Topic: Fall Prevention

Fall Prevention and Injury Reduction Utilizing Virtual Sitters in Hospitalized Patients: A Literature Review

Fall Prevention and Injury Reduction Utilizing Virtual Sitters in Hospitalized Patients: A Literature Review
Quigley BH, Renz SM, Bradway C. Comput Inform Nurs. 2021;39(12):929-934.


Falls remain one of the most well-documented hospital incidents among patients. Yet more than one-third could be prevented.

 In-hospital falls are a global problem—and the statistics in the United States alone are staggering:

  • There are up to 1 million falls each year, which translates into 2.3 to 7 falls per 1000 inpatient hospital days
  • There are nearly 11,000 deaths per year from an injury sustained in a fall during hospitalization
  • Costs to Medicare for falls exceeded $31 billion in 2015
  • Falls and fall-related injuries add 6 to 12 inpatient days to a hospital stay, with costs of more than $30,000 per incident

What’s more, the US Joint Commission has suggested that as many as 33% of falls could be prevented.


Video monitoring using virtual sitters is a novel, cost-effective approach to reduce the risk of falls and maintain safety for hospitalized patients. In a review of the clinical literature, 12 articles that focused on a study or quality improvement project utilizing continuous video monitoring with virtual sitters to prevent falls were analyzed.

The change from 1 sitter per patient to 1 virtual sitter per a cohort of patients consistently demonstrated a decrease in costs, with some studies reporting a decrease in fall rates.


Prevention of falls and fall-related injuries is a hallmark of quality patient care and an expected outcome of hospitalization. Video sitter surveillance was developed for just this reason, while also offering a cost-effective alternative to the use of 1:1 sitters.

This literature review supports the use of video surveillance/virtual sitters as a strategy to decrease or plateau fall rates with an added cost savings benefit. It is likely that future use of video surveillance to maintain safety, prevent or minimize falls and fall-related injuries, and achieve high-quality patient care will expand to other clinical scenarios, such as seizures, substance withdrawal, self-medicating, self-harm, and abuse situations, or to monitor patients in isolation.

Technology Utilization in Fall Prevention

Technology Utilization in Fall Prevention
Oh-Park M, Doan T, Dohle C, Vermiglio-Kohn V, Abdou A. Am J Phys Med Rehabil. 2021;100(1):92-99.


There is a need for cost-effective fall prediction and prevention systems. Recently, technology-based applications have been introduced in healthcare in order to achieve superior patient care outcomes and experience via efficiency, access, and reliability.


Video monitoring using virtual sitters is a novel, cost-effective approach to reduce the risk of falls and maintain safety for hospitalized patients. The common applications of technology are to:

  • Assess the risk of falls
  • Detect falls
  • Prevent falls
  • Intervene

Solutions include a range of approaches—from instrumented gait mats and wearable sensors to robotic systems, wearable airbags to prevent hip injury, and even virtual reality systems—that may be used in patients’ homes or in the hospital.

In the hospital setting, virtual sitter technology that enables 1 sitter to monitor multiple patients has been shown to reduce falls and the cost of care.

Although each of these technology-based applications are associated with both advantages and limitations, combining them with more traditional fall prevention interventions offers promising results in the prevention of falls among patient populations.

The Miriam Honored for Reducing Patient Falls with Use of Monitoring Devices

PROVIDENCE – AvaSure, a Michigan-based patient-monitoring system producer, honored the hospital with its Path to Zero Award in late September.

With the use of audiovisual equipment in patients’ rooms, The Miriam saw its rate of patient falls drop by 25% during its second year of using the devices.

The hospital has used the equipment for about three years.

Designed to monitor patients with impaired mobility or conditions such as dementia, the portable cameras allow hospital staff to keep a remote eye on patients who may be at risk for falling. Staff can speak to patients through a microphone built into the device and quickly send a nurse to hospital rooms to help patients who need help to safely stand up or move around.

“The Miriam Hospital has played a significant role in making strides toward change with the use of our technology. As has been shown in numerous clinical and economic studies, AvaSure is in tune with the need for cost-effective, quality care,” said Lisbeth Votruba, vice president of clinical quality and innovation at AvaSure.

Read the full article on Providence Business News.

AvaSure Recognizes the Miriam Hospital for Most Impressive Fall Reduction Program

BELMONT, Mich. – AvaSure, a leading provider of advanced audiovisual monitoring systems used to care for patients and protect caregivers, honored the Miriam Hospital with the Path to Zero Award as part of AvaPrize, its prestigious annual healthcare awards program.

The AvaPrize program honors individuals and organizations who have advanced patient and staff safety, eased the working lives of nurses and achieved new efficiencies in care delivery. Winners demonstrate the ever-evolving role of continuous video monitoring as it becomes a vital tool in patient care and staff development throughout a healthcare organization.

The Miriam Hospital’s honor, the Path to Zero Award, recognizes an organization with the most impressive fall reduction program centered around patient video monitoring.

“Most experts believe the post-pandemic U.S. healthcare system will be fundamentally different, as downward pressure on costs and a need to show value for dollars spent will fuel widespread reforms,” said Lisbeth Votruba, Vice President of Clinical Quality and Innovation at AvaSure. “The Miriam Hospital has played a significant role in making strides toward change with the use of our technology. As has been shown in numerous clinical and economic studies, AvaSure is in tune with the need for cost-effective, quality care.”

AvaSure selected the Miriam Hospital for the award because its use of the technology decreased falls by an additional 25% in the second year of implementation, dropping the rate below the NDNQI benchmark due to ramping up utilization and garnering buy-in from all inpatient units.

The winners were honored during the company’s symposium Sept. 23-24. The AvaSure national symposium brings together senior leaders, frontline staff and health policy experts to share best practices and new uses for continuous remote patient care. This year’s theme was Leading Through Change.

The fifth consecutive healthcare awards program presented at industry-leading symposium

A Systematic Review: Sitters as a Patient Safety Strategy to Reduce Hospital Falls

Sitters as a Patient Safety Strategy to Reduce Hospital Falls: A Systematic Review
Greeley AM, Tanner EP, Mak S, Begashaw MM, Miake-Lye IM, Shekelle PG. Ann Intern Med 2020;172(5):317-324.


Bedside sitters are often used for patients at high risk for falls, but they are expensive and their effectiveness is unclear. Nurses and other personnel have long been used to monitor patients and prevent falls via continuous or constant observation. The reason for this is logical and rooted in tradition: Staff is by the bedside and on hand to help prevent a fall. However, this practice is costly—US acute care hospitals can each spend more than $1 million annually on sitters.

What’s more, despite a compelling rationale, the evidence supporting the use of 1:1 sitters to reduce falls is lacking.


Video monitoring is well supported by the literature. The strongest evidence regarding sitter alternatives was seen in articles evaluating the benefits of video monitoring:

  • Eight studies provided the most consistent results of either no change or a decrease in falls after implementation of video monitoring, as well as a dramatic decrease in sitter use
  • Several studies also reported a cost savings with video monitoring compared with sitter use

A Trailblazer’s Road to Success

The Cincinnati VA Medical Hospital was the first VA Hospital in the nation to adopt the AvaSure TeleSitter® for continuous patient video monitoring. Within their first year, they were able to reduce sitter costs by 65% and saw a 50% reduction in patient falls. During this webinar, Beth Ackerson, Chief Nurse Procedural Services & Chief Health Informatics Officer, will share Cincinnati’s road to innovation and how they’re blazing the trail for the spectrum of continuum care.

Speaker: Beth Ackerson, RN, MSN, CNOR Chief Nurse Procedural Services & Chief Health Informatics Officer

Outcomes of Patient-Engaged Video Surveillance of Falls and Other Adverse Events

Outcomes of Patient-Engaged Video Surveillance on Falls and Other Adverse Events

Quigley PA, Votruba L, Kaminski J. Clin Geriatr Med. 2019;35(2):253-263.


Traditional surveillance measures aimed at reducing adverse events such as falls create a false sense of safety. For decades, nurses have relied on traditional surveillance methods to proactively meet patient needs: hourly rounding, patient-activated call lights, and movement-initiated alarms.

The ineffectiveness of these traditional interventions has been confirmed by a limited number of published studies and the epidemic of harm still occurring in hospitals. For example:

  • Studies on hourly rounding have been found to be inconsistent in their reporting of the quantity, quality, and reliability of rounding
  • Another study on call light response times reported response times of as long as 17 minutes and 27 seconds, which is more than enough time for a patient to fall out of bed or a chair

Although movement alarms are among the most commonly used fall prevention strategies in  hospitals, studies on patients rescued from experiencing a fall and on the reduction in falls, fallers, or fall rates are very limited, and there are no published studies on the timeliness of nursing staff response to patients’ activated movement alarms.


Patient-engaged video surveillance (PEVS) provides a much-needed safety net for patients. In this study of 71 hospitals and 15,021 patients believed to be most at risk of falls and other adverse events, the incidences of falls; room elopement; and line, tube, or drain dislodgement were rare when patients were monitored using PEVS with the AvaSure TeleSitter® solution.

  • The overall fall rate was 1.50 falls per 1000 days of surveillance. It was even lower (0.38 falls per 1000 surveillance days) in patients aged 85 years and older—the oldest group and the most vulnerable to fall injury. This greatly exceeds the aggregate fall and fall rate reduction among all of the hospitals enrolled in Centers for Medicare & Medicaid Services Hospital Engagement Network/Hospital Innovation Improvement Networks (2010–2014)
  • The average PEVS alarm response time was 15.8 seconds
  • There were69 elopements per 1000 days of surveillance
  • There were <3 lines, tubes, or drains dislodged per 1000 days of surveillance

The TeleSitter® solution enables 1 safety attendant to monitor up to 16 patients at one time. As such, this study calculated that there would need to be 453 annualized full-time equivalents to provide 942,482 hours of surveillance using the traditional one-to-one sitter method. With PEVS providing a monitoring-staff-to-patient ratio of 1:12, the total number of required full-time equivalents is reduced by 92% to 38 full-time equivalents—substantially reducing costs (actual reductions in cost would vary based on the hourly wages of the one-to-one sitters and monitoring staff).


The findings of this study should compel all organizations to implement a PEVS program, such as the AvaSure TeleSitter® solution, in order to be in the position to best correct root causes of harm and create a real-time, broad safety net for patients.

Individualized Fall Prevention Program in an Acute Care Setting

Individualized Fall Prevention Program in an Acute Care Setting: An Evidence-Based Practice Improvement
Spano-Szekely L, Winkler A, Waters C, et al. J Nurs Care Qual. 2019;34(2):127-132.


A hospital’s fall prevention program was not consistently effective. The baseline fall rate was 3.21—higher than the National Database of Nursing Quality Indicators’ median of 2.91. Before the implementation of this evidence-based fall prevention protocol, the fall prevention program at as 245-bed Magnet- and Planetree-designated community hospital located in the Northeast was inconsistent and not effective.


Adding video monitoring. A clinical practice guideline with 7 key practices was used to guide the development of an individualized fall prevention program with interventions to address 4 fall risk categories and an algorithm to identify interventions. Interventions included nurse-driven mobility assessment and purposeful hourly rounding.

Video monitoring was also implemented. Using the video monitor, a safety technician was able to see if patients started to get out of bed and then use the intercom to redirect the patient, thus preventing falls. These “good catches” would not have happened without video monitoring.

With full and consistent implementation of the fall prevention program and the addition of video monitoring, this hospital saw:

  • A 54% reduction in falls from 2.51 falls per 1000 patient days to 1.15 falls per 1000 patient days
  • A 72% reduction in sitter usage, equating to $84,000 in annual savings

Video Monitoring for Fall Prevention and Patient Safety: Process Evaluation and Improvement

Video Monitoring for Fall Prevention and Patient Safety: Process Evaluation and Improvement
Sand-Jecklin, K., Johnson, J., Tringhese, A., Daniels, C., & White, F. (2019). J Nurs Care Qual, 34(2), 145-150.


Background: Although video monitoring has been shown to reduce falls among at-risk hospitalized patients, there are no identified best practices for the monitoring process.

Purpose: The purpose of this study was to evaluate the monitoring process at a large teaching hospital, with the goal of making improvements and standardizing monitoring practices.

Methods: Patients and nursing staff perceptions about the video monitoring process were elicited via survey, and perceptions of monitor technicians were obtained through structured interview.

Results: Video monitoring was perceived by all groups as effective in promoting patient safety. Nursing staff and monitor technicians also indicated that monitoring protects patient safety in other high-risk situations. Suggestions for improvement and standardization in the monitoring process were made by study participants.

Conclusions: Suggested changes and standardization of the monitoring process have been implemented in the study facility. Insights are provided for other facilities considering video monitoring for patient safety.

Improving Patient Safety Through Video Monitoring

Improving Patient Safety Through Video Monitoring
Cournan M, Fusco-Gessick B, Wright L. Rehabil Nurs. 2018;43(2):111-115.


Patients receive mixed messages—try to be as independent as possible, but don’t do anything in your room without calling for assistance. Falls are a significant issue in rehabilitation settings. Patients are encouraged to be as independent as possible, yet not to do anything without assistance. This mixed message leads to the increased risk for falls in this setting.


Video monitoring significantly lowers the risk of falls. The focus of this project was on a 31-bed brain injury unit of an inpatient rehabilitation facility where the majority of falls occurred. Fifteen video monitoring units were installed and total falls and falls rates were tracked.

With video monitoring:

  • The average number of falls was decreased to 6.87 falls per 1000 patient-days compared with 10.26 falls per 1000 patient-days before video monitoring was implemented. This is a statistically significant improvement
  • There were 32 fewer falls in a 1-year period
  • There was a reduction in costs due to falls and fall-related injuries of at least $40,000 —this sum is thought to be a conservative estimate
  • The hospital saved nearly $190,000 on the cost of 1:1 sitters
  • Total costs for the video monitoring system were recouped in 12 months of continued use

Staff response to the video monitoring system has been strongly favorable.

  • 81% of respondents indicated either a generally or strongly favorable reaction to the video monitors
  • Nearly all respondents—96%—felt that video monitoring did not intrude on privacy


Video monitoring can provide greater safety for patients by decreasing falls. Additionally, video monitoring decreases sitter usage and its cost, and enhances satisfaction.