Topic: Pediatrics

Keeping pediatric patients safe with virtual monitoring

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While many may associate virtual monitoring/virtual sitting with falls risk patients, there are a number of ways that the use of Virtual Safety Attendants (VSAs) and video-based monitoring technology can positively impact pediatric patients. Increasing in importance as hospitals across the nation and being exacerbated by persistent staffing shortages and the concurrent mental health crisis amongst young Americans.

The most prevalent use cases for virtual sitting in the pediatric space include:

Low-Moderate Suicide Risk

According to a JAMA editorial, suicide is up by 69.5% for children and adolescents making it essential to have solutions in place for monitoring these patients.

Eating Disorders

While supervision is generally considered an essential element of caring for hospitalized patients with eating disorders, it is costly, reduces staff availability for the care of other patients, and can be a barrier for patients.

Substance Abuse

Children that suffer from either intentional drug exposure due to substance abuse or, as is a rising trend due to the legalization of marijuana in many states, unintentional drug exposure are typically candidates for 1:1 monitoring during a portion of their stay.


While falls in the most thought of sense may not be a risk in pediatric populations, infant falls are a severely under-reported adverse event that can be costly and add to the patient’s length of stay. Often occurring when a parent falls asleep while holding the newborn, dropping the neonate to the floor, an infant fall can occur during transfer of the child from one person to another, by a family member or a slip and fall of family or staff.

Workplace Violence Prevention

Health care workers are 4 times more likely to suffer violence than workers in other industries. Prevention in the pediatric setting can be especially challenging as patients with behavioral tendencies for physical violence (i.e. hitting and biting) may not be identified prior to admission.

Child Protective Use Cases

Non-Accidental Trauma: When there is a concern with the family member, or visitors, behavior that raises a safety concern for a child, it can also present a safety concern for a 1:1 sitter assigned to be in the room.

No Family at Bedside: When children are very ill, parents are not always able to spend time at their bedside due to work commitments and caring for other children, which can create a sense of distress.

Medical Device Interference

Certain devices including IVs, catheters, drains and tubes have placement that is essential to the health, recovery and well-being of the pediatric patient. Virtual Sitting can be useful in keeping extra eyes on these patients, notifying caregivers on the floor if the child is pulling at, twisting or attempting to intentionally or non-intentionally remove the device.

Used in various settings: Emergency Department, Pediatric Units, NICU, PICU, Pediatric Hospitals

The Growing Need for Safety Monitoring Young Patients

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Hear from nurse leaders at a children’s hospital and an acute-care hospital on how remote safety monitoring has succeeded in reducing adverse events for pediatric and adolescent patients.

Caring for children in the inpatient setting presents unique challenges. Like adults, kids can misuse medication devices, elope from the hospital and sustain injuries from falls, but their needs are different and require additional attention from nurses. More than ever, young patients have behavioral health problems ranging from eating disorders to major depressive episodes, a situation made worse by the pandemic. Providing one-to-one care for this patient cohort is costly, ineffective, and resource intensive.

Hear from nurse leaders at a children’s hospital and an acute-care hospital on how remote safety monitoring has succeeded in reducing adverse events for pediatric and adolescent patients while reducing stress on families and caregivers.


  • Jamie Clendenin, BSN, RN-BC, Supervisor, Nursing Operations, Anne Arundel
  • Melanie Lee, MSN, RN, CPN, Clinical Director, Pediatric Emergency and Inpatient Unit. Anne Arundel
  • Ashleigh Nurski, MSN, RN, ACCNS-P, CPN Clinical Nurse Specialist, Helen DeVos Children’s Hospital
  • Stacey Overholt, MBA, BSN, RN, Director of Clinical Sales, AvaSure

Keeping Pediatric Patients Safe with Virtual Sitting

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Learn why virtual sitting is a solution to address the top patient concern for 2023 – the pediatric mental health crisis.

Caring for children in the inpatient setting presents unique challenges for hospitals across the nation. Similar to adults, kids can interfere with medical devices, elope from the hospital, and sustain injuries from falls, but their primary needs tend to differ and nurses caring for these patients need different support. Pediatric patients have always required a different touch, but the situation is being exacerbated by persistent staffing shortages and the concurrent mental health crisis amongst young Americans. Youth patients in need of behavioral health services are being kept in the ED due to a lack of mental health facilities and appropriate staffing. This makes providing safe and effective care to this important patient cohort costly, ineffective and resource intensive.

Advances in technology, like virtual sitting, have proven to support adequate staffing and allow children to be safe and well cared for. Hear how nurse leaders at a children’s hospital and an acute-care hospital are using virtual sitting for pediatric and adolescent patients and have succeeded in reducing adverse events while also reducing stress on families and caregivers. In addition, they will discuss the policies and procedures to consider and how to get buy-in from your team for this specific patient population. 

Learning objectives

  • Policies and procedures needed for video-monitoring pediatric patients.
  • How to get buy-in from your frontline team to use technology for this sensitive patient cohort.
  • Why virtual sitting is a solution to address the top patient concern for 2023 – the pediatric mental health crisis. 

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

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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®)

AONL Industry Insights Webinar: Keeping Pediatric Patients Safe with Virtual Sitting

Caring for children in the inpatient setting presents unique challenges for hospitals across the nation. The situation is exacerbated by persistent staffing shortages and the concurrent mental health crisis amongst young Americans. Hear how nurse leaders at a children’s hospital and an acute-care hospital are using virtual sitting for pediatric and adolescent patients and have succeeded in reducing adverse events while also reducing stress on families and caregivers. This AONL Industry Insights webinar is presented by AvaSure.

Remote Safety Monitoring Helps Address Pediatric Health Crisis

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COVID-19 has had a devastating impact on children. Many have experienced profound social isolation as a result of lockdowns and remote learning; others have had their home lives shattered by the death or debilitating illness of a parent or abuse by a family member. Even before the pandemic, suicide was the second-leading cause of death among adolescents; from 2007 to 2017 rates of teen suicide increased by 56%. After COVID took hold, the proportion of children seeking emergency mental health services who required immediate hospitalization rose 75%.

Suffice it to say, capacity to treat this need, including by inpatient children’s hospitals and within pediatric units of acute hospitals, has been tested. Nurse leaders are seeking solutions that will help keep patients safer while improving productivity, especially by reducing reliance on one-to-one sitters.

One solution that has shown promise for this challenging population is remote patient safety monitoring. Over the past three years, more than 4,000 pediatric patients have been placed under video surveillance using AvaSure’s TeleSitter® solution. Fifty-seven percent of those patients present with low- to moderate-risk suicide ideation. The other 43% are placed on video monitoring for the prevention of elopement, falls, medical device interference and staff injury prevention.

The TeleSitter® solution includes in-room monitoring devices with high-resolution video and digital audio, an invisible and automatic infrared light for low-light viewing and a virtual privacy curtain activated by the monitor staff when a caregiver is working with the patient. Room devices are either mobile (wired or wireless) or a permanent ceiling installation. The camera has 360-degree pan, tilt, zoom capability, allowing it to see minute details such as whether a patient is hiding something to be used later as a ligature. Each device is equipped with a loud and distinctive alarm used to alert staff that a patient is not responding to redirection or needs assistance. The average response time to the alarms nationally is 15 seconds.

The room devices connect via Enterprise software with centralized monitoring located in one hospital or in “hub and spoke” arrangements, with systemwide or regional centers watching patients in multiple hospitals, each tech with 12-16 patients on a large screen at their workstation.

Helen DeVos Children’s Hospital in Grand Rapids, Michigan, had been using AvaSure for several years to reduce the use of safety attendants, also known as patient sitters. Later it was used to monitor pediatric patients considered to be risks for aggression and violence against staff and other patients.

As the need has grown, Helen DeVos Children’s has used TeleSitting to monitor suicide-risk patients. The hospital uses the Columbia Suicide Severity Rating Scale to screen patients who present as moderate risk of self-harm or harm to others.

Joint Commission regulations say that patients with low-to-moderate suicidal ideation must be placed under “demonstrably reliable monitoring,” a standard that can be met by “continuously monitored video” linked to the “provision of immediate intervention” by a qualified staff member when called for.

At Anne Arundel Medical Center in Annapolis, Maryland, the pediatric patient selection criteria are different from adults’. It uses the Joint Commission-validated, four-question Ask Suicide-Screening Questions (ASQ) tool to assess the level of risk the patient presents. If the patient is found to be low-to-moderate risk, he or she qualifies for telemonitoring. Though the hospital also monitors adult patients, staff are given specific training on handling pediatric patients.

One key factor in a hospital’s degree of success in adopting this solution is the effort expended on overcoming institutional resistance to change. With suicide ideation patients, providers are often adamant that a human sitter needs to be in the room at all times, even though the vast preponderance of clinical evidence shows inconsistent results, as many sitters have no medical knowledge or specific training. If sitters are not available, direct patient care staff, such as patient care technicians, are de facto sitters. Once nursing leaders see the benefit of keeping frontline staff at the bedside, the more patients are remotely monitored.

Helen DeVos Children’s has worked on establishing strong communication between the nursing staff and monitor staff to tailor the intervention to each patient’s need. One patient may be restricted to bed, while the next is allowed to get up and sit in a chair. If a patient starts pacing the room and/or exhibits signs of anxiety, the monitor tech will intervene.

For parents, video monitoring means there isn’t a stranger sitting in the room staring at their vulnerable child. Parents are also happy to learn that the video is not recording.

Another best practice is for the monitor staff to greet each patient and family through the audio, so they know a human being is watching over their child. They use a scripted introduction, letting the family know they are there to keep their child safe. We think of it as akin to “the face behind the camera.

Last, but not least, there are the savings. As so many other organizations have discovered, monitoring 12 at-risk patients remotely versus using one-to-one sitters naturally lowers costs. Sitters are a little-known source of spending that can cost a health system millions of dollars annually.

For example, in the first 11,000 hours of monitoring of pediatric patients, Anne Arundel saved $212,000. Along with greater savings at the hospital level, this creates resources that can be put to better use in improving patient care.


  • Jamie Clendenin, BSN, RN-BC, is Supervisor, Nursing Operations, Anne Arundel Medical Center, Annapolis, Maryland
  • Melanie Lee, MSN, RN, CPN, is Clinical Director, Pediatric Emergency and Inpatient Unit, Anne Arundel Medical Center
  • Ashleigh Nurski, MSN, RN, ACCNS-P, CPN, is Clinical Nurse Specialist, Helen DeVos Children’s Hospital, Grand Rapids, Michigan
  • Stacey Overholt, RN, MBA is Clinical Director of Sales at AvaSure.

Managing Eating Disorders on a Generalized Peds Unit: A CVM Pilot

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Managing Eating Disorders on a General Pediatrics Unit: A Centralized Video Monitoring Pilot
Shadman KA, Coller RJ, Smith W, et al. J Hospital Med. 2019;14(6):375-360.


While supervision is generally considered an essential element of caring for hospitalized patients with eating disorders, it is costly, reduces staff availability for the care of other patients, and can be a barrier for patients.

Best practices for patient supervision often include mealtime or continuous 1:1 supervision by nursing assistants or other staff and has been shown to prevent unwanted behaviors and facilitate weight gain leading to earlier discharge. However, best practices to overcome cost and resource availability have not been established.


Centralized video monitoring (CVM) may provide an additional mode of supervision for patients with eating disorders.This study compared the use of CVM with the AvaSure TeleSitter® solution with that of 1:1 nursing assistant supervision.

  • Median cost for supervision via CVM was significantly less—$1166/admission for CVM vs $4104/admission with a nursing assistant
  • Length of stay was reduced by 2 days with the use of CMV—9.8 days (mean) vs 11.7 days with nursing assistant supervision
  • Days to weight gain were comparable between the 2 approaches: 3.1 days (mean) with the nursing assistant and 3.6 days with CVM


Although this study was small and was not powered to detect potential differences or to adjust for all potential confounders (such as other mental health conditions or comorbidities, eating disorder type, previous hospitalizations), these results show that CVM offers significant opportunity to supervise patients with eating disorders in a more cost-efficient manner, without compromising on outcomes.

Keeping the Suicidal Patient Safe at Beacon Health Memorial Hospital

Beacon Health Memorial Hospital Implements Successful Virtual Sitting Program:
Zero Adverse Events Found in Study of 500+ Patients. In a proactive approach, Beacon
Health Memorial Hospital assembled a dedicated multi-disciplinary team of frontline staff.
This team thoroughly assessed their existing procedures, developed new policies, and
implemented a stringent patient selection process using the Columbia Suicide Severity
Risk Scale (C-SSRS) for eligibility criteria. Conducting their study across two hospitals
and involving over 500 patients, their implementation of the TeleSitter solution yielded
impressive results: zero adverse events reported.