Patient safety attendants (PSAs) provide constant direct observation to patients who have cognitive impairments or thoughts. Some estimates report that an acute care hospital in the United States may spend more than $1 million annually on PSAs, an expenditure often not reimbursed. With no national defined standards to regulate or monitor PSA use, this study sought to determine the impact of COVID-19 on a PSA reduction program in a large Midwestern healthcare system.
Falls Church, VA – 20 June 2023. The Department of Veterans Affairs (VA) has awarded Sierra7 and their partner AvaSure a contract to provide a turnkey TeleCare Companion solution to seven Veterans Health Administration (VHA) Medical Centers within the Veterans Integrated Services Network (VISN) 9 region. VHA is the largest integrated healthcare network in the United States, with 1,506 healthcare facilities, including outpatient sites, that serve 9 million enrolled Veterans each year.
Sierra7 and AvaSure’s TeleCare Companion solution delivers safe, cost-effective observation, communication, and analytics that enhance patient safety and facilitate patient care. At the core of our Telecare Companion approach for the VHA is AvaSure’s TeleSitter® solution, an evidence-based and data-driven approach to connecting caregivers more closely with patients, thereby improving the quality of care. The TeleSitter solution enables patients to be monitored remotely by using mobile video and audio devices. This helps to reduce adverse events such as falls, while freeing up clinical and support staff so they can devote more time to the patient.
Currently used in over 30 VA/Government medical facilities nationwide, VHA attributes the TeleSitter solution with more than a 60% reduction in falls since its deployment in their medical facilities.
“The implementation of advanced telehealth technologies has proven beneficial particularly as it relates to the patient experience, safety, and most importantly increased quality of care for veterans,” said Chief Growth Officer Gina Gallagher. “We are proud that our partnership with AvaSure, one of the leading providers of acute virtual care solutions, will support VHA with the centralization of patient observation and ensuring patient safety at medical centers throughout VISN 9.”
AvaSure’s CEO, Adam McMullin, added, “We salute the VA for their unwavering commitment to supporting our nation’s Veterans. In partnership with Sierra7, our solution will help create a solid foundation for continuous innovation, advancements in patient care and increased staff productivity, satisfaction and retention.”
The VISN 9 award includes the installation of mobile and fixed ceiling hardware devices, performing site assessments, clinical education and training, and ongoing clinical and technical support.
About Sierra7
Sierra7, Inc. is a leading consultant to healthcare and federal agencies nationwide providing IT solutions, consulting services, and citizen engagement support. As a Service-Disabled Veteran- Owned Small Business (SDVOSB) and CMMI-SVC Level 3-appraised member of the government technology and services industry, Sierra7 holds critical federal government prime contracts including T4NG, VHA-IHT, GSA VETS 2, NIH CIO-SP3, NASA SEWP V, VA TeleCare Companion, and several GSA schedules. In 2022, Sierra7 achieved AWS Select Partner status in the Amazon Web Services (AWS) Partner Network (APN), ranked No. 457 on the Inc. 5000 list of the fastest- growing private companies in America, recognized as a Vet100 honoree, and as a Disabled American Veterans (DAV) Midsize Patriot Employer of the Year.
Contact: For any media and or public relations inquiries contact, Rachel Thomas, Marketing Manager, at marketing@sierra7.com.
About AvaSure
AvaSure provides the leading hospital virtual care platform to systems with nursing and staffing shortages that are challenged to significantly reduce labor costs without sacrificing patient health outcomes. Recently recognized by KLAS Research as the leader in reducing the cost of patient care, AvaSure is the pioneer in providing best-in-class, video-based AvaSure TeleSitter® and TeleNurse™ solutions. As a trusted partner of more than 1,000 hospitals, AvaSure combines remote patient monitors, virtual nurses and other providers on a single platform to enhance clinical care without placing any additional burdens on existing staff.
We salute the VA for their unwavering commitment to supporting our nation’s Veterans. In partnership with Sierra7, our solution will help create a solid foundation for continuous innovation, advancements in patient care and increased staff productivity, satisfaction and retention.
FALLS CHURCH, Va., April 11, 2023 /PRNewswire/ — Sierra7 and product partner, AvaSure, were recognized as a 2023 Disruptive Tech Awardee for bringing AvaSure’s TeleSitter®/TeleNurse™ solution to Federal healthcare IT programs. This award recognizes an innovative product, program, or emerging technology solution that has been implemented within a Federal Agency and shows measurable results.
“Sierra7 is honored to be recognized alongside our partner AvaSure as a 2023 Disruptive Tech Program Award Winner,” said Rafael Fagundo, Sierra7’s CEO and founder. “I would like to thank G2Xchange for this prestigious award. Our team is proud to continue delivering reliable transformational solutions serving the VA and supporting its mission to enhance the lives of the Veteran community.”
At the height of the COVID-19 pandemic, Veteran Affairs Medical Centers (VAMCs) faced personnel shortages and safety risks for patients and staff. VA’s solution was to implement TeleSitter®/TeleNurse™ enabling medical providers to communicate with patients effectively and safely throughout the pandemic. This solution has made transformational changes by increasing patient safety, improving patient care, and optimizing labor resources at hospitals and medical centers. This technology supports an augmented care environment where a virtual team can assist the bedside team, not replace them.
“We are proud to be such a major part of VA’s drive to improve access to care and quality for the Veterans who have contributed so much to our nation’s security and prosperity over the years,” said Adam McMullin, AvaSure’s CEO. “By establishing new platforms that deliver transformational patient safety and virtual care, we can help VA achieve better health outcomes for Veterans at lower costs.”
Sierra7 and AvaSure continue to develop and drive innovative solutions for VA and the Federal health market. This partnership has resulted in programs that support 29 VAMCs and the award of more than 12 Federal contracts.
G2Xchange will be honoring program awardees, as well as Change Agent Award winners, during their upcoming Disruptive Tech Summit: Programs and Change Agents Shifting the Landscape held in person on Wednesday, April 12, 2023, from 2:00-5:30 PM EDT. Additional event details and registration information can be found here on Eventbrite.
About Sierra7 Sierra7, Inc. is a leading consultant to healthcare and federal clients providing IT, consulting, solutions, and citizen engagement services to federal agencies across the United States. As a Service-Disabled Veteran-Owned Small Business (SDVOSB) and CMMI-SVC Level 3-appraised member of the government technology and services industry, Sierra7 holds critical federal government prime contracts including T4NG, VHA-IHT, GSA VETS 2, NIH CIO-SP3, NASA SEWP V, VA TeleCare Companion, and several GSA schedules. In 2022, Sierra7 achieved AWS Select Partner status in the Amazon Web Services (AWS) Partner Network (APN), ranked No. 457 in the Inc. 5000 list of the fastest-growing private companies in America, recognized as a Vet100 honoree, and as a Disabled American Veterans (DAV) Midsize Patriot Employer of the Year. To learn more, visit: https://sierra7.com.
Contact: For any media and/or public relations inquiries, email Rachel Thomas, Sierra7 Marketing Manager, at marketing@sierra7.com
About AvaSure AvaSure provides the leading hospital virtual care platform to systems with nursing and staffing shortages that are challenged to significantly reduce labor costs without sacrificing patient health outcomes. Recently recognized by KLAS Research as the leader in reducing the cost of patient care, AvaSure is the pioneer in providing best-in-class, video-based AvaSure TeleSitter® and TeleNurse™ solutions. As a trusted partner of more than 1,000 hospitals, AvaSure combines remote patient monitors, virtual nurses and other providers on a single platform to enhance clinical care without placing any additional burdens on existing staff. To learn more about AvaSure visit www.avasure.com.
Media contact: Marcia Rhodes, Amendola Communications, mrhodes@acmarketingpr.com
There is a lack of data and metrics available to help determine when a facility is ready to expand its continuous video monitoring (CVM) program. High-level evidence such as systematic reviews indicate that video monitoring can be effective in reducing adverse events and sitter use. Yet it is unclear when and how to demonstrate that a CVM program is ready for expansion.
An average of 5593 adverse events were prevented per 1000 patient-days in the past year (such as falls, elopements, and abusive behaviors)
When the video monitoring technician sounds the STAT alarm due to concerning patient behaviors, nursing staff had an average response time of 11 seconds to the patient bedside—this is 6 seconds fewer than the average response time according to Online Reporting of Nursing Analytics (ORNA)
By replacing up to 13 sitters every shift, this hospital realized a cost savings of $2 million a year—this equates to $200,000 cost savings per camera per year
Although this did not include savings related to the prevention of adverse events such as falls, elopements, or line pulls, the costs saved on sitter replacement alone provided for an ample return on investment (ROI)
Solution
CVM readiness for expansion is evident when metrics such as utilization rates, wait-list expansion, and sitter patient population outgrow current camera capacity.
Utilization rates
Weighing the balance of program cost and associated program expansion needs can be difficult, particularly in cost-containment environments.
One suggestive metric that indicates readiness for expansion of video monitoring programs is climbing and/or high stabilized utilization rates. The initial CVM goal for a large academic Magnet-designated medical center in the Pacific Northwest of the United States was more than 50% of the cameras in use at all times. Within the first year of CVM use, utilization was consistently greater than 80% for all devices, including the 10 mobile units and 3 stationary ceiling mounts located in the medicine unit and pediatric emergency department. This is a total of 13 cameras in use 80% of the time. Mobile devices provide additional flexibility, and the organization’s 10 mobile units are in use 90% to 95% of the time.
With this high utilization rate, and an average length of stay of 64 hours per patient, there is little camera availability despite increased demand from the nursing staff. This leaves only the highest-risk patients on camera, with less room for utilization of CVM for primary fall prevention and overall environmental safety management for less at-risk patients.
Increasing need for sitters
There has been an increase in demand related to patients who require constant observation in all settings. The continued upward trajectory is related to the growth in behavioral health populations—and is a national trend for inpatient pediatrics and adults. In pediatrics, the prevalence of behavioral health admissions has been increasing over time, yet the lengths of stay have been shortened. This results in higher-acuity needs and, thus, more intense monitoring, such as sitter use.
When CVM cannot be implemented because of exclusion criteria, sitter usage is still a necessity. Alternatively, when CVM can be used to replace a sitter, waitlists create a barrier and are yet another indicator that program expansion is needed.
Video monitoring waitlist growth
A waitlist is defined and created by the assurance that all sitters in the system have been trialed on camera and/or excluded because of inclusion criteria constraints.
There is an associated cost with consistent waitlist increases. On average, there is a risk of losing $134,000 annually due to limited availability of cameras. This amount is nearly enough to purchase additional cameras.
Thus, the tracking of CVM waitlist growth can show missed opportunities that provide clear metrics for expansion of CVM programs.
Front-line staff satisfaction
Staff satisfaction is essential to the acceptance of CVM technologies. Thus, frequent and intentional check-ins with staff about their overarching needs and/or readiness for program growth is essential.
A survey implemented at this institution showed that nursing staff were accepting of the technology and most felt it was part of the organization’s culture of safety.
96% of staff were satisfied with or neutral on CVM capabilities related to patient safety
94% were satisfied with or neutral on the decision of the organization to invest in CVM
96% believed investing in additional cameras was operationally necessary
Conclusion
Despite budget challenges and financial constraints, with the right metrics, organizations can clearly show that the benefits of video monitoring outweigh the associated costs, and that ROI can be easily obtained through sitter reduction, prevention of adverse events, and staff satisfaction.
Multiple compounding factors result in the increased demand for additional safety monitoring in the inpatient setting
At a large, academic, Magnet-designated medical center in the Pacific Northwest, nursing leadership saw that the need for sitters was rising. Much of this increasing need was being driven by an increase in admissions for inpatient mental health care, requiring additional inpatient monitoring for suicide risk, substance withdrawal, fall risk, eating disorders, elopement, and general safety concerns for both adult and pediatric populations.
Providing 1:1 care for all is costly, ineffective, and resource-intensive—and has a negative effect on staff satisfaction, patient safety, and productivity.
Solution
Continuous video monitoring with AvaSure
Continuous video monitoring (CVM) was identified as a bridge for the nursing staff to enhance safety for patients and as an additional safety intervention when sitter use was not reasonable or feasible. The trick was implementing this program in a way that would enable it to become an accepted part of the healthcare environment.
Adoption of the AvaSure technology was influenced by nurse enculturation and education, leader standard work (standard parameters used by nurse leaders for process improvement), data tracking management, and patient/family feedback.
A multidisciplinary team
Implementation of this program was organized with representatives from across the hospital, including nursing leadership, clinical nursing staff, Clinical Technology Services, Psychiatric Professional Practice Leader, Marketing, Department of Quality Management, Nursing Resource Management, and Nursing Administration.
Ongoing training and education
The monitoring staff received specialized training related to anticipation of at-risk behaviors, system functionality, determination of adverse events, and chain of resolution. Education focused on the clinical nursing staff and consisted of unit in-services, leadership classes, champion classes, case management classes, and transitional care classes for community partners. Clinical nurse champions were integral to the adoption of technology in all settings.
Development of policy, procedures, and patient criteria
Clearly defined inclusion and exclusion criteria for CVM with the input from clinical nurses allowed for clear expectations for clinical staff members. A decisional algorithm was designed to help nurses with clinical decision-making regarding whether to use a sitter or CVM as an intervention.
Leader standard work
Lean management principles are critical to continuous improvement and empower the frontline staff to solve problems, eliminate waste, standardize work, and improve the value of care delivered to patients. Because Lean management focuses on the frontline staff, it provides an opportunity to enculturate new systems and to identify barriers.
With proper implementation, the benefits became clear.
Enhanced nurse safety: With the video monitoring technicians (VMTs) out of harm’s way, they can act quickly to respond to patients who may be escalating and the nursing staff cannot safely advocate for themselves. This keeps both staff and patients safe during high-risk behavioral events
Often, the verbal alerts from VMTs can deter the patient long enough so that clinical staff can safely enter rooms that may have additional precautions, such the need to don personal protective equipment
Cost savings: Conservative estimates showed that CVM saved this hospital $109,511 in the first 3 quarters of use
Reductions in falls: With CVM, the hospital reported an average of 2768 potential “fall events” prevented each month
Patient and family satisfaction:
93% of family members indicated that they received more respite opportunities because of the presence of the camera
93% of patients and families felt that they had an added level of security
80% said that they had more privacy compared with 1:1 sitters
Conclusions
The CVM program at this hospital has provided a bridge for the nursing staff to use technology to enhance patient safety and to provide an additional opportunity for intervention when sitter use is not reasonable or effective. Implementation of CVM reduced costs, improved resource allocation, and enhanced staff and patient family satisfaction.
AvaSure isn’t just for acute care anymore. Panelists will share the benefits and success of remote video monitoring in long term acute care hospital settings and skilled nursing facilities.
Presented by Essentia, Gaylord Specialty Healthcare
Kelowna General Hospital is now using AvaSure TeleSitter®, a remote patient video monitoring system that aims to improve patient safety by preventing falls and injuries.
“Our health-care teams strive for continuous improvement in the care we provide, and it’s exciting to see our team at KGH use this new technology to increase patient safety,” said Susan Brown, Interior Health’s president and CEO.
Brown said that they have already seen early success with the pilot project.
“In just two months, there have been more than 2,000 interactions with patients using the TeleSitter which helped prevent falls thanks to the ability to virtually monitor patients,” she noted. TeleSitter is an IV-like pole in a patient’s room that provides live video and two-way audio feeds to a trained staff member who is monitoring from a central screen. In the case that a patient tries to get out of bed unattended, the care aide monitoring the video can ensure the patient gets the assistance they need.
According to IH, up to 10 patients can be monitored at the same time.
KGH’s executive director of clinical operations, Jaymi Chernoff said she’s pleased with how the roll-out of TeleSitter has gone at KGH.
Within 10 hours of monitoring patients, she explained, a care aide was able to provide assistance to a patient and prevent a potential fall from happening.
“Having the ability to virtually monitor patients who may be at risk of falling, means the caregivers who sit bedside and don’t want to leave their loved one unattended, can go home and get some rest,” Chernoff explained.
“The feedback from caregivers has been so positive so far; they are grateful and appreciative of the technology.”
Since initially launching with two devices in January, ten TeleSitters have now been deployed to help monitor patients at the hospital and there are plans to expand the service to additional units. IH said that KGH is the first hospital in the region to implement this technology and the health authority will continue to review the success of the project before expanding to other hospitals.
To share research results in three recent national studies on the use of the TeleSitter solution, AvaSure recently hosted Telesitting: What’s New and Where it’s Heading, a webinar attended by over 500 chief nursing officers from all 50 states plus Washington, D.C., including VAs from around the country. The webinar was presented by AvaSure’s Chief Innovation Officer Lisbeth Votruba, MSN, RN, and Nurse Consultant Patricia Quigley, PhD.
Their studies on Patient Engaged Video Surveillance (PEVS) based on AvaSure’s Online Reporting Of Nursing Analytics (ORNA), the groundbreaking research is clear:
PEVS is clinically proven to foster significantly safer hospital environments for patients and caregivers In addition to considerable cost savings with the use of PEVS, perhaps the most telling outcome of the studies is the substantial improvement in safety for patients in witnessed events.
Prevent Falls In Falls Prevention, the 12-month study of 71 hospitals and 15,021 patients considered as high risk for fall by nursing staff, shows that with PEVS, falls were reduced to .38 falls/1000 patient days of surveillance.
“This is getting to zero, where falls hardly exist,” Quigley said. The study revealed that hospitals equipped with PEVS saw:
A savings of 453 annualized FTEs typically used for traditional sitting, representing over 943,000 hours
A 92 percent reduction to 38 FTEs to monitor PEVS
Improving nurse safety against violence The second study focused on violence against nursing workforce.
“While industry principles, OSHA guidelines and Joint Commission challenges to reduce sentinel events have been published in the past few years, there hasn’t been much improvement in reducing violence,” said Votruba.
This study included 300 witnessed events, 15,434 patients in 73 hospitals over a 21-month period to learn impact of PEVS on nursing workforce safety. The study found that with PEVS, for every abusive event witnessed, 25 were reported, including usually non-recorded verbal incidents.
And while most of the patients in this study were being monitored for fall prevention, and not violence, Votruba noted that these findings present an opportunity for more research on how to identify which patients might have the tendency to become violent.
Using PEVS for COVID-19 isolation patients The third study, by Quigley, Votruba and Jill Kaminski just released in MedSurg Nursing, focused on PEVS for COVID-19’s acute isolation population, monitoring 1,625 patients in 97 hospitals over a two-month (March-April 2020), and representing 98,918 hours of observation.
Key findings included:
42 witnessed adverse events experienced among 39 patients
29 of the events involved a dislodgement of lines
9 falls (one unassisted)
2 self-harm events
2 physical abuse toward nursing events
while response time was lowered due to the donning of PPE, there were more verbal interactions per day to comfort isolated patients during this surge period
These studies show that real-time surveillance at the point of care is cost-effective, improves safety and is easily adoptable by nurses. Nurses were resourceful in fast-tracking the technology in the early weeks of the COVID-19 pandemic as they were pulling from as many resources as they could at the height of the surge.
Lisbeth also shared highlights from several studies she recommends for further reading as CNOs consider the technology for their hospitals. Those studies are linked below for further reading.
AvaSure is working hard to advocate that PEVS programs be a workplace safety initiative through the American Nursing Association.
