On Sept. 24, hundreds of patient safety experts and healthcare leaders will gather for a symposium in Grand Rapids, Mich., to share experiences, knowledge and insights on patient safety, quality and efficiency. The event will be the first time that so many users of the AvaSys® TeleSitter® Solution and other interested parties come together to assess the state of play in continuous visual monitoring of at-risk patients.
It takes place just nine years after AvaSure, a provider of business security services, first saw the opportunity to adapt its internet protocol cameras and high-quality digital audio to improve safety and efficiency in inpatient care. An early use of AvaSys was for reducing falls, one of the most frequent preventable adverse events in healthcare. From 700,000 to 1 million patients suffer a fall in U.S. hospitals each year, the Agency for Healthcare Research and Quality reports. At least 30 percent of those falls result in moderate to severe injury, and in 1 percent of those cases, in death, according to the Institute for Healthcare Improvement.
This content is sponsored by AvaSure
From its humble beginnings in one hospital in Michigan, AvaSys is now found in hundreds of hospitals across the U.S., including half of the U.S. News and World Report Honor Roll of the Top 20 Hospitals and all of the top three. These organizations are using this new program to prevent patient harm, protect staff from violent patients and visitors, stop elopements, take pressure off nursing resources, improve patient throughout in the emergency department and reduce costs. Many hospitals are seeing reductions in fall rates of more than 50 percent, while nearly eliminating falls with major injury.
"The fact is that the falls interventions we have been using for all these years are not working," said Patricia Quigley, PhD, ARNP, CRRN, a nationally known expert on patient falls. "We have over-relied on fall-risk assessments and on signage and bed alarms, which only lead to nurse fatigue. AvaSys provides the real-time, continuous surveillance we need, which, combined with the audio, allows for immediate intervention in time to prevent harm."
The program has expanded its scope dramatically. AvaSys monitor staff have also prevented patients from eating prior to surgery, stopped the sale and use of illegal drugs and saved the lives of patients having seizures. The system has been used with patients with infectious diseases such as tuberculosis to ease the sense of loneliness in isolation care and to reduce the burden on nurses of donning and removing protective gear.
A major use of AvaSys is now in behavioral health, ensuring the safety of patients and staff for lower-risk patients with suicide ideation. An Arizona hospital, recognizing that 27 percent of inpatients have documented behavioral health comorbidities, 1.33 days longer average lengths of stay and readmission rates of 37 percent, created a special Visual Monitoring Unit for mental health centered on AvaSys. The project led to zero use of alarms, a decrease in security incidents, zero use of restraints and zero assaults.
"AvaSys is a new arrow in the quiver for achieving healthcare's Quadruple Aim," says Brad Playford, AvaSure's founder and CEO. "This emerging movement in healthcare quality adds a fourth dimension – enhancing the work life of clinicians and staff — to the Triple Aim of improving population health and the patient experience of care while lowering costs."
The cost control comes from AvaSys saving hospitals millions of dollars annually by drastically reducing spending on an often-hidden line item: the use of nursing assistants or technicians as one-to-one patient sitters. This practice is nearly universal, despite a wealth of studies that cast doubt on the effectiveness of the intervention for preventing patient harm.
What AvaSys does, Mr. Playford says, can be called virtual patient engagement, an evidence-based, data-driven and cost-efficient means of connecting caregivers more closely with patients and families while improving the quality of care delivered.
One key to success with the program is having enough of the patient census on monitoring. A handful of carts for a 500-bed hospital is not enough to make a dent in outcomes, according to Mr. Playford. That conclusion plays out in data collected by AvaSure on fall rates (see graphic). "Ideally, you need at least 10 percent of census being monitored," he said.
The System
There are three major components to AvaSys: technology, clinical workflow and data analytics.
Technology: A mobile or fixed device in the patient's room sends images over the regular hospital network to a 40-inch video screen in a centralized location, where a trained observer monitors multiple patients simultaneously — sometimes as many as 16 individuals. The room unit is most often a portable, wireless cart, but it can also use the hospital's Ethernet. The cart, with a base of locking casters, is simply wheeled from a storage facility into the patient room, turned on and the monitor staff called to log in the patient. For hospitals with smaller rooms, there are wall-mounted portable units as well as permanent units installed in the ceiling.
In all four configurations, the camera has 360-degree pan, tilt, zoom capability, allowing the monitor staff to see anywhere in the room, including fine details such as skin color changes, shallow breathing and whether a pulse-oximeter is still attached. The system uses an infrared illuminator to provide low light (night) viewing capabilities. A digital two-way audio system includes a speaker and microphone. A privacy curtain can be activated to permit patient privacy during exams or times of undress.
Through two-way audio, the observer vocally engages with the patient. If the patient tries to do something he or she shouldn't — such as get out of bed on his or her own — the monitor staff will intervene, saying "Mr. Jones, what are you doing?" or "Hold it right there, I'm going to get somebody to help you." If the patient is unresponsive to verbal direction, there is a distinctive and loud Stat alarm on the room unit that sends nurses running to the patient's room. When there is a language barrier, staff can use the solution's pre-recorded statements that come in more than 200 languages.
Clinical workflow. AvaSys is about far more than technology. It is a solution that is centered on a clinical program designed and led by nurses. AvaSure makes sure the hospital has the appropriate protocols in place to support the technology. Before implementing the solution, the company's clinical team determines how the hospital currently responds to these types of patients. The team then works with the hospital to create policies, procedures and protocols that ensure reliable identification of patients that require watching; consistent patient monitoring criteria; comprehensive observer job descriptions; and accurate data collection.
During onsite clinical and technical training, AvaSure clinical educators come to the facility and train staff on how to be successful with this new program. This training is based on best practices developed over years from hundreds of deployments. The company shares policies and procedures, job descriptions and patient and staff education materials. After go-live, the AvaSure clinical team checks in every 30 days. In those cases where a replacement observer is hired, hospitals can use an e-learning tool to get the individual up to speed.
Data analytics. The AvaSys software includes data reporting capabilities. The first capability is a real-time dashboard. This is a valuable tool for program administrators to log in and see program metrics in real time. This is accessed via secure web browser. One of the key program metrics that can be viewed on the dashboard is the number of room units in use. If there are 20 carts and only 10 are in use, the monitoring team needs to move down the list of risk assessments to find the next patients who should be placed on monitors. The dashboard reflects when a patient has been admitted on AvaSys monitoring and how long they have been monitored as well as the reasons for AvaSys monitoring. The number of verbal redirections and number of Stat alarms for a rolling 24-hour period are reflected as well, providing a window into the acuity of the patient population.
AvaSure has recently introduced ORNA, or Online Reporting of Nursing Analytics. The only database of its kind in the U.S., it enables a hospital to run comparisons on utilization, alarm rates, monitor staff interventions, effectiveness of monitor tech interventions and bedside staff responsiveness. AvaSure is adding over 100,000 hours of monitoring data every month from hospitals across the country.
"Experience shows you can't improve if you can't measure your current performance," Mr. Playford said. "ORNA is a key differentiator for us moving forward."
For more about AvaSys please visit avasure.com. There you can also register for free for AvaSure's first symposium.