It’s no surprise that hospitalized patients are at an increased risk of falls. They’re in unfamiliar surroundings and may be taking new medications with side effects. And many experience decreased activity while recovering from various illnesses or surgeries. What may be surprising are the numbers: Each year, an estimated 700,000 to one million people fall in hospitals, according to the Agency for Healthcare Research and Quality.
Falls can cause additional medical problems and more medical bills. In an effort to monitor patients at a high risk for falls, some hospitals have employed patient sitters — non-clinical staff who are assigned to provide in-room monitoring. Sitters may be trained to calm patients who are disoriented or encourage them to stay in bed while they call for a nurse or other caregiver. But this is a high-intensity solution, and it doesn’t come cheap. One community hospital in Tennessee reported employing 14 sitters a day to the tune of $425,000 annually, according to the Harvard Law School’s Bill of Health blog. Such services typically are not reimbursed by insurers.
In recent years, this type of monitoring has been evolving into virtual care. Some hospitals are incorporating telesitting as part of virtual nursing, in which experienced nurses work remotely on administrative tasks and patient communication through two-way cameras and microphones stationed in patient rooms. Others have been employing companies or technology programs that allow people to monitor a dozen or so patient rooms at once. Orlando Health in Florida, Community Health Systems in Tennessee, Kaiser Permanente in Oakland, Calif., and Bon Secours Mercy Health in Cincinnati have all embraced the care model within the past couple of years. The Orlando hospitals have virtual care carts, essentially a monitor on a wheeled stand, through which sitters can interact with patients. Others allow sitters to interact through stationary television monitors hung on the wall.
Some hospitals say these programs make a big difference. Since implementing a telesitting program at two hospitals in 2021 (and later expanding), Community Health Systems has experienced a 76% drop in falls at some hospitals, and no patients in the program reported any falls with injuries in 2022, Becker’s Health IT reported.
“They have eyes on the patients at all times,” Lynn Simon, M.D., president of healthcare innovation and chief medical officer of the health system, told Becker’s. “There’s also two-way audio, so the person watching can audio into the room and talk and have a conversation with the patient, ask them if they’re uncomfortable, remind them to stay in bed … It’s really the back-and-forth communication with the patient that helps keep them safe and keeps them from falling.”
With national nursing and caregiver shortages, sitters help ensure that patients aren’t waiting long for staff assistance. One hospital reported its average staff response time after being alerted by a telesitter was just 15.1 seconds, the Harvard law blog noted.
Some technologies can also integrate bed sensors, motion detectors and other methods to sense the potential need for interventions, Healthcare IT Today reported. Sitters can also document alerts within electronic health records.
Moving forward with AI
By adding in the power of artificial intelligence to further study movement in patient rooms, the possibilities of so-called augmented video analysis are “endless,” said Mike Brandofino, president and CEO of monitoring equipment company Caregility during a June 2021 Becker’s Hospital Review webinar. This type of analysis combines real-time video with machine learning to determine if there is an activity happening in patient rooms that could cause a risk of harm. It incorporates movement of caregivers, doctors, visitors and patients, along with the location of objects such as IV pumps and bedside trays, and can track movement of patient limbs to see when they are active.
Hospitals could use the footage to monitor patient visitors and intervene if they are treating the patient badly or putting them at risk, Brandofino said. They can track when environmental service workers enter the rooms to clean. They can analyze a patient’s gait as they walk to the bathroom or make sure they’re not eloping from the room. They also could help in the patient-throughput process by indicating to operations staff when a patient has vacated a room, allowing staff to prepare it for the next patient.
Virtual patient monitoring could also help provide extra eyes on patients at risk of suicide or other dangerous behaviors. And it could be beneficial to monitor infants in neonatal intensive care units.
Addressing patient privacy
As more of these technologies are implemented, however, there are concerns about patient privacy and consent. There are steps that hospitals and the technology companies can take in that regard, Brandofino said during the webinar. For example, the systems could be set to blur or pixelate patients’ faces and erase any personal health information from the video. If there are no issues noted, patient video does not have to be stored. Consent often is incorporated into the hospital admissions process.
Story ideas
Health care journalists could find interesting stories by talking to hospitals using these services. How are they helping? Are there any patient stories/anecdotes they could share with you about how the service has helped intervene before patients had a fall or other incident? Has telesitting had any demonstrated effects on the number of patient falls? How do they protect patient privacy?
Other story angles could be found by talking to people working as sitters: What kind of training do they receive? What do they look for while monitoring patients? Are there any particular instances of helping or even saving a patient that stick out to them? Likewise, interviewing a patient who had intervention from a telesitter (or their caregivers/family members) could provide interesting insight.