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.

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.

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.

Augmenting an Inpatient Fall Program With Video Observation

BACKGROUND

Keeping patients safe is a goal for all health care facilities. Facilities should look at technology as a way to help improve outcomes. Patient falls are a dangerous, costly, and preventable health care-associated event.

LOCAL PROBLEM

The fall rate on the host facility's orthopedic unit was 2.6 per 1000 patient-days.

METHODS

Patients on an inpatient orthopedic unit who had a fall risk score greater than 13, based on the Johns Hopkins Fall Risk Assessment Tool, were provided with an added intervention, video observation.

INTERVENTION

Video observation units with 2-way communication were introduced to help prevent patient falls.

RESULTS

The fall rate per 1000 patient-days after implementing this intervention for 6 weeks was 0 falls per 1000 patient-days.

CONCLUSIONS

There was a 100% decrease in patient falls on the inpatient unit where video observation was implemented.

Virtual monitoring of suicide risk in the general hospital and emergency department

OBJECTIVE

To determine whether continuous virtual monitoring, an intervention that facilitates patient observation through video technology, can be used to monitor suicide risk in the general hospital and emergency department (ED).

METHOD

This was a retrospective analysis of a protocol in which select patients on suicide precautions in the general hospital and ED received virtual monitoring between June 2017 and March 2018. The primary outcome was the number of adverse events among patients who received virtual monitoring for suicide risk. Secondary outcomes were the percentage of patients for whom virtual monitoring was discontinued for behavioral reasons and the preference for observation type among nurses.

RESULTS

39 patients on suicide precautions received virtual monitoring. There were 0 adverse events (95% confidence interval (CI) = 0.000-0.090). Virtual monitoring was discontinued for behavioral reasons in 4/38 cases for which the reason for terminating was recorded (0.105, 95%CI = 0.029-0.248). We were unable to draw conclusions regarding preference for observation type among nurses due to a low response rate to our survey.

CONCLUSIONS

Suicide risk can feasibly be monitored virtually in the general hospital or ED when their providers carefully select patients for low impulsivity risk.