Across the spectrum of healthcare facilities, developing cost-effective solutions to reduce accidental falls without compromising patient safety has become a priority. Each year, somewhere between 700 thousand and one million people in the United States fall in the hospital. Upwards of 30 percent of these falls result in an injury that requires additional treatment and sometimes prolonged hospital stays.(1)
Furthermore, the average cost of a fall with injury is $14,000 (2); a cost not reimbursable from Medicare and other payers. Beyond patient safety and the associated costs, these falls put facilities at risk for litigation and negatively impact patient satisfaction and a facilities’ reputation.
As a result, healthcare facilities are reevaluating the tools and care processes that are in place in order to significantly reduce the number of falls and more importantly, the injuries they often cause. While not every patient fall is preventable, fall prevention programs identify ways to manage a patient's underlying fall risk factors and optimize the facilities’ physical design and environment. From a facilities standpoint, technology has become instrumental in reducing fall risk and improving patient satisfaction – from low-tech bed alarms to integrated communication systems. Yet most healthcare facilities still rely on patient sitters to monitor patients round the clock. Intrusive and resource intensive, patient sitters are often only feasible for extremely high-risk patients.
For a growing number of facilities, the right-size solution is somewhere in the middle – a combination of technology and caregiver involvement. Through remote monitoring of patients via video surveillance technology, trained hospital staff can observe the activity of multiple high-risk patients from a central location on each floor. For patient privacy, the video is live and not recorded. Used in conjunction with advanced communications and other procedures, video monitoring can lower staffing requirements while reducing risk and exposure for patients and the facility itself.
In 2012, a large Midwestern nonprofit healthcare network sought to reduce patient falls while simultaneously reducing costs. The solution at the time was to redeploy a highly-trained nursing staff as sitters to monitor high risk patients – sometimes leaving units understaffed and overwhelmed during shifts. After reviewing their needs and the solutions available, the hospital opted to implement a three-month video surveillance pilot program.
Video was selected because it provided an additional option for close supervision and offered increased privacy and as a result, decreased stress for the patients. A total of 12 cameras were installed on a unit with predominantly high risk fall patients. Nursing assistants were trained to observe the patients; each nursing assistant monitored six patients (after three months, the ratio was changed to a 1:9 ratio). Leveraging the existing network infrastructure, the video monitors are tied to the Nurse Call system so nursing assistants can communicate to floor staff just as if they were physically present in the room as “sitters.”
Like any “new technology,” the biggest obstacle that was encountered was resistance to change of the status quo. Staff members initially had the perception that the technology would mean less 1:1 interaction with patients and as a result, lower quality of care. Additionally, concern was expressed over the impact the technology would have on their job security. Those concerns were quickly dissipated when patients and staff recognized the benefits of the technology almost immediately.
Not only did the technology reduce the number of falls but it also improved the level of service provided by the staff. No longer “stretched to the max,” staff were able to spend quality 1:1 time with each patient rather than running from room to room. Overall, the video made the staff “feel more at ease with their high risk patients,” improved patient safety and decreases the need for patient sitters.
According to one staffer, “You don’t have to run in the room every five seconds to make sure your patient is okay and you can get more done this way. I like it.” Others wished there were “more cameras” and commented on how the video provides them with “an extra pair of eyes on the patient.” From a patient perspective, they reported feeling more comfortable and less anxious because they knew someone was watching then but they didn’t have to a “sitter” right there in the room.
Another concern was patient privacy. The hospital took great lengths to educate staff, patients and family about the video surveillance program within the unit. In addition to integrating language about the video surveillance program into the admission papers, patients and families were given a brochure explaining video monitoring programs, a sign was placed outside the door of the patient’s room and an additional sign was placed at the head of the patient’s bed. A key element of all communication was that the video was live and that nothing was recorded.
Following the successful pilot program, the hospital moved forward with the installation of cameras into every patient room. Part of a $140 million expansion and renovation of the hospital to improve the facilities, the video surveillance system is being implemented as each floor/unit is upgraded.
In all situations there is a “human element” that could fail but according to Cisco, a supplier of video monitoring solutions, there are redundancies that can be built into the program. For example, built-in motion detectors on the cameras can detect movement and send alerts to the monitoring station that patients may be attempting to get out of bed without assistance. While motion alerts do not replace visual monitoring, they give trained staff an additional cue that a situation requires intervention.
Additionally, video analytics can be applied to determine situations when a patient has moved beyond a specified area – like a bed or chair – or if they have left the room. Using analytics software tied into a hospital’s building infrastructure allows for varying levels of actions to take – from staff members receiving alerts via alerts or intercom pages to security being called or access to/from the unit or floor automatically restricted.
As demonstrated by the pilot program outlined, video surveillance can be used to effectively and efficiently mitigate fall risk without compromising patient care. A middle-ground between high-touch patient sitting and low-touch bed alerts, video surveillance provides constant visibility into high-risk patient rooms. With the confidence that patients are being monitored, unit nursing staff are empowered to spend more time with each patient on the floor and deliver a higher-quality of care.
Norm Spear is the director of building infrastructure delivery for Parallel Technologies.
1 The Agency for Healthcare Research and Quality
2 Galbraith J, et al: Cost analysis of a falls-prevention program in an orthopedic setting. Clinical Orthopedics and Related Research, 2011;469(12):3462-3468. doi:10.1007/s11999-011-1932-9.
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