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change innovation & analytics
Sitter usage webinar
© 2016, Confidential and Proprietary
Housekeeping
 Download today’s PowerPoint presentation 
from our website www.nashgroup.com
 We’ll take questions during the last 10‐15 
minutes
 We’d like your feedback
© 2016, Confidential and Proprietary
Today’s objectives
 Quantify sitter usage
 Real time monitoring of sitter usage
 Determine when it is best to “hard‐wire” 
sitters into the budget
 Review alternatives to sitters as outlined in 
this Medscape article 
http://www.medscape.com/viewarticle/806798_3
© 2016, Confidential and Proprietary
Required metrics
Capture all care givers including care givers 
pulled out of staffing
Track by care giver type or job class code
Calculate the FTEs, hours and cost of sitter 
consumption
Track patient types
© 2016, Confidential and Proprietary
Patient types
 The main reason cited for use of sitters is 
prevention of patient falls 
 Patients with specific symptoms or conditions 
⁻ Confusion, disorientation, or delirium 
⁻ Hallucinations, agitation, psychosis
⁻ Physical aggression
⁻ Suicidal ideation 
⁻ Risk for removal of lines, catheters, devices, or 
equipment
 Physician’s and/or family request
© 2016, Confidential and Proprietary
Midwest case study
© 2016, Confidential and Proprietary
Emory sitter experience
 Clinical Staffing Resources Center (CSRC).
⁻ Multidisciplinary team to evaluate the issue
 Most frequent indications for sitter use were identified
 Goal was set to reduce sitter use by 50% across the health care 
system in 1 fiscal year without significant negative impact on quality. 
 Baseline data obtained and preliminary questions answered. "Why do 
we use sitters, what was the cost, and were sitters the most efficient 
way to use staff?“
 Equipment, education, rounding, culture change
 Goal to reduce sitter use by 50% in 1 fiscal year without negative 
impact on quality was achieved
 http://www.medscape.com/viewarticle/806798_5
© 2016, Confidential and Proprietary
6 months post implementation
© 2016, Confidential and Proprietary
Agency sitter costs
© 2016, Confidential and Proprietary
Track usage and share with staff
 The most difficult challenge associated with 
this practice change was shifting the 
mindset of the nursing staff. Ordering a 
sitter for any patient situation out of the 
ordinary was no longer an option. Staff 
were surprised to learn that presence of a 
sitter did not necessarily translate into a 
decrease in falls or other quality metrics. 
Rather, it was the intentional presence of 
the nursing staff that was pivotal to the 
successful reduction in sitter use.
© 2016, Confidential and Proprietary
Hours detail report
© 2016, Confidential and Proprietary
Cost detail report
© 2016, Confidential and Proprietary
Alternative sitter options
 Move room close to desk
 Hourly rounding/toileting schedule
 Identify patients at risk for fall in shift safety 
huddles
 Identify environmental concerns
 Bed alarms, bedside commode sensors, chair 
alarms
 Activity aprons
 Nonskid socks and floor mats
 Arm bands, chart stickers, color coded blanket

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