With increasing acuity and simultaneous pressures for optimal productivity, reducing unnecessary patient companions has been a focus for many health care organizations. At the same time, nursing leaders are seeking to accelerate improvement in patient safety, specifically the prevention of falls. This study suggests the use of remote video monitoring is a safe tool for fall prevention. While there was a decrease in 1:1 sitter usage, there was no corollary increase in falls. In fact, falls decreased 35%. Not only was video monitoring a safe intervention, it was more effective than patient companions alone in decreasing falls by expanding the number of patients who are directly observed 24/7.
Sitters are a variable staffing resource that can be difficult to predict and accurately budget. Given multiple pressures to reduce self-injury from falls and other high-risk safety concerns, such as pulling tubes and lines, elopement risk, and suicide risk, the UC San Diego Health System (UCSDHS) implemented a patient sitter program. Sitters were used to closely observe 1 or more patients in direct line of sight. Yet, the costs of these sitters continued to rise.
Annual sitter costs in 2012 were estimated to be $3,197,515 across both UCSDHS locations
Therefore, nursing leaders initiated an evaluation of the sitter program with the aim of recommending and implementing new technologies or changes in current practice that would maintain or improve patient safety while reducing costs of care.
Solution
Goals for the video monitoring project included reducing sitter costs and outperforming national benchmarks and nursing-sensitive indicators (falls, falls with injury, and restraints).
In the first year (9 of 12 months implementation), there was a 24% reduction in combined video monitor technician and sitter staffing, for an estimated savings of $771,919
In the second year, the program realized a 54% reduction in staffing, for an estimated savings of $1,718,823
The return on investment for these units alone was 8.9 times the initial investment (calculated based on combined costs for video monitor technician and sitter staffing)
26% (average) reduction in falls with injury—outperforming or equaling benchmarks per 1000 patient days
Conclusion
The UCSDHS experience has demonstrated that nursing culture can shift and trust in the effectiveness of a new technology to address patient safety, such as video monitoring.
