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Remote Video Monitoring: A Novel Approach in Fall Prevention



Adequate fall prevention interventions are a challenge that nurses continue to endure. Remote video monitoring can be used in conjunction with other fall prevention interventions. This article describes remote video monitoring technology and the benefits and challenges associated with its implementation.
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clinical updates
Associate Editors: Elaine L. Smith, EdD, MSN, MBA, RN, NEA-BC, ANEF
Karen L. Rice, DNS, APRN, ACNS-BC, ANP
Associate Editors: Elaine L. Smith, EdD, MSN, MBA, RN, NEA-BC, ANEF
Karen L. Rice, DNS, APRN, ACNS-BC, ANP
Author: Kenesha Bradley, MSN, APRN, ACNS-BC
Remote Video Monitoring: A Novel Approach in Fall Prevention
Clinical staff are challenged daily
to identify risks and imple-
ment prevention measures to keep
patients from falling. Adequately
mastering and sustaining this skill
has been a challenge in nursing for
decades primarily because fall pre-
vention is complex and involves
individualized multimodal patient
interventions. Often, when all else
fails, nurses turn to one-to-one
safety sitters as an intervention to
prevent falls that can be costly to
health care institutions (Rochefort,
Ward, Ritchie, Girard, & Tamblyn,
2012). Remote video monitoring is
becoming more popular as an alter-
native to safety sitters and is begin-
ning to show its worth in reducing
inpatient falls (Brown & Wollosin,
Safety sitters are typically used
in hospitals to directly observe one
to two patients to prevent patients
from falling or injuring themselves.
Safety sitters are a resource that are
often not readily available to nurs-
ing staff due to the difficulty in
predicting when they are needed.
Hence, this frequently results in ac-
quiring per diem staff or removing
a staff member (i.e., unit secretary,
nursing assistant, or nurse) from
their shift assignment to monitor
fall risk patients. Frequent changes
in staffing assignments or removing
ancillary resources to sit can lead to
negative perceptions of job satisfac-
Safety sitters increase care de-
livery costs associated with staff-
ing and redirect available resources
from patients with less risk to those
at a higher risk. A recent study at a
U.S. institution estimated their an-
nual sitter cost at $3,197,515 across
two hospitals in a system (Burtson
& Vento, 2015). In an effort to find
an alternative to safety sitters, many
institutions are now looking to re-
mote video monitoring to help with
patient safety.
Remote video monitoring lever-
ages the health care facility’s current
wireless system, providing live-
stream video of patient activity as
an adjunctive safety intervention to
prevent falls with injury. The wall-
mounted or mobile video monitor
is placed in the patient’s room for
the telesitter to directly visualize
the patient and facilitate two-way
communication with the patient us-
ing a speaker and microphone. This
video-monitoring technology is
equipped with infrared technology
to help with visualizing the patient
during the night or in the dark, and
360° rotation with zooming capa-
bilities to scan the area and closely
monitor patients’ activities. To pro-
tect patient privacy, the system is
only capable of live video feed and
does not record or store any video.
The AvaSys® system is a popular
video-monitoring technology be-
cause it does not require integration
with the nurse call bell system. Prior
to initiating this type of system, it is
important to collaborate with your
Ms. Bradley is Clinical Nurse Specialist, Ochsner Medical Center Westbank, Gretna, Louisi-
The institution has a contract with AvaSure and is currently utilizing AvaSys video monitor-
ing system.
The author has disclosed no potential conflicts of interest, financial or otherwise.
Address correspondence to Kenesha Bradley, MSN, APRN, ACNS-BC, Clinical Nurse
Specialist, Ochsner Medical Center Westbank, 2500 Belle Chase Highway, Gretna, LA 70056;
Adequate fall prevention inter-
ventions are a challenge that nurses
continue to endure. Remote video
monitoring can be used in con-
junction with other fall prevention
interventions. This article describes
remote video monitoring technol-
ogy and the benefits and challenges
associated with its implementation.
J Contin Educ Nurs. 2016;47(11):484-
The Journal of Continuing Education in Nursing · Vol 47, No 11, 2016
facility’s information technology
department to ensure that Internet
bandwidth can support the wireless
The telesitter role has typi-
cally been designated to nursing
assistant-level employees who
monitor multiple patients re-
motely from a bunker area. These
individuals are trained to use the
computer software functions, such
as navigating the camera and alert
options and how to identify and
verbally intervene when they rec-
ognize unsafe patient behaviors.
The bunker where the telesitter
monitors at-risk patients should be
staffed 24 hours per day, 7 days per
week to ensure continual patient
coverage. The number of patients
a telesitter can observe at once var-
ies by each institution’s standards,
but the literature suggests that no
more than 12 patients is accept-
able (Votruba, Graham, Wisinkski,
& Syed, 2016). During the remote
video-monitoring admission, the
primary nurse must communicate
to the telesitter the patient’s name,
nurse contact information, reason
for admission to video monitor-
ing, and any potential hazards or
concerns to watch for (e.g., intra-
venous lines, catheters, seizure his-
tory). The telesitter must be able to
multitask, such as demonstrating
competencies using the PC while
monitoring the television screen,
allowing them to visualize the pa-
tients. Although there has been
little research describing the out-
comes of video monitoring, many
institutions have published or pre-
sented quality improvement data
supporting its use and have report-
ed a decrease in fall rates among
their monitored patients (Votruba
et al., 2016).
Figure. Algorithm to operationalize remote video monitoring; EEG = electroencephalogram.
486 Copyright © SLACK Incorporated
Fall prevention requires multiple
interventions to be put in place si-
multaneously to help with prevent-
ing patient injury; having an extra set
of eyes to monitor patient activity
can always help. Many institutions
are faced with reducing sitter costs
and optimizing staffing despite the
pressure to remain productive and
cost effective and to maintain patient
safety. This new technology provides
an innovative fall prevention strategy
that allows the telesitter to moni-
tor more than one to two patients
at a time. Although predicting pa-
tients who are most at risk for falls
continues to be a
challenge, using an
algorithm or proto-
col to identify po-
tential remote video
monitoring patients
can be helpful in
deciding whether
or not to use this
technology for a
patient (Figure).
Finally, to have a
successful remote
program as evidenced by decreased
fall-related safety outcomes and
continuous usage of the equipment,
operationalization must facilitate
open communication between the
telesitter and the direct care staff.
One must remember that the telesit-
ters are not able to intervene directly
with the patient as they once did as
safety sitters, so they rely heavily on
the prompt clinical staff responses
when called. There are a few chal-
lenges that have been identified and
should be addressed before operat-
ing a remote video-monitoring pro-
gram. However, the benefits of the
program outweigh those challenges
Remote video monitoring is not
the solution to end patient falls;
however, it is an additional resource
that can be used in the clinical ar-
senal of fall interventions. Using
this new technology in conjunction
with other interventions that have
been shown to reduce patient falls
could be promising in improving
fall-related patient outcomes and sit-
ter costs.
Brown, D., & Wollosin, R. (2013). Safe-
ty culture relationships with hospi-
tal nursing-sensitive metrics. Jour-
nal of Healthcare Quality, 35, 61-74.
Burtson, P., & Vento, L. (2015). Sitter re-
duction through mobile video moni-
toring. The Journal of Nursing Ad-
ministration, 45, 363-369. doi:10.1097/
Rochefort, C., Ward, L., Ritchie, J., Gi-
rard, N., & Tamblyn, R. (2012). Patient
and nurse staffing characteristics associ-
ated with higher sitter use costs. Journal
of Advanced Nursing, 68, 1758-1767.
Votruba, L., Graham, B., Wisinski, J., & Syed,
A. (2016). Video monitoring to reduce
falls and patient companion costs for adult
inpatients. Nursing Economic$, 34, 185-
Benefit Challenge
Patient safety and fall
and injury prevention.
Adequate wireless capabilities.
Potential reduction in
sitter costs.
Effective communication between
telesitter and direct care staff.
Dedicated staff to moni-
tor patients.
Self-directed telesitters for 24/7
Reproduced with permission of the copyright owner. Further reproduction prohibited without
... 36,37 Hospitals began using CVM in 2012 38 as a lower cost alternative to sitters. [38][39][40][41] Central video monitoring uses unlicensed [38][39][40][41] or licensed personnel 42 to continuously observe up to 16 patients 38,40-42 on video monitors from a central location. To protect privacy, CVM uses live video and does not record. ...
... 36,37 Hospitals began using CVM in 2012 38 as a lower cost alternative to sitters. [38][39][40][41] Central video monitoring uses unlicensed [38][39][40][41] or licensed personnel 42 to continuously observe up to 16 patients 38,40-42 on video monitors from a central location. To protect privacy, CVM uses live video and does not record. ...
... To protect privacy, CVM uses live video and does not record. 39,40 Upon observing unsafe patient behavior, a monitoring technician may communicate directly with the patient via intercom, call the assigned nurse, activate the patient call system or an alarm, or use an overhead paging system. 40,41 Of 6 evaluations of CVM, 3 reported decreases in total fall rates of 20% to 29% and decreases in sitter-related costs, 38,40,43 2 were underpowered because of too few patients 42 or cameras, 44 and 1 was descriptive without pre-post comparisons. ...
Objective: The purpose of this study was to explore the characteristics and predictors of falls in high- and low-risk inpatients in a tertiary hospital in Korea. Methods: Fallers' data were extracted from quality improvement reports and electronic health records from June 1, 2014, to May 31, 2015. Data on nonfallers matched by the length of hospitalization and medical departments of fallers were extracted from electronic health records. Participants were classified into a high- or a low-risk group based on their Morse Fall Scale score, fall risk-related symptoms, and medications known to increase fall risk. Characteristics of falls and risk factors were analyzed using descriptive statistics and logistic regression analysis, respectively. Results: In the high-risk group, education, surgery, department, impaired mobility, intravenous catheter placement, use of ambulatory aid, gait disturbance, and some medications were significantly different between the fallers and nonfallers. From these variables, education, operation, department, intravenous catheter placement, gait disturbance, and use of narcotics, vasodilators, antiarrhythmics, and hypnotics were statistically significant factors for falls. In the low-risk group, sex, age, length of hospitalization, surgery, department, diagnosis, and mental status were significantly different between the fallers and nonfallers. From these, sex, age, length of hospitalization, surgery, and liver-digestive diseases were statistically significant factors for falls. Conclusions: Characteristics and risk factors for falls differed between the risk groups. Fall prevention strategies need to be tailored to the risk groups and fall risk assessment tools need to be revised accordingly.
... Nurses evaluated appropriate observation levels on admission, after a safety event and during nursing rounds to identify at-risk patients eligible for video monitoring with the guidance of an algorithm ( Figure 1). This intervention allowed for simultaneous monitoring of patients and freed up 1:1 sitters for patient care on the unit (Bradley, 2016) and contributed to better patient outcomes and cost savings. ...
Falls and fall-related injuries occur far too often in hospitals every year. The goal of the quality improvement (QI) project reported here was to reduce the number of falls and fall injuries in hospitalized patients using virtual sitters and continuous video monitoring (CVM) cost effectively. Run charts portray data trends for fall rates and fall related injury rates at the inpatient care facility in two-week increments over a six-month period. Descriptive statistics were collected to characterize the sample and setting, and differentiate components of the falls, falls with injuries and related costs. The literature review noted positive outcomes regarding both cost savings and reduction in fall rates with the launch of virtual sitters. The QI project with the implementation of CVM with virtual sitters depicted a 14% decline in fall rates and a 6% decrease in fall-related injury rates with a cost savings to the hospital. Plans for expansion of the program were underway with integration into the electronic health record. As modalities such as CVM with virtual sitters are adopted by more institutions, additional at-risk patients will be monitored for fall prevention and additional uses continue to prevail. Fall prevention and injury reduction remain at the forefront of quality care, keeping patients safe.
Objectives: This study aimed to evaluate the effectiveness of using 1 to 4 mobile or fixed automated video monitoring systems (AVMSs) to decrease the risk of unattended bed exits (UBEs) as antecedents to unassisted falls among patients at high risk for falls and fall-related injuries in 15 small rural hospitals. Methods: We compared UBE rates and fall rates during baseline (5 months in which patient movement was recorded but nurses did not receive alerts) and intervention phases (2 months in which nurses received alerts). We determined lead time (seconds elapsed from the first alert because of patient movement until 3 seconds after an UBE) during baseline and positive predictive value and sensitivity during intervention. Results: Age and fall risk were negatively associated with the baseline patient rate of UBEs/day. From baseline to intervention: in 9 hospitals primarily using mobile systems, UBEs/day decreased from 0.84 to 0.09 (89%); in 5 hospitals primarily using fixed systems, UBEs/day increased from 0.43 to 3.18 (649%) as patients at low risk for falls were observed safely exiting the bed; and among 13 hospitals with complete data, total falls/1000 admissions decreased from 8.83 to 5.53 (37%), and injurious falls/1000 admissions decreased from 2.52 to 0.55 (78%). The median lead time of the AVMS was 28.5 seconds, positive predictive value was nearly 60%, and sensitivity was 97.4%. Conclusions: Use of relatively few AVMSs may allow nurses to adaptively manage UBEs as antecedents to unassisted falls and fall-related injuries in small rural hospitals. Additional research is needed in larger hospitals to better understand the effectiveness of AVMSs.
Introduction Patient falls in the emergency department are a unique patient safety issue because of the often challenging nature of the environment. As there are a variety of potential causative factors for patient falls in the emergency department, this project employed a multifactorial approach to prevent patient falls in a Level 1 trauma center emergency department (adult only) in an urban tertiary care teaching hospital. Methods This project was a single-unit quality improvement intervention that compared postintervention monthly unit-level data to historic monthly rates on the same unit. The intervention was multifaceted with patient-level, nurse-level, and unit-level interventions employed. A task force was convened to review and identify specific departmental gaps related to fall prevention, complete a retrospective review of departmental patient falls to determine causative factors, and implement interventions to reduce ED falls. A comprehensive program consisting of an ED-specific fall risk assessment tool, remote video monitoring (RVM), stretcher alarms, and a robust patient safety culture, among other interventions, was implemented. Patient falls and falls with injuries were tracked as an outcome measure. Results After data driven analysis of causation, selection of key interventions, staff education, and sustained focus for 2 years, the department experienced a 27% decrease in falls and a 66% decrease in falls with injuries. Discussion A multifactorial approach was an effective strategy to decrease patient falls in the emergency department.
Background: Keeping patients safe is a goal for all health care facilities. Facilities should look at technology as a way to help improve outcomes. Patient falls are a dangerous, costly, and preventable health care-associated event. Local problem: The fall rate on the host facility's orthopedic unit was 2.6 per 1000 patient-days. Methods: Patients on an inpatient orthopedic unit who had a fall risk score greater than 13, based on the Johns Hopkins Fall Risk Assessment Tool, were provided with an added intervention, video observation. Intervention: Video observation units with 2-way communication were introduced to help prevent patient falls. Results: The fall rate per 1000 patient-days after implementing this intervention for 6 weeks was 0 falls per 1000 patient-days. Conclusions: There was a 100% decrease in patient falls on the inpatient unit where video observation was implemented.
Background: There is limited research addressing how to optimize both staffing and patient outcomes with the use of technology to reduce falls during hospitalization. Purpose: We compared the effects of 2 staffing patterns in conjunction with the use of an electronic surveillance system on patient falls on an inpatient medical unit. Methods: Study participants were randomized to receive electronic surveillance system monitoring with a dedicated rounder or electronic surveillance system without a dedicated rounder. Falls during the study period were analyzed. Results: Of 1032 patients, there were 8 falls during the 3-month study. Six falls occurred in the intervention group, with no rounder, and 2 occurred in the group with a dedicated rounder. The data showed no statistical significance but had clinical implications. Conclusion: In response to our findings, the dedicated rounder will function as a mobility technician, providing support to our nursing staff and a resource for fall risk patients.
Falls are abnormal activity events that occur infrequently, however, they are serious health problems among the elderly individuals. With the advancements of technologies, falls have been widely studied by scientific researchers to minimize serious consequences and negative impacts. Fall detection and fall prevention are two strategies to tackle fall issues with a variety of sensing techniques and classifier models. Currently, many reviews on fall-related technologies have been presented and analyzed, however, most of them give surveys on the subfield of fall-related systems, while others are not extensive and comprehensive reviews. In fact, latest researches have a new trend of fusion-based methods to improve the performance of the fall-related systems based on a combination of different sensors or classifier models. Adaptive threshold and radio frequency-based systems are also researched and proposed recently, which are seldom mentioned in other reviews. Therefore, a global taxonomy for current fall-related studies from four aspects, including current literature reviews, fall detection and prevention systems based on different sensor apparatus and analytic algorithm, low power techniques and sensor placements for fall-related systems are conducted in this paper. Several research challenges and issues in the fall-related field are also discussed and analyzed. The objective of this review paper is to conclude and provide a good position of current fall-related studies to inspire researchers in this field.
Objective: To determine whether continuous virtual monitoring, an intervention that facilitates patient observation through video technology, can be used to monitor suicide risk in the general hospital and emergency department (ED). Method: This was a retrospective analysis of a protocol in which select patients on suicide precautions in the general hospital and ED received virtual monitoring between June 2017 and March 2018. The primary outcome was the number of adverse events among patients who received virtual monitoring for suicide risk. Secondary outcomes were the percentage of patients for whom virtual monitoring was discontinued for behavioral reasons and the preference for observation type among nurses. Results: 39 patients on suicide precautions received virtual monitoring. There were 0 adverse events (95% confidence interval (CI) = 0.000-0.090). Virtual monitoring was discontinued for behavioral reasons in 4/38 cases for which the reason for terminating was recorded (0.105, 95%CI = 0.029-0.248). We were unable to draw conclusions regarding preference for observation type among nurses due to a low response rate to our survey. Conclusions: Suicide risk can feasibly be monitored virtually in the general hospital or ED when their providers carefully select patients for low impulsivity risk.
With increasing acuity and simultaneous pressures for optimal productivity, reducing unnecessary patient companions has been a focus for many health care organizations. At the same time, nursing leaders are seeking to accelerate improvement in patient safety, specifically the prevention of falls. This study suggests the use of remote video monitoring is a safe tool for fall prevention. While there was a decrease in 1:1 sitter usage, there was no corollary increase in falls. In fact, falls decreased 35%. Not only was video monitoring a safe intervention, it was more effective than patient companions alone in decreasing falls by expanding the number of patients who are directly observed 24/7.
This article describes the implementation of a mobile video monitoring program, combined with a nursing-driven sitter protocol and administrative oversight, resulting in a significant return on investment over a 2-year period. Program implementation, structures, and processes are described. Financial and quality outcomes are summarized and compared to national benchmarks.
Public demand for safer care has catapulted the healthcare industry's efforts to understand relationships between patient safety and hospital performance. This study explored linkages between staff perceptions of safety culture (SC) and ongoing measures of hospital nursing unit-based structures, care processes, and adverse patient outcomes. Relationships between nursing-sensitive measures of hospital performance and SC were explored at the unit-level from 9 California hospitals and 37 nursing units. SC perceptions were measured 6 months prior to collection of nursing metrics and relationships between the two sets of data were explored using correlational and regression analyses. Significant relationships were found with reported falls and process measures for fall prevention. Multiple associations were identified with SC and the structure of care delivery: skill mix, staff turnover, and workload intensity demonstrated significant relationships with SC, explaining 22-45% of the variance. SC was an important factor to understand in the quest to advance safe patient care. These findings have affordability and care quality implications for hospital leadership. When senior leaders prioritized a safety culture, patient outcomes may have improved with less staff turnover and more productivity. A business case could be made for investing in patient safety systems to provide reliably safe care.
This paper is a report of a study of the relationships between patient health conditions, nurse staffing characteristics and high sitter use costs. Increasing recourse to patient sitters is a major cost concern to hospitals. To reduce these expenses, we need to understand better the factors associated with high sitter use costs. From a cohort of 43,212 medical/surgical patients admitted to an academic health centre in Montreal (Canada) in 2007 and 2008, all 1151 patients who received a sitter were selected. We applied multivariate logistic regression, using the Generalized Estimating Equation framework, to estimate the relationships between patient health conditions, nurse staffing characteristics and being in the upper two quintiles of sitter costs, vs. the lower three. The median sitter cost per patient, in Canadian dollars, was $772·35 (IQR = $1737·84); and $2397·00 (IQR = $3085·03) among the patients with high sitter use costs. In multivariate analyses, dementia, delirium and other cognitive impairments (OR = 1·49; 95% CI = 1·01-2·22) and schizophrenia and other psychoses (OR = 2·42; 95% CI = 1·08-5·76) increased the likelihood of high sitter use costs. In addition, every additional worked hour per patient per day by Registered Nurses (OR =0·33; 95% CI = 0·27-0·39) and by patient care assistants (OR = 0·11; 95% CI = 0·08-0·15) reduced the likelihood of high sitter use costs. Conclusion.  Circumstances of understaffing and patients having psycho-geriatric conditions are associated with high sitter use costs. Improving staffing and providing additional resources to support the care of psycho-geriatric patients may lower these expenses.
Sitter reduction through mobile video monitoring
  • P Burtson
  • L Vento
Burtson, P., & Vento, L. (2015). Sitter reduction through mobile video monitoring. The Journal of Nursing Administration, 45, 363-369. doi:10.1097/ NNA.0000000000000216