Krystle Gandhi, BSN, RN, Director Clinical Informatics and Operations
Trudy Sanders, PhD, VP Patient Care Services (JPS Health Network)
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Acute care hospitals are challenged with growing populations of patients exhibiting confusion, delirium, and agitation (Laws & Crawford, 2013). These patients, who are at risk for falls, elopement, or pulling out medically necessary lines and tubes, present patient safety challenges. In the past, many hospitals have incorporated bedside patient sitters, who give constant patient observation to manage patient safety risk behaviors and prevent interference with medical care. Recent developments in video technology provide a new avenue to control cost and increase patient safety through real-time video monitoring.
In December 2014, when the monthly cost of physical patient sitters exceeded $112,000, a 537 bed acute care facility began to explore alternative patient constant observation systems. The primary objectives were to increase the capacity of constant patient observation, decrease patient sitter hours, and decrease inpatient falls. Two types of real-time video observation were considered. Centralized monitoring with 2-way communication was studied by Jeffers et.al (2013), who found video monitoring with two-way communication allowed staff to have extra warning for patient intervention. In the first three months, the Jeffers program reported 57 prevented falls. Estimated savings in their program exceeded expectations with “more than $2.02 million in deferred cost savings”. Research of in-room web cams by Hardin, Dienmemann, Rudisill, & Mills (2013), found the use of the web cam system decreased the average monthly fall rate. Even though this system provided the addition of ‘virtual side rails’, an alarm system to detect patient bed exit, it exhibited limited flexibility and required patient movement into monitored rooms.
The centralized video monitoring system was chosen due to its portability. The system consists of a 360 degree infrared camera with 2-way communication capability. The device is placed in the patient’s room while trained observers monitor the patient through a live feed from a central location in the hospital. Patient behaviors are managed through distraction and redirection by the observer, or by alerting medical staff with an alarm.
Ten portable camera monitors were implemented on inpatient units, which included Critical Care and Medical-Surgical patients. To differentiate between the need of a physical sitter or a camera monitor, a patient observation tool was developed to document the physical sitter’s interactions with the patient every 15 minutes. With this tool, the need for the bedside sitter was easily assessed, allowing the bedside sitter to be exchanged for a camera monitor in many incidences.
The initial goal of this project were to reduce patient falls by 5% and decrease physical sitter hours by 10% in the first six months of the project. In the first thirteen months following implementation, these goals were exceeded with the following results: Fall rates decreased 14% with zero reported injuries, physical sitter hours decreased an average of 21%, and constant patient observation hours increased 29% allowing more patients to be monitored.
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