A hospital was using bedside sitters to monitor high-risk patients but found it ineffective and expensive. To reduce costs and improve outcomes, the hospital proposed implementing a central video monitoring system (VMS) to replace sitters. An analysis estimated the VMS would cost around $150,000 initially but save over $500,000 annually by reducing falls and sitter costs. Over 3 years the VMS was projected to save $1.3 million compared to continuing sitter use. The proposal was to test the VMS on 8 patients initially using existing monitoring staff.

1. ORDER NOW FOR CUSTOMIZED, PLAGIARISM-FREE PAPERS
NUR 4325 Efficacy of Central Video System v Staff SitterNUR 4325 Efficacy of Central Video
System v Staff SitterI must present this Power Point in Zoom class, stating the reasonings
why a Central Video System would benefit the hospital vs using Staff as sitters for safety,
Suicidal Ideation, Combative patients….. I will provide may articles, the Comparison
Findings Table are completed on this, and also Information on a Central Video System used
in a hospital I used to work in.ORDER NOW FOR CUSTOMIZED, PLAGIARISM-FREE
PAPERSSonya L. Kowalski Rosanne Burson Elaine Webber Margaret Freundl Budgeting for
a Video Monitoring System to Reduce Patient Falls and Sitter Costs: A Quality Improvement
Project EXECUTIVE SUMMARY A review of available evidence for the use of video monitors
to reduce patient falls and bedside sitter costs revealed few evidence-based, peer-reviewed
articles. Large numbers of clinically based reports in the form of poster and podium
presentations were found. Available data were used to stimulate interprofessional and
collaboration for a video monitoring budget plan as a quality improvement project intended
to reduce patient falls and sitter costs at one government healthcare facility. The process of
data collection and analysis is detailed, providing a blueprint for nurse leaders. R EDUCING
HEALTHCARE COSTS while improving patient outcomes and experiences are explicit goals
for healthcare organizations (Institute for Healthcare Improvement [IHI], 2016). In an era of
cost containment, healthcare organizations may be reluctant to invest in costly innovations
to meet these goals without significant evidence that demonstrates efficacy of the
intervention and timely return on investment.NUR 4325 Efficacy of Central Video System v
Staff SitterWhile randomized controlled trials are slow, expensive, and time consuming,
analyzing large amounts of data collected from clinical care environments can create
opportunity for healthcare improvement (Haughom, 2018). According to the Institute of
Medicine (1999), “safety should be an explicit organizational goal” for health care (p. 4).
Patient falls SONYA L. KOWALSKI, DNP, RN, ACNS-BC, is Associate Clinical Professor,
University of Detroit Mercy, College of Health Professions, McAuley School of Nursing,
Detroit, MI. ROSANNE BURSON, DNP, RN, ACNS-BC, CNE, CDE, FAADE, is Associate
Professor, University of Detroit Mercy, College of Health Professions, McAuley School of
Nursing, Detroit, MI. ELAINE WEBBER, DNP, RN, PPCNP-BC, IBCLC, is Associate Clinical
Professor, University of Detroit Mercy, College of Health Professions, McAuley School of
Nursing, Detroit, MI. MARGARET FREUNDL, MSN, RN, is the retired Associate Chief Nurse
for Research, Education, Recruitment, and Professional Practice, John Dingell VA Medical
Center, Detroit, MI. NURSING ECONOMIC$/November-December 2018/Vol. 36/No. 6 have

2. been identified as a threat to patient safety in hospitals and are the number one reported
adverse event, with over 1 million falls reported in U.S. hospitals annually. Fall reports
indicate approximately 33% of patient falls are preventable (Ganz, Huang, Saliba, & Shier,
2013). Injuries as a result of falls are costly from the patient, family, and healthcare system
perspectives. During the past decade, the Centers for Medicare & Medicaid Services (2008)
have not reimbursed additional hospital costs associated with falls and fallrelated injuries.
Hospitals are required by The Joint Commission to have a fall-reduction program as a
national safety standard (Jorgensen, 2011). Fall risk tools, such as the Morse Fall Score Tool,
are utilized to identify patients at high risk of falling and direct a protocol of standard
interventions. Many hospitals have attempted to reduce falls by placing sitters at the
bedside of patients at high risk of falling (Burtson & Vento, 2015; Jeffers et al., 2013;
Votruba, Graham, Wisinski, & Syed, 2016). Using available assessment tools, hospitals may
determine which patients should be provided with a direct observation sitter; however,
there is little evidence the intervention 291 is effective in reducing fall-related injuries
(Harding, 2010). Nevertheless, inpatient sitter costs have been rising and may be as high as
$3 million per year (Rochefort, Ward, Ritchie, Girard, & Tamblyn, 2011). Problem
Description A Midwest medical center has had an interprofessional fall prevention taskforce
in place for several years. The group formulated a fall prevention protocol based on findings
from the Morse scale assessment scores. Additionally, bedside sitters were utilized to
monitor patients identified as having the highest risk of falling. The taskforce accomplished
early gains in fall prevention, but over time fall rates began to level out with minor
variations over several years, based on data from this facility’s incident report tool. It was
determined that use of bedside sitters did not lead to an appreciable decrease in patient
falls, and aggregate fall rates fluctuated between 1.09 and 5.30 falls per 1,000 bed days of
care between January 2013 and June 2016.NUR 4325 Efficacy of Central Video System v
Staff SitterPatient fall injury rates were also noted to be among the highest among
comparable facilities according to the quality data reports within this large healthcare
system of demographically similar medical centers. Bedside sitters were typically utilized
after the patient’s first fall if fall prevention measures were considered likely to be
ineffective due to patient characteristics, such as impulsivity or dementia. Incident reports
indicated patients continued to fall even with 1:1 bedside sitters in attendance. The medical
center did not have a pool of available bedside sitters and therefore utilized existing staff to
function as sitters. The personnel utilized were nurse technicians, licensed vocational
nurses, or registered nurses. When a staff member was used as a sitter, either the employee
worked overtime or was removed from the unit’s staffing model. The latter option reduced
the staff available for patient care and made unit nurses 292 reluctant to request a sitter
except in the most severe cases. The annual sitter costs at the institution were estimated to
be $284,488.00 for acute care, $21,053.20 for long-term care, and $116,544.50 for mental
health units (total $422,086 annually). These estimates were obtained by utilizing staffing
records and sitter salaries from an average month, dividing by the number of days in the
month to determine an average daily cost, then annualizing by multiplying average daily
cost by 365 days. The use of staff as direct observation sitters was ineffective and expensive,
contributing to staff fatigue and dissatisfaction. The use of video monitoring to replace

3. direct observation bedside sitters to reduce patient falls was identified as a possible
solution. Available Knowledge A literature review was conducted searching for fall-
reduction technologies, including video monitors. The Cochrane Library, CINAHL, and
PubMed Central were searched for peer-reviewed articles within the last 10 years with
keywords fall risk, fall reduction, fall prevention, technology, video monitors, video
surveillance, and video cameras. Several technologies to reduce patient falls, such as smart
shoes, smart carpet, floor sensors, necklace sensors, and personal airbags, have been
developed, but liability and practicality issues have not led to market availabilityNUR 4325
Efficacy of Central Video System v Staff Sitter(Comstock, 2013). Only a few peerreviewed,
evidence-based articles were available to use of video monitors to improve patient safety
and reduce fall rates. The use of video monitoring within healthcare systems to address the
important issue of patient fall reduction has been of interest to nurse leaders since Denver
Health described the use of video monitors as part of a Lean journey (Jeffers et al., 2013),
but evidence has been lacking. Available peer-reviewed evidence included that Burtson and
Vento (2015) implemented a mobile video monitoring system (VMS) to reduce the use of
bedside sitters. The results of the study found decreased falls, fall-related injuries, use of
restraints, and sitter-related costs. Additionally, Votruba and coauthors (2016) found use of
video monitors to be not only cost effective, but also safe for use in fall prevention. After
understanding potential cost savings and safety of utilizing a VMS to replace bedside sitters,
the next logical step was developing a plan to demonstrate the potential benefits within the
local healthcare facility. The literature search was then expanded to include gray literature,
such as non-refereed sources and healthcare websites. A large number of poster and
podium-presented data was available. These data reports indicated that with use of video
monitors sitter use declined, patient fall rates were reduced, fall injuries were reduced,
return on investment was rapid, and sitter cost avoidance was substantial, with the lowest
annual site-specific savings estimate reported at $77,200 (Votruba et, al., 2016). No reports
indicated regret over adopting the system. A VMS utilized by a healthcare system was
demonstrated at a national conference (Lee, 2016). Nurse managers and nurse users of the
system gave testimonials about benefits of the system and shared facility data outcomes
reports. Similar positive outcomes were reported during several site visits to hospitals
where video systems were being utilized. Specific Aims Video monitoring technology is
expanding rapidly and becoming a standard of care among the healthcare systems in this
Midwest region. Facility adoption of a VMS was viewed as necessary to provide regionally
equitable levels of monitoring for at-risk patients. An analysis of costs and benefits of the
VMS to the hospital was intended to demonstrate the feasibility of adopting this technology
as a quality improvement project. The purpose of this project was to utilize available
evidence to create a budget proposal and work with an interprofessional team to prepare
for implementation of a VMS in a healthcare organization in the NURSING
ECONOMIC$/November-December 2018/Vol. 36/No. 6 Midwest. Due to this hospital
system’s budget planning constraints, it was anticipated that if the budget proposal was
accepted, the time frame until implementation could be greater than a year or longer.
Because the budget proposal portion of the project did not involve any patients and the
expected time frame was lengthy, it was agreed by all participants to defer institutional

4. review board approval for the quality improvement study until the budget proposal was
accepted, funding was approved, and a purchase in progress. This article is designed to
create a blueprint for assembling clinically based data and working with an
interprofessional team including medical center leadership, nurse managers, fall-prevention
committee, biomedical engineering, and quality and safety managers, to create a budget
proposal for this healthcare innovation aimed at reducing patient falls. The clinical
questions proposed were: If the typical sitter model of staffing were to be replaced with the
video monitor model of staffing at this medical center: 1. What could be the sitter and fall-
related cost savings to the facility? 2. How could fall rates and fall injury rates be affected? 3.
NUR 4325 Efficacy of Central Video System v Staff SitterHow much staff could be returned
to the unit? Methods Facility fall rates have been trended on an ongoing basis. The fall and
fall-related injury costs were estimated by annualizing a 6-month record of falls and
fallrelated injuries and multiplying the most recent and conservative cost estimates from
the literature within the injury categories of none ($1,139), minor ($7,136), and major
($30,931) by the number of falls within each category (Spetz, Brown, & Aydin, 2015).
Patient falls with no reported injury were estimated utilizing the no-injury cost calculation.
The cost estimate total for combined non-injurious falls and fall-related injuries was
$403,728. Gray literature reports video monitoring fall reductions ranging from 6% to 99%
with a 50% reduction near median. A 50% reduction in non-injurious falls would result in
an estimated annual cost savings of $61,506 (54 falls with no injury or no injury reported
multiplied by lowest cost estimate of $1,139 from the literature and reduced by 50%). A
50% reduction in fall-related injury costs would result in an estimated annual cost savings
of $140,358 (11 falls with minor injury multiplied by lowest cost estimate from the
literature of $7,136 plus two falls with major injury multiplied by lowest cost estimate from
the literature of $30,931 and reduced by 50%). The 1-year facility sitter costs were
estimated to be $422,086 and were calculated by annualizing the daily sitter costs from an
average month of actual staffing records using average salaries for the categories of staff
utilized. Financial Narrative A financial narrative was completed and presented to facility
stakeholders to gain for the project. The cost of the VMS was estimated to produce an
overall savings to the facility within less than a year after implementation. The estimated
cost of the VMS was projected to be less than $150,000 for an initial purchase of eight video
monitors, including equipment, installation, and staff training. The monitors were estimated
to be $10,000 each for a total cost of $80,000 for eight monitors (verbal statement by a
regional healthcare system user). NUR 4325 Efficacy of Central Video System v Staff
SitterThe cost of establishing a central monitoring area was estimated to be $30,000
(Browne & Sterne, 2015). The cost of licensing and system was not available until the
formal bid process but was estimated to be approximately $20,000 annually. The
subsequent staff costs were projected as cost neutral because existing nursing staff would
be utilized as trained video monitor technicians in the same monitoring station as
centralized cardiac telemetry. The number of full-time equivalents (FTEs) to staff 24/7
would be NURSING ECONOMIC$/November-December 2018/Vol. 36/No. 6 five, and the
average hourly wage of certified nursing assistants was $19.10. (Use of unit managers,
technology, and biomedical was considered a part of normal job duties and not included in

5. calculations.) Based on the facility reports, approximately 25% of bedside sitters are
utilized in the mental health units and direct observation for many of those patients will
continue to be required. Therefore, a reduction of bedside sitter use of 75% was anticipated.
Using the calculated bedside sitter cost to the facility of $422,086, a 75% reduction in
bedside sitter costs would result in an estimated $316,564 annual savings. Total annual cost
savings of the VMS for both avoided sitter costs ($316,564) and avoided fall-related costs
($61,506 + $140,358 = $201,864) was estimated to be $518,428. After adjusting for costs of
the system, the first-year cost avoidance for the VMS was estimated to be $368,428
($518,428 – $150,000) for the facility. Total 3year estimated fall-related costs of using a
VMS were $1,093,531 (see Table 1). Total 3-year estimated costs of continuing current
bedside sitter practice was estimated to be $2,477,442. Estimated 3-year fallrelated cost
savings with the use of the VMS was $1,383,910 (see Table 2). Proposed Intervention The
proposed intervention was to implement a VMS with threeway communication to replace
bedside sitters for all patients not on suicide precautions within the inpatient units of the
medical center. This intervention was designed as a quality improvement project. NUR 4325
Efficacy of Central Video System v Staff SitterThe Plan-Do-Study-Act cycle was utilized to
implement the project (IHI, 2016). After budget approval, system installation, staff training,
and pre-implementation data collection, the VMS would be implemented with an initial
capacity of eight patients. The eight video monitors would be on a single screen placed in
the telemetry monitoring station, which then utilized existing staff (one person already
being used for telemetry 293 Table 1. Comparative 3-Year Cost of Video Monitors and
Current Sitter Practice Budget Item Year 1 VM Year 1 Sitters Year 2 VM Year 2 Sitters Year 3
VM Year 3 Sitters Eight monitors at $10,000 each $80,000 0 0 0 0 0 Central monitoring
station $30,000 0 0 0 0 0 4.2 FTE VMT staffing (pulled from existing model) (0) (0) (0) (0)
(0) (0) 8 hours of training for five CNAs as VMTs $764.00 0 0 0 0 0 8 hours of training for
two CNAs as VMTs $0 0 $305.60 0 $305.60 0 $20,000 0 $20,000 0 $20,000 0 (0) (0) (0) (0)
(0) (0) Licensing/System contracts Managers, technical, biomedical Use of direct
observation sitters (Avg daily sitter cost x 365) Use of VM observation Fall-related injury
costs Total estimated costs $422,086 $105,521.50 $422,086 $105,521.50 $422,086
$105,521.50 $201,864 (50% reduction) $403,728 $201,864 $403,728 $201,864 $403,728
$438,149.50 $825,814 $327,691.10 $825,814 $327,691.10 $825,814 CNA = certified
nursing assistant, FTE = full-time equivalent, VM = video monitoring, VMT = video monitor
technician Table 2. Cost Savings Summary Sitter Model $1,266,258 $316,564.50 3-year
estimated fall and fall-related injury cost $1,211,184 $605,592 3-year video monitor system
cost 3-year total cost 0 $171,375.20 $2,477,442 $1,093,531.70 0 $1,383,910.30