By Lisbeth Votruba, MSN, RN
Everyone is talking about the shortage of registered nurses, but there’s less discussion about the shortage of unlicensed bedside caregivers in hospitals.
When it comes to patient care technicians (PCTs) and certified nursing assistants (CNAs), health systems are seeing turnover rates exceeding 30 percent. These caregivers are crucial for supporting sustainable care delivery models in hospitals. RNs cannot work at the top of their license if there are not enough unlicensed caregivers to delegate tasks to.
Because of this, it is not surprising that patient safety has been compromised in many ways. Patient falls are the most costly and frequent inpatient adverse event and can serve as a proxy for many other safety events that plague patient care. From 2020 to 2022, sentinel event falls have increased by 253 percent, according to The Joint Commission’s Sentinel Event Data 2022 Annual Review.
Because of this, hospitals are under pressure to develop care systems that address the shortage of PCTs and CNAs and can no longer afford the unsustainable practice of utilizing one-to-one sitters for patient safety.
Bedside sitters have been historically used to provide one-to-one observation for patients at high-risk for falls and other safety events, but there is scant evidence to support the practice, and this one-on-one care is extremely costly to hospitals.
Because of the costs and general unfeasibility of employing one-to-one sitters, virtual sitting has become mainstream in acute care. The practice enables a single trained employee to monitor multiple patients simultaneously, preventing falls, elopement, violence against caregivers and many other adverse events. Today, two-way video and more versatile configurations of room devices are enabling a wide range of virtual monitoring advances, resulting in a dramatic decrease in sitter use.
Here are the most recent publications from four hospitals that have successfully implemented virtual sitting programs.
Gaylord Specialty Healthcare. As a long-term acute-care hospital, Gaylord placed a particularly high emphasis on promoting patient independence and rehabilitation, but this increases patients’ risk for falling. The hospital’s demand for sitters started to outpace supply and the program grew more costly.
To respond to the more challenging macroeconomic environment, Gaylord implemented a monitoring program in which mobile telemonitors were deployed to patient rooms for continuous visual monitoring by virtual safety attendants. The goal was to decrease dependence on one-on-one sitters without compromising patient safety.
Gaylord assessed the effectiveness of the program by conducting a three-year study comparing 20 months of baseline data with 20 months of intervention data. At the end of the period, the data showed with statistical significance that the virtual sitting program had driven a 90 percent decrease in sitter hours and a 25 percent reduction in falls.
Houston Methodist Baytown Hospital. A community hospital within a greater health system in Southeast Texas, Houston Methodist Baytown Hospital implemented a virtual sitter program to increase resources for bedside staff, meeting the changes to the healthcare system following the COVID-19 pandemic.
To guide implementation, an interdisciplinary team headed by a nurse leader collaborated with other hospitals within the system to adopt best practices tailored to the hospital’s specific needs.
The hospital’s fall rate in 2022 dropped from an average of 1.43 to 0.98 per 1000 patient days post implementation, which is a 30 percent decrease. There were no falls by monitored patients. The hospital estimated that the program helped to save $295,000 in staff costs. Because of the success of the virtual sitting program, Houston Methodist Baytown Hospital plans to expand from virtual sitting into virtual nursing.
TidalHealth. For at-risk patients, TidalHealth had been running a patient companion program with one-on-one companions, but the $1.1 million initiative had proven to be expensive and unsuccessful. To reverse the trend, the health system implemented virtual sitting in two hospitals after modifying workflows and training staff.
The program dramatically reduced in-person sitter hours in both hospitals by 58 percent and 70 percent resulting in a cost savings of $425,000 in the first six months alone.
Upstate University Hospital SUNY. Although Upstate University Hospital had a virtual sitting program in place, the hospital was under-utilizing the technology they had purchased and falling short of its one-on-one sitter reduction targets. To increase utilization of virtual sitting and decrease sitter usage, nursing leaders developed and implemented a pilot program in four inpatient units that included a mandatory two-hour trial of virtual sitting before deploying a one-on-one sitter when the bedside RN was unsure how the patient would respond to virtual sitting. Most of the mandatory trials were successful in enabling the patient to continue with a virtual sitter and negating the need for a one-on-one sitter.
After completing a successful pilot, Upstate University rolled out the mandatory two-hour trial policy for hospital-wide implementation. After four months of trending data, the team found that the program reduced sitter usage by an average of 7.1 full-time equivalents, which translates to an additional 33 percent decrease of one-to-one sitter utilization just by optimizing the use of the technology they had already purchased.
The experiences of these four hospitals demonstrate the value of virtual sitting in decreasing labor costs while improving patient safety. As financial headwinds increasingly force health systems to explore alternative ways of delivering care, we will see more and more examples of how virtual sitting can help hospitals solve some of their most persistent problems.
Virtual sitting solutions offer a proven approach to alleviating staffing shortages in addition to supporting the bedside care team so everyone is working at the top of their license.
Lisbeth Votruba, MSN, RN is chief clinical officer of AvaSure.