. This acknowledgment went a long way in her feeling valued in her role.

Q: Were You Skeptical When You First Heard About The Avasure Telesitter Program?

  • Juliet had a strong interest coming from a long term care environment. The VA already had a program in place when she joined, but when she was trained by current monitor staff & rounding with the bedside staff, she got a new perspective on the work. She was excited by the challenge of getting the program on the right track to work in partnership with the bedside team & help to expand the program further.

Q:  What Best Practices Are There For Developing Relationships With Patients & Does That Help With Redirecting Them?

  • It’s all about communication. Acknowledgement that their need is heard goes a long way – let them know you’re going to get their nurse, come back on after making the call to say someone is coming and check in after that everything is okay. Providing verbal feedback goes a long way.
  • Introductions can help to ensure they understand the why & view the camera as a helper. Build some rapport by having a conversation with them so you build confidence that this tool is to keep them safe, not some sort of “big brother.”
  • When verballing queuing, make sure it comes across in the tone of, “how can I help you?”
  • If possible, having a manager round in person to introduce the device and program and verbally prompting the introduction of the monitor staff can go a long way to build confidence – especially if the family is in the room. This usually opens a dialogue for questions and ends with a positive view of the monitor’s role.
  • Best Practice: in a VA setting, patients are at high risk of having some form of PTSD. In these situations, when doing introductions walk them through what a verbal intervention & stat alarm will sound like. This can help ensure they aren’t startled, especially when sleeping, potentially causing a trigger.

Q: What Are Some Best Practices For Handoff?

  • You need to ensure you consider both types of handoff – handoff from one monitor staff to another about a patient, but also handoff from one bedside nurse to another for the monitor staff. It all comes down to communication! A best practice from one panelist is a handoff report sheet where they document any key events, patient/nurse preferences or interventions during the 8 hour shift. That sheet is then passed to the next staff member & so on. This allows for a record for the particular patient that can be referenced at any time.
  • When it comes to the bedside nurses, ensure you always check in at the beginning of a new nurses shift to see if there are changes to be aware of. Different nurses may have different preferences for what you watch for, communication, etc. so reset expectations with every shift.
  • Monitor staff can provide valuable information to the bedside staff during report outs on things to watch for, the patient condition over the past days & if they’ve been “busy.”
  • If you’re in a hub & spoke model, ensure there is a standard procedure across all facilities to ensure ease of compliance for your monitor team
  • Constant, easy communication between the monitor staff & front-line staff is the key to a successful program – at all times, not just at shift change or handoff.

Q: Monitor Staff Sometimes Witness Upsetting Events They May Not Be Used To If They Didn’t Come From A Clinical Environment. How Do Leaders Support Staff During These Events?

  • Staff without previous hospital experience may be overcome by events like a patient passing away and can be unsure how to move past such an event. Ensure they feel comfortable being able to reach out to their manager whenever such an event may occur. Listen to them openly and continuously follow up/check in on them over the coming days or weeks. It can be helpful to use the data & reporting available to show that they fulfilled their role to the best of their abilities and that there wasn’t anything they could do. Bedside staff are typically supportive in these situations as well, especially if an adverse event like a fall occurred, assuring the monitor staff that they followed all procedure correctly. This can help to alleviate guilt they may feel.
  • If your facility has employee assistance program for clinical staff dealing with these situations, extend it to monitor staff so they can have a support network.
  • Use any adverse event as a learning opportunity for the team to review what happened, what interventions occurred, and discuss if there were any further actions that could be taken in the future.
  • Be supportive, understanding and transparent with your team – this goes a long way!

A great catch from Juliet: “We had just admitted a new patient to the AvaSure TeleSitter program and within a few minutes, the monitor staff could tell something didn’t look quite right. The monitor staff called the nurse right away and discovered the patient was unconscious. A rapid response was called and the patient was then transferred to the ICU. This could have been an adverse event without the camera, as it would’ve been a while for the patient to be checked on. The bedside staff called the monitor staff later that day to thank them for alerting staff in item to catch this.”

Monitor staff are key members of the care team who build relationships with the patients & provide essential care. Sometimes, these team members are monitoring patients for weeks, months or longer – so it’s important to realize the impact they are making. A best-in-class TeleSitter program has communication, camaraderie, and respect between the on-site and off-site teams that fosters an environment of elevated patient care. At AvaSure, we have a best-in-class education team that helps to share best practices for building, staffing, and running your monitor team.

Keeping Suicidal Patients Safe, Virtually

Posted on November 28, 2022 by - Uncategorized

illustration of AI in virtual monitoring

In this post-pandemic world, we are seeing an uptick in behavioral health patients across the u.s., especially in our vulnerable pediatric population. When we pair this with a shortage of mental health professionals, there is a risk in our ability to adequately care for this important demographic. One particular challenge is handling suicide ideation (si) patients in acute care facilities, as they require a one-to-one sitter for their health and safety.

With our current staffing situation, providing this sitter often means pulling a much-needed member of the care staff off the floor. This can exacerbate already strained staffing, which is why telesitter solutions are so important for low and moderate risk si patients and why AvaSure pulled together this panel for our annual symposium. There is a perception that telesitter solutions aren’t allowed or suitable for these patients – in reality,  policies may have to be adjusted, but most governing bodies allow for the virtual monitoring of si patients that are assessed to be low or moderate risk. Using a telesitter program for these patients can help reduce placing additional staffing constraints on your system while keeping patients safe.

Read below for key highlights from our panel discussion on this underutilized but important use case of the telesitter solution:

Q: Why did you first implement a TeleSitter program? Did you consider using it for SI patients at that time?

  • HCA Methodist & St Peter’s Health both were primarily focused on falls prevention when first building out their programs and the inclusion of use on SI patients came down the road. Both saw challenges increasing where CNAs, RNs, and even administrators were being pulled to sit with patients exacerbating the need for another solution.
  • Ascension Michigan started the program with SI in mind, but offsetting sitting costs related to patient falls were the driving factor

Q: Was there a perception that TeleSitter solutions couldn’t be used for SI patients & how did you overcome this challenge?

  • Most hospitals have a policy in place that needs to be addressed & reviewed. In some instances, depending on state legislation, it may be important to include your regulatory/compliance managers as well. Ensure that you have an adequate screening tool in place – most customers on the panel utilized the Columbia suicide screening tool to assess for low/moderate/high risk. This will be important in case of an potential JCO visits that staff is aware that screening does take place before placing a patient on virtual vs. in-person sitting.
  • As the program gets started, be sure to share good catches with hospital leadership, nurse managers, and front-line staff. This is key to building good will around the program and gaining support.
  • Once the team understood that the devices do not record & are fully HIPPA compliant, there was no longer a concern about it potentially violating JCO regulations to utilize virtual monitoring

Q: Were there any specific challenges with getting physicians on board?

  • Some physicians were hesitant at first, especially pediatrics. To help build confidence, multiple facilities conducted a pilot where a video monitor was used in combination with an in-person sitter who sat outside the room. This allowed for a safety net while they proved out the efficacy of the system.
  • One panelist noted that less than a year into the program, providers don’t hesitate to rely on the TeleSitter staff for monitoring these patients
  • However, all systems noted you’ll have to stay on top of educating new providers & residents as they join the system – so continue to share great catches even after initial implementation

Q: Are the monitor staff for SI patients required to be clinical or specially trained in any way differently from those monitoring for falls, elopement, etc.?

  • All the systems on the panel utilize the same monitor staff which can be clinical but are not required to be when monitoring all patients – including SI
  • The training modules on monitoring Suicide Ideation Patients from AvaSure were viewed by all as an essential tool in training staff to properly monitor this patient population
  • One panelist recommended the best practice of rotating “on-site” 1:1 sitters and virtual monitors so they have an appreciation for both versions of the program helping to build consistency
  • Another best practice is that if monitor techs aren’t yet at their maximum number of patients being monitored, consider having multiple monitor techs viewing a SI patient for an extra set of eyes on these patients
  • In addition to training monitor staff, it’s essential to train bedside staff. Most aren’t adequately educated on the details of their hospital policy regarding sitting & sharing stories of what could happen when things go wrong can help to drive the need for compliance.

Q: What advice do you have for customers just thinking about rolling out a TeleSitter program for monitoring SI patients?

  • Consider your use cases when selecting devices. Not all TeleSitting devices are ligature free, so if you’re thinking about monitoring SI patients from the onset or down the road, share this with your vendor to ensure you purchase the correct devices
  • Hold a roundtable with various departments allowing for open conversation between leaders prior to rollout. This can help to identify any areas of concern that you can then be laser focused on addressing.
  • Don’t underestimate the number of cameras you’ll need – Kim Beckett from Ascension said the program would be easier to manage with a camera in every patient room!
  • “It’s possible, efficient & effective. The camera prevents harm,” said one panelist while another noted, “don’t hesitate. Education is how you overcome any potential pushback. The results will speak for themselves.”

The team was able to share several great catches, all noting they have not yet had a successful attempt on a patient being monitored by their TeleSitter program. In addition to more typical catches, such as a patient attempting to strangle themselves with heart monitors, they also caught things like a patient who was able to smuggle in materials from the outside & an incident where an on-staff security guard entered a pediatric patient room and was overly aggressive with the patient. Events like this have caused the facilities to think outside the box on future potential use cases for their TeleSitter programs – such as watching infants for potential abduction, monitoring eating disorder patients & keeping an eye on family members in the room for potential staff or patient injury & medication theft. With a well supported program, the use cases truly are endless. If you’d like to learn more about potential use cases, we’d be happy to complete a complimentary on-site assessment and make recommendations.

​​Watch the recorded session

Panelists:

  • Debbie Cronin, RN, Director of Patient Care Services, St.Peter’s Health
  • Kim Beckett, RN Manager – Clinical Surveillance, Ascension Michigan
  • Wesley Wingate, Director Cardiac Telemetry, HCA Methodist