Zero injuries from patient falls: One hospital demonstrates how it's possible

How St. David's North Austin Medical Center incorporated virtual sitters to decrease patient falls

A fall can be "devastating" to a patient, especially elderly patients, says Jane McCurley, RN, the CNO of St. David's North Austin Medical Center in Austin, Texas. "We don't want them to fall and get hurt."

Each year, between 700,000 and 1 million patients in the U.S. fall in the hospital, according to estimations from the Agency for Healthcare Research and Quality, and those falls can result in fractures, internal bleeding or other harm to the patient — as well as increased healthcare utilization and costs.

Additionally, patient falls can bring down the morale of hospital staff, says Lisbeth Votruba, RN, vice president of clinical quality and innovation with AvaSure, a patient safety technology company. "Caregivers are really disheartened by it as well," she says.

At St. David's North Austin, Ms. McCurley and staff already had a multitude of fall prevention precautions in place prior to May 2014, such as fall assessments, special-colored socks for fall-prone patients, fall contracts and hourly rounding. Sometimes, the hospital would also use sitters — professionals sitting in the room with a patient at all times to make sure he or she didn't try to get up unassisted.

Use of the sitters "was going up and up," Ms. McCurley says. At one point, the hospital had 10 sitters working each day, which can be expensive and pull resources away from other patients, she says.

As often happens in healthcare today, St. David's North found a solution in technology. At the end of May 2014, the hospital started using a virtual sitter system called AvaSys, made by AvaSure, which monitors patients via a live video feed with two-way audio. A patient care technician can watch several feeds at once and communicate with patients in their rooms via a microphone and speaker, so as to discourage patients from getting up and possibly falling.

Patient privacy concerns?

Having videos continuously showing patients seems like 1984's Big Brother, but AvaSure insists the system doesn't negatively affect patient privacy.

"We are really concerned with patient privacy and dignity," says Ms. Votruba. "A one-to-one sitter is the alternative…and that can be invasive."

To meet CMS requirements for patient safety, the video does not record patients and the area where the observer is watching must not be visible to the public. At St. David's, the technician watching the screen is in an enclosed room with frosted glass windows to ensure privacy.

Additionally, if a patient is receiving care, the observer is instructed to white-out that patient's feed, for privacy.


After acquiring 10 AvaSys telesitter units, not only did St. David's North not experience any falls with injuries for six months, Ms. McCurley notes family satisfaction also increased. This is because family members felt they could go home and get some sleep since their loved one has a watchful eye 24/7.

One somewhat unintended consequence of the telesitter system is that the patient care team can "get to know" the patients in better, more complete way, she says. In one instance, the virtual sitter was able to alert hospital staff that a patient wasn't eating his food, he was just moving it around. "He was just lonely and a little confused," Ms. McCurley says, and once a staff member started sitting with him during meals, he started eating.

"They bond with the patients even though they're watching them remotely," she says.

Other times, the virtual sitter has noticed and stopped patients from self-mutilating, trying to take out their IVs or drink beer brought in by family members.

Right now, St. David's North has 10 mobile telesitter units that can travel from room to room based on patient need. They prioritize the patients who get the units based those who have high risk of injuries from falls, but Ms. McCurley is hoping for more in the future to prevent all falls.

"I would install 50 if I could afford it," she says. "The young men who never call a nurse to go to the bathroom fall, too."

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