Mission Health piloted a "virtual sitter" system that significantly reduced patient falls—and has the potential to save the health system hundreds of thousands of dollars, three Mission Health leaders write in NEJM Catalyst.

The hospital system's SVP of Innovation Marc Westle, Center for Innovation Manager George Burkert, and CEO Ronald Paulus, note that patient falls are a persistent threat to patient safety. Of the hundreds of thousands annual patient falls nationwide, between 30 and 50 percent result in injury, they note. And according to one study, such falls add 6.3 days to a hospital stay and cost $14,000 on average.

Finding cost savings with improved patient observation

Mission has "long adhered" to fall-prevention best practices, the authors write, such as locking beds in a low position with rails up, using call bells, nonslip patient footwear, and hourly clinician rounds. For high-risk patients, Mission Health uses additional safety measures, such as bed and chair alarms and yellow identification armbands.

But Mission's leaders thought the health system could do better. The system collaborated with Cerner to design and pilot a fall-reduction program in Mission's neuroscience unit using advanced remote monitoring technology.

How it works  

Cerner and Mission used Microsoft's Kinect sensor as the technological base for the program. Kinect uses a depth sensor and infrared camera to map the movement of objects in 3-D space. It works in any ambient light and features voice recognition and two-way audio communication. "Thanks to open-software programming, a unique [Kinect] application can be created to define and draw virtual zones, trip wires, and other trigger points around a patient within a field of view," the authors write.

Mission designed an assessment system to identify high-risk patients who would be monitored by the Kinect system, and unit staff educated the selected patients about how the system worked. Mission piloted Kinect in six rooms of neuroscience unit (accounting for 98 patients overall, representing about 15 percent of patients in the unit).

After staff had installed Kinect in patient rooms, certified nursing assistants who were trained as monitoring technicians "had a full view of the room, could introduce himself or herself via two-way audio, and then briefly explain the 'virtual sitter' monitoring system to the patient and family," the authors explain.

 "The monitor technician remotely draws virtual zones and virtual trip wires around the patient's bed or chair, and visual and auditory alerts are set to detect when a patient moves across the virtual boundaries," the authors write. The software is sophisticated enough that it minimizes alert fatigue.

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When a patient's movements triggered an alert, the monitoring technician first directed the patient via two-way audio to remain in his or her bed or chair. If needed, the technician then contacted a registered nurse or certified nursing assistant to intervene directly. In emergency situations, the technician contacted the unit supervisor. "The pilot project team met weekly to review outcomes and identify opportunities for improvement," the authors write.

The results

During the pilot from August to October 2015, the 98 monitored patients experienced no unassisted falls and no injuries. During the same period, patients who experienced standard fall-prevention protocols had an unassisted fall rate of 4.06 and an injury rate of 2.45 per 1,000 patient-days of care.

In the 12-month period before Mission launched the pilot program, the neuroscience unit had an overall fall rate of 4.77 and an injury rate of 0.91 per 1,000 days of patient care. In the 12 months after the launch, those rates fell to 3.45 and 0.74, respectively—even though the pilot involved only 15 percent of patients in the unit.

The pilot revealed that verbal redirection (used in 50 percent of cases) was highly effective. "This discovery was significant because the verbal redirection not only averted patient falls, but it also prevented nurses from being interrupted from other tasks," the authors write.

The technology can also significantly reduce costs. Based on the pilot data, the authors say they expect the virtual sitters "to reduce annual bedside-sitter hours by 42 percent—to roughly 27,300—during the next two years," with a minimum savings of $286,230. Costs could decline even further if Mission increases the ratio of monitors to sitter from six to one to 12 to one, which the system is considering.  

Going forward, Mission may bring the technology to other units and make improvements to the system to provide other types of care. "Potential additional uses include patient elopement, virtual visits, nurse documentation through voice recognition, and others," the authors say (Westle etl al., NEJM Catalyst, 2/5).

Patient experience: An investment worth making

Do you or your colleagues ever question the value of investing in the patient experience?

It's about more than raising HCAHPS scores—it's about building customer loyalty. Following a non-satisfactory resolution to a service failure, fewer than two in 10 customers will return. On the other hand, more than five in 10 customers will return if the organization reaches a satisfactory resolution in the moment.

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