Challenge

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.