Topic: Sitter Reduction

Continuous Video Monitoring: Implementation Strategies for Safe Patient Care and Identified Best Practices

Continuous Video Monitoring: Implementation Strategies for Safe Patient Care and Identified Best Practices
Abbe JR, O’Keeffe C. J Nurs Care Qual. 2021;36(2):137-142.



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.


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


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.

The Evidence Based Case for a Virtual Care Solution

Read our white paper where peer-reviewed articles and presentations validate AvaSure TeleSitter’s success in improving safety, quality, and productivity outcomes.


In 2008, AvaSure devised a remote observation technology called the TeleSitter to help hospitals reduce the cost of using one-on-one sitters to avert patient harms. Fourteen years later, that application has evolved into a complete patient observation, communication and analytics solution that improves safety, productivity, and the experience of care. Avasure prizes its technological innovation, but what truly sets it apart is not the new hardware or software; it is evidence-based improvement.

Early on, AvaSure recognized the need for a clinical program to help hospitals and health system…

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New Technology at KGH Is Improving Patient Safety, Health Authority Says

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.

Read the full article here.

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.

Midland Health: TeleSitter® Program Offers Increased Patient Safety, Peace of Mind

Being able to protect our patients and offer quality care are of the utmost importance at Midland Health. In always looking at innovative ways to enhance patient safety, we created the TeleSitter® Program, a video monitoring system that gives our patients extra attention and further promotes their safety. The primary staff responsible for monitoring patients with this technology are our behavioral health assistants who are experts in this area.

Read the full article to learn more.

Henry Mayo Newhall Hospital Unveils New Technology for the Betterment of Patients

AvaSure’s TeleSitter® Technology is a system that is designed to connect caregivers more closely with patients and families while improving the quality of care delivered, according to Henry Mayo officials.

This new technology is part of Henry Mayo’s “Fall Prevention Program,” which is intended to keep patients safe and allow Henry Mayo patient care associates (PCAs) to spend more time caring for patients.

“We have specific patients that meet certain criteria that don’t need a physical body present, but can use the robot services from the AvaSure product,” said Jennifer Castaldo, Henry Mayo vice president and chief nursing officer. “The TeleSitter® devices will give our nurses and PCAs more time to spend with patients, while at the same time keeping our high-risk patients safer.”

Castaldo mentioned how the need for their PCAs to be bedside with patients is becoming more of a necessity.

Read the full story here.

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