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

Behavioral Health, Pediatrics

August 15, 2023

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.

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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.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


  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.
  2. Insights from AvaSure’s national database on virtual monitoring (ORNA®)

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Get in touch with an AvaSure representative to learn more about AvaSure's AI-enabled virtual care solutions.

Ready to get started?

Get in touch with an AvaSure representative to learn more about AvaSure's AI-enabled virtual care solutions.