The following is a guest article by Wendy Deibert, EMBA, BSN, RN, VP Clinical Solutions at Caregility.
A common practice in hospitals today is the use of patient sitters, also called “specialling”, in which non-clinical staff is assigned on a one-to-one basis to provide in-room monitoring of patients at high risk for falls, self-harm, or other types of perilous events. Patient types often include those with neurological conditions or injuries, those who are agitated from substance abuse withdrawal, and those in mental distress who may be at risk of suicide. This layer of observation can bolster patient safety and prevent costly in-hospital injuries. The Agency for Healthcare Research and Quality estimates that 700,000 to 1 million hospitalized patients fall each year, with more than one-third resulting in serious injury.
Sitters are trained to respond to patient needs by following specific hospital protocols. A sitter might verbally respond to a disoriented patient, answering questions and providing reassurance. A fall-risk patient attempting to get out of bed would be redirected by a sitter, who may also alert nursing staff if necessary. The goal is twofold — keep patients safe and free up nursing staff to tend to more demanding and specialized clinical duties.
While patient sitting is typically provided by non-nursing staff with lower wages (Indeed.com reports an average of $10.67 per hour), the cost is unreimbursed and unbudgeted and can have a significant impact on a hospital’s bottom-line. For example, one 900-bed hospital reportedly contended with a $3 million annual unbudgeted expense for human patient sitters alone.
An Emerging Alternative to In-room Sitters
The field of telehealth has been a panacea for a host of current healthcare challenges–access to care in rural areas, the growing physician shortage, treating patients with limited mobility. One emerging trend is the use of video cameras to replace a human and serve as the in-room virtual sitter, or e-sitter.
Not every patient who could benefit from a human sitter will be appropriate for a virtual substitute, however, the use cases for deploying a camera-based solution are many and varied. And as a supplement to existing patient safety policies, ie. non-slip socks, proper lighting, keeping patient belongings within reach, hospitals can see a reduction in negative events while decreasing their unbudgeted hourly staff expenses.
How It Works
In-room cameras, either hard-mounted or based on a portable cart, provide real-time, continuous visibility to trained staff who can observe patient rooms on multiple monitors at a workstation. Some workstations display up to 24 embedded screens, significantly increasing the number of rooms that one individual can monitor.
The workflow remains essentially the same. If a patient behavior warrants an intervention, the virtual sitter alerts the appropriate personnel via the methods available through their facility’s system. Paging, sounded alerts, texts, two-way audio and two-way video are possible notification options depending on the technology solution. Some platforms may even integrate with the existing nurse call system. In some cases, two-way technology that allows the sitter to speak directly to the patient is enough to redirect the behavior or provide the assistance needed.
Some available technologies also integrate bed sensors, motion detectors and other methods for detecting the potential need for interventions. Alerts are documented within the system, and staff are required to incorporate their observations within the patient’s record to ensure the necessary level of communication is sustained across the care team.
In my experience, I’ve seen virtual sitting not only limit in-hospital falls, but also prevent suicide attempts and even expose dangerous illicit drug usage. It’s important to note that while both human sitters and e-sitters add value to a patient safety protocol, neither approach is permitted by the JCAHO to replace patient checks performed by nurses.
Patient and Visitor Privacy Concerns
Patient privacy is always a consideration in a hospital setting and video monitoring is no exception. Each hospital has its own policies which may be as simple as turning the camera off at certain times or requiring a badge scan to turn the camera on by approved providers. Patient video is not recorded or stored, which can ease the concerns of patients or their family members. Often the consent is incorporated into admissions forms.
- The ease of adopting an e-sitting program relies heavily on your institution’s existing telehealth roadmap. If telehealth is already being used in some capacity, the path will be much smoother.
- Alert fatigue is a real problem in an acute setting so comprehensive training for your virtual sitters helps ensure interventions are appropriate and the right situations are escalated to clinical staff.
- Humans are still at the helm even in a virtual sitting program so ergonomics, shift coverage and rotations, and easing monotony should all be factored into the implementation.
- Multi-functional audio and video endpoints that support more than one telehealth initiative can incrementally improve your return on investment.
About Wendy Deibert
Wendy Deibert serves as the VP of Clinical Solutions, Consultancy and Business Development for Caregility. She joined the company in 2018 after spending 34 years in nursing as a bedside critical care nurse, manager, senior consultant, operations manager and vice president. Wendy, as the vice president of telehealth services, played an integral role in building Mercy Virtual, the first hospital with no patients that enables 160+ clinicians caring for patients remotely 24/7.