Augmenting an Inpatient Fall Program With Video Observation

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.

Novel interventions significantly reduce falls with fractures: A meta-analysis and systematic review

INTRODUCTION

Worldwide, falls lead to possible complications such as prolonged hospitalization, prolonged bed rest, pressure injuries, fractures and mortality.

AIMS

The study aimed to evaluate the effectiveness of novel fall prevention strategies that utilized technology in preventing falls.

METHODS

The meta-analysis and systematic review was guided by the Cochrane guidelines for systematic reviews of interventions. The authors searched databases for specified keywords.

RESULTS

A total of 22 studies were included. Interventions included multi-modal fall prevention interventions, camera surveillance, motion sensors and bed/chair exit alarms. Video monitoring was equivocal in reducing fall rates. Exit alarms statistically significantly reduce falls between groups but not within groups. The interventions were not statistically significant in reducing falls with minor injuries but they were statistically significant in reducing falls with serious injuries including fractures.

CONCLUSION

A comprehensive fall prevention care plan, rather than one specific intervention, is necessary to prevent falls effectively.

Safety hazards in patient seclusion events in psychiatric care: A video observation study

WHAT IS KNOWN ON THE SUBJECT?: Coercive measures such as seclusion are used to maintain the safety of patients and others in psychiatric care. The use of coercive measures can lead to harm among patients and staff. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study is the first of its kind to rely on video observation to expose safety hazards in seclusion events that have not been reported previously in the literature. The actions that both patients and staff take during seclusion events can result in various safety hazards. IMPLICATIONS FOR PRACTICE?: Constant monitoring of patients during seclusion is important for identifying safety hazards and intervening to prevent harm. Nursing staff who use seclusion need to be aware of how their actions can contribute to safety hazards and how they can minimize their potential for harm ABSTRACT: Introduction Seclusion is used to maintain safety in psychiatric care. There is still a lack of knowledge on potential safety hazards related to seclusion practices. Aim To identify safety hazards that might jeopardize the safety of patients and staff in seclusion events in psychiatric hospital care. Method A descriptive design with non-participant video observation was used. The data consisted of 36 video recordings, analysed with inductive thematic analysis. Results Safety hazards were related to patient and staff actions. Patient actions included aggressive behaviour, precarious movements, escaping, falling, contamination and preventing visibility. Staff actions included leaving hazardous items in a seclusion room, unsafe administration of medication, unsecured use of restraints and precarious movements and postures. Discussion This is the first observational study to identify safety hazards in seclusion, which may jeopardize the safety of patients and staff. These hazards were related to the actions of patients and staff. Implications for Practice Being better aware of possible safety hazards could help prevent adverse events during patient seclusion events. It is therefore necessary that nursing staff are aware of how their actions might impact their safety and the safety of the patients. Video observation is a useful method for identifying safety hazards. However, its use requires effort to safeguard the privacy and confidentiality of those included in the videos.

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.

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.