Implementation of Video Monitoring to Decrease 1:1/Sitter Costs

Purpose:
The need for 1:1 staffing to provide constant observation of patients at risk for suicide, fall, elopement and/or confusion is an ineffective utilization of FTE's. The use of continuous, non-recorded video monitoring for constant observation patients was implemented to decrease personnel costs.

Significance:
The average daily number of sitters utilized was 21 for 38 patients at an average daily cost of $5,660. The annual cost was estimated at $2,065,871 or 88 FTE's. Ineffective staffing patterns were noted to cover patients on multiple units due to the patient's admitting diagnosis.

Strategy and Implementation:
A camera for 86 beds was installed and monitoring stations were placed on 12 participating units. Total equipment cost was $161, 501. Each monitoring station is covered by one Technician (PCT) 24/7. All staff completed competencies on the system prior to implementation. Each PCT's monitor 2-12 patients and is required to respond immediately to the patient if anticipating an untoward event. When the PCT is required to leave the monitor urgently the closest staff member is required to cover the monitoring station. All monitored patients are accompanied to the bathroom. Issues related to the system include: PCT distractions, remaining alert, hand-off report, coordination of urgent patient needs and physician education. Documentation includes an every 10 minute checklist and handoff report summary. PCT's cover the monitors for four hour shifts, and are provided short breaks every 2 hours. Patient care management, documentation and rules are consistent across all units.

Evaluation:
Including the cost of equipment, the first year estimated savings was $470,679 and 25 FTE's. Pre and post implementation fall rates have remained consistent. Ongoing process issues are resolved through a manager, staff and educator task force.

Implications for Practice:
Implementation of a video monitoring system has been an effective strategy to replace sitters. Within the first year the number of patients requiring a sitter has increased to an average of 50/day. The cost of service has decreased significantly while fall/elopement rates have remained consistent.