The rise of the patient sitter — one of healthcare's most undervalued safety tools

One important position in the healthcare industry today that didn't commonly exist 20 years ago is that of the patient sitter. As the focus on care quality and patient safety grows — and as efforts to improve behavioral health develop — so too does the significance of this role.

The scope of a patient sitter's responsibilities vary, depending on the hospital, but can include sitting with patients who are suicidal, homicidal, combative, confused, distressed, dying, at risk of falling or in need of supervision in some other way. Some hospitals have patient sitters on staff to keep patients company to reduce the burden on families or loved ones who want to take a break to grab food or go home to take a shower.

According to Susan B. Frampton, PhD, president of nonprofit advocacy and membership organization Planetree, forces that have driven the use of patient sitters include reports published by the Institute of Medicine on quality and patient safety and the industry's general shift away from using punitive measures like restraints and seclusion rooms to deal with difficult patients. Patient sitters provide a more humane alternative.

"As our nation tries to do a better job of supporting the needs of behavioral health patients, the role of patient sitters will become even more important than it is currently," says Dr. Frampton. "It will only become more so as the patient-centered movement, which demands hospitals to personalize care, progresses."

Although the significance of the patient sitter role is steadily being more accepted in healthcare, actual data surrounding this role is scarce. The International Healthcare Security and Safety Foundation published a report in December 2014 on how hospitals use patient sitters and found very little research has been done and very little data currently exists on these care providers.

Based on what is known, hospitals use patient sitters in both clinical and nonclinical capacities, but they typically are hired to help improve patient and worker safety within emergency departments and mental health wards or facilities.

"It's so important for people who engage in sitter activities to be viewed as important members of the healthcare team, and not as some quasi-technical staff that exist for hospital ambiance as opposed to safety," says Dr. Frampton.

The background experience and qualifications hospitals look for when hiring patient sitters also varies, according to Dr. Frampton, depending on their assigned role. Some institutions look to hire individuals with previous healthcare experience, while others are just looking for candidates who are competent and compassionate.

Once hired, many patient sitters are required to complete training of some kind, be it in handling combative patients, helping perform activities of daily living or assisting with basic nursing functions, like taking vitals. According to Dr. Frampton, one of the advantages of hiring patient sitters — besides improved patient safety and satisfaction — is helping out nurses and other clinicians.

"Patient sitters are a very important extra set of hands to have around the hospital," says Dr. Frampton. "By having these individuals sit with high-needs patients, hospitals can free up some of the time of the highly trained professional staff who are needed to perform other clinical tasks."

Planetree's general position is that any measure that enhances patient safety and improves care is a measure healthcare organizations must take seriously. The larger a hospital or medical center, the more appropriate and important the position of the patient sitter, according to Dr. Frampton. Even smaller institutions could make a patient sitter position worthwhile by combining it with other duties, such as running messages and lab results throughout the facility.

For hospitals that opt out of hiring patient sitters, Dr. Frampton suggests training volunteers or patients' family members to help try to fill any gaps in care.

To access the full International Healthcare Security and Safety Foundation report on patient sitters, click here.



More articles on patient safety:
UMMC wins 2 prestigious patient care and safety IHA awards
Joint Commission names Dr. Ronald Wyatt first ever patient safety officer
Investigation finds 10 deficiencies at Florida hospital that forcibly removed patient in December

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