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Hospitals that deploy remote video monitoring systems staffed with dedicated, trained observers can reduce patient falls significantly, with one reporting a reduction in patient falls and employee injuries, while also reducing associated costs.
Video monitoring is being employed by more hospitals seeking a way to prevent these non-reimbursable “never events.” Since 2008, Medicare has refused to pay the extra cost of treating a fall with injury, which averages $27,000. From 700,000 to 1 million patients suffer a fall in U.S. hospitals each year, according to the Agency for Healthcare Research and Quality.
At least 30% of inpatient falls result in moderate to severe injury, according to the Institute for Healthcare Improvement. Of those, 6% to 44% involve head injuries, serious fractures, subdural hematomas, and excessive bleeding. In 1% of falls with injury, or 11,000 times per year, the injuries result in death.
TIRR Memorial Hermann, a rehabilitation hospital in Houston, introduced a video monitoring system in July 2014. It is intended as the first line of defense for patients at risk, and it allows staff to immediately and directly intervene when a patient is at risk of falling, says DeAnne Roberts, RN, MSN, clinical effectiveness director of enterprise quality, patient safety, and infection control at TIRR. The monitoring units at TIRR are portable, wireless units, but the same technology could be permanently installed in the ceiling.
The hospital started by using the monitors on five units, and it added five more in December 2014. It is using all of the monitoring units primarily for brain-injured patients at risk of falling.
Falls have been reduced 8.6%, Roberts says. TIRR previously used patient sitters for fall risk patients and has not eliminated them. At press time, the hospital had 10 patients monitored remotely by one person and 10 with sitters.
The system also contributed to an 18.6% reduction in the number of days a patient requires constant visual observation (CVO) by a sitter who is in the room. “We have a nice trend with the CVO sitter in the room and interacting with the patient for a certain time, and then we can step them down to the telesitter,” Roberts explains. “That is consistent with our goal of making them more independent. It lets us keep our eyes on them and gives them confidence while they move toward more independence.”
TIRR now has twice the number of brain injury patients the hospital could treat in the previous year because, in addition to reducing falls, the system made it possible for TIRR to admit more brain-injured patients because more could be monitored for falls, says Mary Ann Euliarte, RN, MSN, MBA, vice president of operations and chief nursing officer at TIRR. That increased admission helped TIRR’s referring centers but also complicated the calculation of cost savings from the remote video system.
However, from July 2014 to December 2014, TIRR saw a 60% reduction in sitter costs, Euliarte says. A reduction in employee injuries during the same period also appears related to the use of the monitoring system, Euliarte says. Injuries for staff working with brain-injured patients have fallen 54% since the introduction of remote monitoring, Roberts says.
The cost of the system was recouped within the first six months, Euliarte estimates.
Roberts notes that the two-way audio communication is useful with brain-injured patients because it allows nurses to redirect a patient rather than always intervening in person, which encourages the patient to be more cooperative while also gaining independence. The audio connection in the room isn’t always open, but the monitor can open it if patients or families wave or otherwise signal that they want to talk.
Most patients and family members have responded well to the system, Roberts says. They say they are reassured by having someone looking in on the room constantly, she says. They are assured that the video and audio feeds are never recorded, and a virtual privacy screen can be activated for that room’s video feed.
With the virtual privacy screen, the monitor cannot see the patient but can still hear audio. The monitor can set a timer for the privacy screen so that the video feed is not inadvertently left obscured.
As good as the results are with the video monitoring, it should not be introduced as a single solution to patient falls, notes Kerry Davis, BSN, RN, nurse manager on the brain injury and stroke team at TIRR and the project lead. A month before the video monitoring was introduced, a multidisciplinary TIRR team reassessed how the hospital identified patients who need a sitter and how staffs throughout the hospital communicate about fall risks.
“We needed everyone using the same terminology,” Davis explains. “A neuropsych doctor may have his own definition of what makes a patient impulsive or reckless; 200 nursing staff may describe it differently. So one shift might say the nurse can handle this reckless patient, while the next shift requires the CVO sitter.”
The hospital’s goal is for any patient with a CVO sitter to move to video monitoring before discharge. A patient who has a sitter throughout the entire stay is costing the hospital money and probably is not gaining the independence that is part of the clinical plan, Davis says.
“If the patient comes to us on a sitter, and after a week of our assessment and intervention, that patient is on a telemonitor, that’s where we see our savings,” Davis says. “We went from using a sitter one-to-one 24 hours a day to using a telemonitor who can watch 10 people.”