Reduce 1:1 staffing and patient fall rates? Technology makes it possible

As hospitals evaluate ways to improve patient outcomes, advance patient safety and address staffing shortages while minimizing costs, they face a pressing concern: How can they provide 24/7 monitoring for high-risk patients without incurring unsustainable labor costs?

This article is sponsored by AvaSure.

Twenty-three healthcare leaders gathered April 13 for a roundtable discussion sponsored by AvaSure at Becker's Hospital Review's 9th Annual Meeting, where Terry Olinger, president of the Hospitals and Clinics Acute Care Group at Great Falls, Mont.-based Benefis Health System, shared how the system used the AvaSys TeleSitter video-observation system to improve patient safety and lower staffing costs.

"The thing I was really skeptical about was, will this make a difference? … but the [system] really does work in 99 percent of the cases … it's amazing when you see it in action," Mr. Olinger said. Benefis has been using AvaSys for about two years, with funding support from its foundation.

The AvaSys room unit is offered in three options: a mobile cart, a portable wall-mounted unit or a permanent ceiling unit.  It lets a single monitor technician keep tabs via video on up to 12 patient rooms from a command center – at Benefis it is in the patient flow center. The monitor tech can use the two-way audio to immediately intervene via two-way audio when a patient is at risk of self-harm, such as a fall. The monitor tech can talk to the patient to verbally redirect them. If the situation is emergent, the tech can activate an alarm and a nurse will know to get there right away. Overall, AvaSys helps improve staffing efficiencies by allowing nursing assistants to stay on the floor instead of watching patients 1:1.

Mr. Olinger outlined how the hospital reduced both staffing costs and patient falls.

Thorough market research

After realizing the hospital had a large number of staff dedicated to 1:1 patient monitoring and seeing the need for more certified nurse assistants on the floor, Benefis knew it was time to rethink its nurse-sitter strategy.

It researched mobile video monitoring best practices by combing through peer-reviewed articles and learned that a video solution could help reduce falls, drive down staffing costs and improve patient safety. The health system considered developing and implementing its own video solution from scratch, but it quickly discovered that it was too complex and expensive an undertaking when a vendor could offer the same thing at a lower cost. That's when Benefis' CNO discovered AvaSys, and the Benefis team went to see it in action at Sacred Heart Medical Center in Spokane, Wash.

"The most impressive part of this thing is when I actually observed it ... because I really was skeptical of a voice coming down from the ceiling … but it really makes a difference in how much it calms the patient down immediately," Mr. Olinger said about the importance of seeing AvaSys in-person.

Introducing incremental change

Benefis started with 12 wall-mounted cameras; it now has 24. Mr. Olinger said Benefis uses the system to track patients in a variety of care settings. After implementation, the hospital saw a decrease in reported falls and an even greater decrease in falls with injury.

At Benefis, a care team member is stationed in one central hub where he or she monitors all of the room units in operation. Command centers don’t need to be on the hospital premises, and one center can serve multiple hospitals within a health system. When the team member observes a potentially dangerous situation, such as a patient who dropped his or her TV remote and is about to move to pick it up, the team member can sound the Stat alarm on the room unit to summon a nurse. Although the national average response time is 15 seconds, AvaSure reports, Benefis nurses average 9 seconds from alarm sounding to arriving in the patient room. Additionally, the command center staffer can use AvaSys to communicate with the patient and let them know someone is on the way.

Gaining physician buy-in

As with any new technology, gaining physician buy-in can be a challenge. However, when Benefis implemented AvaSys, this wasn't an issue. "Anytime you do anything with your medical staff … [they] are really hard to convince," Mr. Olinger said. But, "getting their buy in [for AvaSys] was relatively easy … it makes a lot of sense to have one person monitor 12 patients versus one on one."

When it came to teaching staff how to use the new system, Mr. Olinger explained AvaSure worked hard to train staff on how to monitor patients with varying conditions, including behavioral health. The hospital also used online modules that aid in the training.

Because AvaSys can generate nursing analytics reports based on reported data, Benefis can compare itself against other hospitals using AvaSys to identify areas for improvement or expansion.

Success breeds success.

After implementing AvaSys, Benefis drastically reduced patient falls from 259 in 2015 to 139 in 2016 and 145 in 2017. Mr. Olinger was even more impressed with the decline in patient falls that resulted in injury. Prior to implementing AvaSys, Benefis saw 49 falls with injuries in 2015. In 2016, that number dropped to 20, and in 2017, to just 17.

AvaSys has played a part in Benefis’ impressive effort to lower costs. The 530-bed system, which has more than 3,000 employees, boosted its operating margin to 5.7 percent in 2017 and has reduced its costs by $60.2 million since 2009.

With AvaSys, Mr. Olinger explained Benefis reduced its labor costs without making a single layoff — instead, the health system is becoming more efficient. It is recording fewer falls, which results in lower readmissions and ultimately, saves costs. And although Benefis began its AvaSys journey to reduce its use of 1:1 sitters within the medical-surgical unit, it is expanding AvaSys to behavioral health.

"It's not just a camera with audio," said Brad Playford, the founder and CEO of AvaSure. “AvaSys offers scale and reliability to ensure patients are as safe as possible.”

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