Protecting Patient Safety: Can Video Monitoring Prevent Falls in High-Risk Patient Populations?

The Impact of Adding a 2-Way Video Monitoring System on Falls and Costs for High-Risk Inpatients

OBJECTIVES

We aimed to investigate the value of adding a video monitoring (VM) system with falls and costs for patients at high risk.

METHODS

We conducted a retrospective, historically controlled study of adults (≥18 y old) at high risk of fall admitted at the University of Miami Hospital and Clinics from January 1 to November 30, 2020 (pre-VM) and January 1 to November 30, 2021 (post-VM); in-person sitters were available in both periods. Fall risk assessment was conducted on admission and at every nursing shift; we defined patients as high risk if their Morse Fall Scale was ≥60. We conducted a multivariable logistic regression model to evaluate the association of period (pre- versus post-VM) with falls and performed a cost analysis.

RESULTS

Our primary cohort consisted of 9,034 patients at high risk of falls, 4,207 (46.6%) in the pre-VM and 4,827 (53.4%) in the post-VM period. Fall rates were higher in the pre- than the post-VM periods (3.5% versus 2.7%, P = 0.043). After adjustment, being admitted during the post-VM period was associated with a lower odds of fall (odds ratio [95% confidence interval], 0.49 [0.37-0.64], P < 0.001). The median adjusted hospital cost (in 2020 dollars) was $1,969 more for patients who fell than for patients who did not (interquartile range, $880-$2,273). Considering start-up and ongoing costs, we estimate VM implementation to partly replace in-person monitoring has potential annual cost savings of >$800,000 for a hospital similar to ours.

CONCLUSIONS

Video monitoring to augment in-person sitters is an effective fall prevention initiative for patients at high risk of falls, which is likely also cost-effective.

The Effectiveness of Remote Video Monitoring on Fall Prevention and Nurses' Acceptance

BACKGROUND

The use of remote visual monitoring (RVM) technology as a "telesitter" in hospitals can reduce falls and increase the efficiency of patient observation.

PURPOSE

This study aimed to examine RVM effectiveness as a strategy to decrease patient falls and investigate nurses' acceptance and perceived usefulness of RVM technology.

METHODS

Remote visual monitoring was implemented within a health system in the Southeastern United States. Falls data 6 months prior to and postimplementation were analyzed, and 106 nurses completed a survey evaluating their acceptance of the RVM technology.

RESULTS

There was a significant 39.15% reduction in falls with injury ( P = .006), and 70.6% of the RVM redirections were successful. Nurses' acceptance and perceived usefulness of RVM were moderate.

CONCLUSION

Implementing RVM has the potential to enhance patient safety by reducing falls with injuries and is considered acceptable and useful by nurses.

Utilization and effects of security technologies in mental health: A scoping review

Violence in healthcare is an urgent and increasing issue. Mental health settings are particularly affected, with severe negative impacts on staff, patients, and organizations. Security technologies could help maintain and improve safety in this field. However, knowledge of their utilization and effectiveness in mental health is lacking. A scoping review was conducted using the methodology recommended by the Joanna Briggs Institute to map research on the utilization and effects of security technologies in mental health, identify how research is currently performed, and highlight gaps in the existing knowledge. Literature search for peer-reviewed publications was performed on PubMed, CINAHL, PsycInfo, Embase, and Scopus. Following the screening process and the eligibility criteria, 22 articles were included in this review. The publication range was 2002-2020, many studies were surveys, and European countries were the most investigated, especially the United Kingdom. Overall, the use of 10 different technologies was reported 46 times. The most represented category was alarms, followed by video cameras, other technologies (such as wearable sensors), and metal detectors. More than half of the included papers reported positive effects of these measures on safety. This review indicates that several security technologies are available in mental health settings, with encouraging positive safety outcomes for both patients and healthcare professionals, especially nurses. However, research on the topic is still emerging, with a limited number of sources and a few high-quality designed studies. Therefore, future research should focus on producing evidence on the availability and effectiveness of these measures in mental health settings across countries.

An Experience Sampling Analysis of the Impact of Video Monitoring Technology and In-Person Sitters on Nurse Burnout: The Moderating Effect of Nurse Commitment and Mediating Effect of Emotional Labor

BACKGROUND

While it is established that video monitoring technology (compared with the use of in-person sitters) is a safe and cost-effective solution for hospitals, little is known about the impact of these approaches on nurses' stress and well-being.

PURPOSE

To compare the use of video monitoring technology and in-person sitters (likely a resource reallocated from nurses) for monitoring patients on nurses' emotional labor and burnout.

METHOD

An experience sampling method was conducted by surveying nurses twice a day for 3 weeks, resulting in 524 survey administrations provided by 74 nurses. The surveys included measures of daily video monitoring technology and in-person sitter use, emotional labor, emotional exhaustion, and nurse career commitment.

FINDINGS

There were positive effects from video monitoring technology and negative effects of in-person sitters on emotional labor and emotional exhaustion, particularly for nurses lower in commitment.

DISCUSSION

Hospital adoption of video monitoring technology has a positive impact on nurses compared with in-person sitter use.

Preventing Patient Falls Overnight Using Video Monitoring: A Clinical Evaluation

Inpatient falls are devastating for patients and their families and an ongoing problem for healthcare providers worldwide. Inpatient falls overnight are particularly difficult to predict and prevent. The aim of this cohort study was to evaluate effectiveness of overnight portable video monitoring as an adjunct falls prevention strategy for high falls risk patients in inpatient clinical units. Over three months, three clinical inpatient wards were provided with baby monitor equipment to facilitate portable video monitoring. Portable video monitoring registers were completed nightly and nursing staff were invited to complete surveys (n = 31) to assess their experiences of using portable video monitoring. A total of 494 episodes of portable video monitoring were recorded over the three-month period, with clinical areas reporting a total of four inpatient falls from monitoring participants (0.8% of total portable video monitoring episodes). Overall, there was a statistically significant reduction in total inpatient falls overnight on the target wards. Surveyed nursing staff reported feeling better equipped to prevent falls and indicated they would like to continue using portable monitoring as a falls prevention strategy. This study provides evidence to support the use of portable video monitoring as an effective falls prevention strategy in the hospital environment.

Preventing falls with remote video monitoring

This article describes an evidence-based project that aimed to identify nursing staff perceptions on the use of remote video monitoring (RVM), collect fall data following the implementation of RVM, and determine the benefits of RVM in reducing falls.

Innovating in a Crisis: A Qualitative Evaluation of a Hospital and Google Partnership to Implement a COVID-19 Inpatient Video Monitoring Program

Objective

To describe adaptations necessary for effective use of direct-to-consumer (DTC) cameras in an inpatient setting, from the perspective of health care workers.

Methods

Our qualitative study included semi-structured interviews and focus groups with clinicians, information technology (IT) personnel, and health system leaders affiliated with the Mount Sinai Health System. All participants either worked in a coronavirus disease 2019 (COVID-19) unit with DTC cameras or participated in the camera implementation. Three researchers coded the transcripts independently and met weekly to discuss and resolve discrepancies. Abiding by inductive thematic analysis, coders revised the codebook until they reached saturation. All transcripts were coded in Dedoose using the final codebook.

Results

Frontline clinical staff, IT personnel, and health system leaders (N = 39) participated in individual interviews and focus groups in November 2020–April 2021. Our analysis identified 5 areas for effective DTC camera use: technology, patient monitoring, workflows, interpersonal relationships, and infrastructure. Participants described adaptations created to optimize camera use and opportunities for improvement necessary for sustained use. Non-COVID-19 patients tended to decline participation.

Discussion

Deploying DTC cameras on inpatient units required adaptations in many routine processes. Addressing consent, 2-way communication issues, patient privacy, and messaging about video monitoring could help facilitate a nimble rollout. Implementation and dissemination of inpatient video monitoring using DTC cameras requires input from patients and frontline staff.

Conclusions

Given the resources and time it takes to implement a usable camera solution, other health systems might benefit from creating task forces to investigate their use before the next crisis.

Fall Prevention and Injury Reduction Utilizing Continuous Video Monitoring: A Quality Improvement Initiative

BACKGROUND

Reduction of falls and fall-related injuries in hospital patients remains a priority. Consideration of technology via continuous video monitoring (CVM) is relevant for safe, quality care with favorable cost implications.

LOCAL PROBLEM

Although fall rates were in the acceptable national safety standard guidelines, interventions were explored with the aim to further decrease falls using CVM.

METHODS

The quality improvement project collected descriptive statistics. Run charts portrayed data trends for falls and injuries in 2-week increments over a 6-month period.

INTERVENTIONS

Two-way cameras and a virtual sitter were used to observe fall risk patients.

RESULTS

Implementation of CVM with virtual sitters depicted a 14% decline in fall rates and a 6% decrease in fall-related injury rates with positive budget implications.

CONCLUSION

Cost savings, fall rates, and fall injury rates all improved with the inception of video monitoring.

Continuous Video Monitoring: Readiness for Growth

BACKGROUND

A large academic medical center in the Pacific Northwest successfully introduced continuous video monitoring (CVM) as an adjunct measure to replace sitter use when appropriate. Adoption of the technology was influenced by nurse enculturation, standard work, data tracking management, and patient/family engagement. The purpose of this article is to identify critical data metrics to inform expansion of CVM programs when determining readiness for growth.

PROBLEM

There is a lack of literature to advise organizations on needed data and metrics to inform growth readiness of CVM programs. Specific indicators can support initiatives to achieve financial support for program expansion.

APPROACH

CVM readiness for expansion is evident when metrics such as utilization rates, wait-list expansion, frontline staff perception, and sitter patient population outgrow current camera capacity.

CONCLUSION

Successful metric analysis can inform initiatives to grow CVM programs, which, in turn, support a culture of safety at large academic medical centers for at-risk populations.

Evaluation of Automated Video Monitoring to Decrease the Risk of Unattended Bed Exits in Small Rural Hospitals

OBJECTIVES

This study aimed to evaluate the effectiveness of using 1 to 4 mobile or fixed automated video monitoring systems (AVMSs) to decrease the risk of unattended bed exits (UBEs) as antecedents to unassisted falls among patients at high risk for falls and fall-related injuries in 15 small rural hospitals.

METHODS

We compared UBE rates and fall rates during baseline (5 months in which patient movement was recorded but nurses did not receive alerts) and intervention phases (2 months in which nurses received alerts). We determined lead time (seconds elapsed from the first alert because of patient movement until 3 seconds after an UBE) during baseline and positive predictive value and sensitivity during intervention.

RESULTS

Age and fall risk were negatively associated with the baseline patient rate of UBEs/day. From baseline to intervention: in 9 hospitals primarily using mobile systems, UBEs/day decreased from 0.84 to 0.09 (89%); in 5 hospitals primarily using fixed systems, UBEs/day increased from 0.43 to 3.18 (649%) as patients at low risk for falls were observed safely exiting the bed; and among 13 hospitals with complete data, total falls/1000 admissions decreased from 8.83 to 5.53 (37%), and injurious falls/1000 admissions decreased from 2.52 to 0.55 (78%). The median lead time of the AVMS was 28.5 seconds, positive predictive value was nearly 60%, and sensitivity was 97.4%.

CONCLUSIONS

Use of relatively few AVMSs may allow nurses to adaptively manage UBEs as antecedents to unassisted falls and fall-related injuries in small rural hospitals. Additional research is needed in larger hospitals to better understand the effectiveness of AVMSs.

Camera-assisted nursing observation of restless patients in an acute care setting, a multi-method feasibility study

AIM

To evaluate the implementation, practicality and acceptability of camera-assisted observation of restless patients in the acute care ward.

DESIGN

A multi-method feasibility study.

METHODS

Data consisted of nurses' written records, a brief survey among all nurses and individual interviews with eight nurses. Data analysis encompassed numerical analyses as well as descriptive content analysis.

FINDINGS

Camera-assisted observation was implemented by 44 patients from 60-95 years old, for 6 months. The practicality was enhanced by equipment that was easy to operate but the nurses were hampered by carrying the institutional mobile phone while caring for other patients. The intervention's acceptability depended on its potential for improved patient safety and the ability to adjust nursing care to meet the patients' needs as this could enhance feelings of confidence and control.

Fall Prevention and Injury Reduction Utilizing Virtual Sitters in Hospitalized Patients: A Literature Review

Falls and fall-associated injuries continue to occur in hospitals worldwide. Video monitoring using virtual sitters is a novel, cost-effective concept that has emerged as an intervention to address falls and maintain safety for hospitalized patients. This literature review examines the evidence regarding hospital-associated falls and fall-related injuries when video monitoring and virtual sitters were included as an intervention. Ten observational studies and two quasi-experimental studies (N = 12) were identified for inclusion from the Cumulative Index of Nursing and Allied Health Literature, Scopus, and PubMed databases. Overall, current evidence is focused on fall rates and cost savings. Eight studies demonstrated a fall reduction and the remaining three showed no statistical difference in fall rates with the use of video surveillance or virtual sitters. Cost savings for these interventions are based on the transition from 1:1 observation to virtual sitters; all 12 studies reported decreased overall costs transitioning to virtual sitters. Small sample size and limited studies are the primary limitations of current published evidence. As the novel clinical practice evolves and more hospitals are equipped with video capability, future research with virtual sitters should include expanded patient populations, a focus on fall-related injuries, and examinations of staff safety.

Towards Responsible Implementation of Monitoring Technologies in Institutional Care

Increasing awareness of errors and harms in institutional care settings, combined with rapid advancements in artificial intelligence, have resulted in a widespread push for implementing monitoring technologies in institutional settings. There has been limited critical reflection in gerontology regarding the ethical, social, and policy implications of using these technologies. We critically review current scholarship regarding use of monitoring technology in institutional care, and identify key gaps in knowledge and important avenues for future research and development.

Satisfaction and Technology Acceptance of Staff Regarding Use of Continuous Video Monitoring in Comparison With Sitters

OBJECTIVE

The purpose of this study was to determine staff satisfaction and technology acceptance of continuous video monitoring (CVM) in comparison to sitters.

BACKGROUND

Traditionally, sitters have been used to prevent falls in hospitals. Continuous video monitoring has emerged to reduce costs associated with sitters while maintaining safety.

METHODS

A descriptive online survey using a modified version of the Technology Acceptance Model was used to gain insight on technology acceptance and satisfaction levels of clinical staff related to CVM.

RESULTS

Only 12.73% found CVM to be as effective as sitters. Statistical significance was shown comparing sitters with CVM. A positive correlation was found with perceived ease of use and perceived usefulness of CVM.

CONCLUSIONS

Understanding staff satisfaction and technology acceptance is imperative for nurse leaders and administration when implementing new technologies.

Staffing Utilization and Fall Prevention With an Electronic Surveillance Video System: A Randomized Controlled Study

BACKGROUND

There is limited research addressing how to optimize both staffing and patient outcomes with the use of technology to reduce falls during hospitalization.

PURPOSE

We compared the effects of 2 staffing patterns in conjunction with the use of an electronic surveillance system on patient falls on an inpatient medical unit.

METHODS

Study participants were randomized to receive electronic surveillance system monitoring with a dedicated rounder or electronic surveillance system without a dedicated rounder. Falls during the study period were analyzed.

RESULTS

Of 1032 patients, there were 8 falls during the 3-month study. Six falls occurred in the intervention group, with no rounder, and 2 occurred in the group with a dedicated rounder. The data showed no statistical significance but had clinical implications.

CONCLUSION

In response to our findings, the dedicated rounder will function as a mobility technician, providing support to our nursing staff and a resource for fall risk patients.

Development and Psychometric Testing of the Remote Visual Monitoring Acceptance Tool

BACKGROUND AND PURPOSE

Using remote visual monitoring (RVM) technology to observe patients at high risk for falls can effectively reduce falls and sitter costs. However, RVM is underutilized by direct care nurses. This study describes the development and testing of a new tool to measure nurses' acceptance of RVM technology.

METHODS

The RVM Acceptance Tool (RVMAT) was tested among nurses recruited from a large health system.

RESULTS

Three factors accounted for 70.38% of the total variance: Value, Patient Selection, and Availability and Intent to Use. The overall 25-item scale had good internal consistency (Cronbach's alpha = .98).

CONCLUSION

The RVMAT is a theoretically grounded, valid, and reliable tool. Further research is needed to test its use in predicting nurses' acceptance and intent to incorporate new technology into daily nursing care.

Do No Harm: A Multifactorial Approach to Preventing Emergency Department Falls-A Quality Improvement Project

INTRODUCTION

Patient falls in the emergency department are a unique patient safety issue because of the often challenging nature of the environment. As there are a variety of potential causative factors for patient falls in the emergency department, this project employed a multifactorial approach to prevent patient falls in a Level 1 trauma center emergency department (adult only) in an urban tertiary care teaching hospital.

METHODS

This project was a single-unit quality improvement intervention that compared postintervention monthly unit-level data to historic monthly rates on the same unit. The intervention was multifaceted with patient-level, nurse-level, and unit-level interventions employed. A task force was convened to review and identify specific departmental gaps related to fall prevention, complete a retrospective review of departmental patient falls to determine causative factors, and implement interventions to reduce ED falls. A comprehensive program consisting of an ED-specific fall risk assessment tool, remote video monitoring (RVM), stretcher alarms, and a robust patient safety culture, among other interventions, was implemented. Patient falls and falls with injuries were tracked as an outcome measure.

RESULTS

After data driven analysis of causation, selection of key interventions, staff education, and sustained focus for 2 years, the department experienced a 27% decrease in falls and a 66% decrease in falls with injuries.

DISCUSSION

A multifactorial approach was an effective strategy to decrease patient falls in the emergency department.

Recommendations for Fall-Related Injury Prevention: A 1-Year Review of Fall-Related Root Cause Analyses in the Veterans Health Administration

BACKGROUND

Injurious falls continue to challenge health care. Causes of serious falls from the largest health care system in the United States can direct future prevention efforts.

PURPOSE

This article analyzes injurious falls in the Veterans Health Administration and provides generalizable recommended actions to prevent future events.

METHODS

We categorized root cause analysis (RCA) reports and coded injury type, fall type, location, and root causes. We describe interventions during the fall and provide resources for future prevention.

RESULTS

There were 154 reported fall RCAs during this time. Most (83%, n = 128) resulted in major injury: hip fractures (43%, n = 66), other fractures (25%, n = 38), and head injury (16%, n = 24). Most falls were unwitnessed (75%, n = 116).

CONCLUSIONS

Patients who fell were not wearing hip or head protection. Most falls were unwitnessed, and none were on 1:1 observation. Such interventions may help prevent future injurious falls.

Sitters as a Patient Safety Strategy to Reduce Hospital Falls: A Systematic Review

BACKGROUND

Bedside "sitters" are often used for patients at high risk for falls, but they are expensive and their effectiveness is unclear.

PURPOSE

To review evidence about the effect of sitters and alternatives to sitters on patient falls in acute care hospitals.

DATA SOURCES

PubMed searches to 8 October 2019, other databases from inception to December 2018, citation searches on key articles, and a Google search (22 October 2019).

STUDY SELECTION

English-language studies of any design that assessed the effect of adding sitters to usual care or compared alternatives to sitters (for example, video monitors or "close observation units") for adult patients on general wards of acute care hospitals and reported falls as a primary outcome.

DATA EXTRACTION

Dual-reviewer extraction of study data and risk of bias; single reviewer with group discussion for GRADE (Grading of Recommendations Assessment, Development and Evaluation) certainty of evidence.

DATA SYNTHESIS

Of 20 studies meeting inclusion criteria, 2 added sitters to usual care and 18 compared alternatives to sitters. There were no randomized trials, 11 time-series studies, 1 retrospective quasi-experimental study, and 8 pre-post studies. All studies had at least 1 methodological limitation. Two studies provided very-low-certainty evidence that adding sitters reduced falls. Eight studies provided moderate-certainty evidence that interventions that included video monitoring reduced sitter use and either did not affect or reduced the number of falls. Very-low-certainty evidence suggested that interventions that included nurse assessment tools (3 studies) or a close observation unit (2 studies) were effective alternatives to sitters.

LIMITATION

No studies had low risk of bias, publication bias is likely, and studies may have been missed.

CONCLUSION

Despite a compelling rationale, evidence is scant that adding sitters to usual care reduces falls.

PRIMARY FUNDING SOURCE

Veterans Affairs Quality Enhancement Research Initiative. (PROSPERO: CRD42019127424).

Managing Eating Disorders on a General Pediatrics Unit: A Centralized Video Monitoring Pilot

Adolescents with severe eating disorders require hospitalization for medical stabilization. Supervision best practices for these patients are not established. This study sought to evaluate the cost and feasibility of centralized video monitoring (CVM) supervision on a general pediatric unit of an academic quaternary care center. This was a retrospective cohort study of nursing assistant (NA) versus CVM supervision for girls 12-18 years old admitted for medical stabilization of an eating disorder between September 2013 and March 2017. There were 37 consecutive admissions (NA = 23 and CVM = 14). NA median supervision cost was more expensive than CVM ($4,104/admission vs $1,166/admission, P < .001). Length of stay and days to weight gain were not statistically different. There were no occurances of family refusal of CVM, conversion from CVM to NA, technological failure, or unplanned discontinuation. Video monitoring was feasible and associated with lower supervision costs than one-to-one NA supervision. Larger samples in multiple centers are needed to confirm the safety, acceptability, and efficacy of CVM.

Outcomes of Clinical Nurse Specialist Practice in the Implementation of Video Monitoring at an Academic Medical Center

PURPOSE/OBJECTIVES

The purpose of this project was to design and implement a program that utilizes video cameras with the goal of monitoring for and preventing unsafe patient events that can lead to poor outcomes.

DESCRIPTION OF THE PROJECT

The Concerns-Based Adoption Model was utilized to address users' concerns in different stages of diffusion of the new technology. Clinical nurse specialists, as part of a Constant Observation Workgroup, addressed these concerns during initial development and subsequent implementation of video monitoring on adult inpatient units. Establishing initiation criteria for video monitoring and documentation in the electronic health record was critical to success of the project.

OUTCOMES

Video monitoring was successfully implemented on 8 inpatient units. A decline in full-time employment numbers for 1:1 sitters was demonstrated with no increase in fall numbers.

CONCLUSIONS

Clinical nurse specialists were successful in collaborating with interdisciplinary colleagues to support the development of a Constant Observation Program that included video monitoring. In addition, clinical nurse specialists developed documentation, policies, and procedures to support this new technology. Success was evidenced by support of and growth of the program over time.