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Sitter Reduction Through Mobile Video Monitoring: A Nurse-Driven Sitter Protocol and Administrative Oversight
A large Magnet® designated academic health system with 2 inpatient locations saw a significant $2.4M return on investment over a 2-year period.


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.


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


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.


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