Health 'sitters': Keeping an eye on at-risk patients remotely

Like other hospitals, New Hanover Regional Medical Center in Wilmington, N.C., assigns nurse assistants to provide one-on-one, constant observation for patients who are severely confused, at risk for self-harm or have fallen after trying to get out of their hospital bed.

These so-called sitters are merely observers: they don't participate in the care of a patient, and in some cases they're not even allowed to touch them. Their importance, however, can't be understated. They're an attempt to prevent the roughly 700,000 to 1 million patient falls that take place in U.S. hospitals each year. But leaders at New Hanover were convinced there had to be a more cost-efficient way to appropriately monitor these patients.

New Hanover and other hospitals are now trying technology developed by AvaSure, a Belmont, Mich.-based company that provides “telesitter” technology to monitor multiple at-risk patients at once. The solution, called AvaSys, allows a trained observer to remotely watch and interact with multiple patients.

The patient-facing component of AvaSys consists of a camera capable of night vision, a microphone and a speaker, usually on a wireless cart but also available to be permanently mounted in a care area. In another room, or at an off-site location, trained observers watch and talk to patients on an average of 12 screens each, with some hospitals assigning as many as 18 patients per observer.

The observers can redirect a patient who tries to get out of bed or pull at an IV tube line. They also have an alarm they can activate if a patient is in imminent danger. AvaSys can deliver pre-recorded messages in over 200 languages if a patient doesn't speak English, and there are privacy options if patients or clinicians want to block visibility during an exam or while dressing.

The technology is in use at more than 300 hospitals across a variety of care settings and departments, including oncology, rehabilitation, behavioral health and surgery recovery units. The company's customers include national hospital systems HCA and Ascension Health.

Clinicians determine whether a patient's condition and risks call for using the system. For example, in-person sitters may still be used for high-risk patients at New Hanover, including patients who are at a risk of committing suicide. Chief Nurse Executive Mary Ellen Bonczek said the system is most often used for patients with a contusion or dementia.

AvaSure estimates that its system, including the technology, training and labor, costs about 20% of the average cost of hiring sitters, according to Brad Playford, the company's founder and CEO. Sitter pay ranges from $11 to $40 an hour, while the cost to use AvaSure is under $3 an hour per patient, he said. The company says hospitals typically use sitters for about 3% of their patient census.

New Hanover was spending hundreds of thousands of dollars a year on sitter services, said David Long, the hospital's director of patient-care operations. The hospital was keen to use those nurse assistants to actually care for patients.

“The clinical advantage that the sitters provide comes at a cost,” Long said. “We want to make sure that we're utilizing dollars as effectively and efficiently as possible.”

New Hanover, which has 30 cameras, estimates that it has avoided roughly $1.5 million in costs. Labor costs were the main reason New Hanover decided to use the system, but Long said AvaSys also has helped the hospital reduce falls and the costs related to them.

Some facilities using AvaSys have seen fall rates drop up to 67%, in part by allowing providers to observe patients who would not otherwise have been assigned a sitter. For lower-risk patients, many hospitals use alarms that sound when patients get up from their beds, but Bonczek says those devices rarely allow nurses to prevent a fall.

Observers must log patient behavior and any incidents that occur during their shift, which provides hospitals with useful analytics on falls and other incidents that can help identify areas for improvement. The system also generates data about observer interactions that can help managers ensure patients are getting adequate attention.

“It's the personal touch,” Bonczek said. “The voice behind that monitor—it's a personal relationship.”