Decreasing the Costs of Constant Observation

Abstract

A performance improvement project employed a bachelor's-prepared psychiatric liaison nurse (PLN) to reduce one-to-one (1:1) constant observation (CO) on all medical patient-care areas of a large, metropolitan hospital. The project succeeded in cutting the costs of CO in half. It showed that PLNs can safely facilitate large reductions in CO without associated increases in falls or restraint prevalence, yielding significant cost savings for hospitals.

Registered Nurses' Job Demands in Relation to Sitter Use

“…These escalating trends in job demands and workload occur at a time when the prevalence of sitters is increasing in acute care hospitals (Rausch & Bjorklund, 2010;Worley, Kunkel, Gitlin, Menefee, & Conway, 2000). Sitters are unlicensed assistive healthcare providers whose functions are to provide close surveillance of at-risk patients and give an early warning signal to healthcare providers when the behavior of these patients deteriorates (Jaworowski et al, 2008;Rausch & Bjorklund, 2010;Tzeng, Yin, & Grunawalt, 2008).…”

“…Sitters are unlicensed assistive healthcare providers whose functions are to provide close surveillance of at-risk patients and give an early warning signal to healthcare providers when the behavior of these patients deteriorates (Jaworowski et al, 2008;Rausch & Bjorklund, 2010;Tzeng, Yin, & Grunawalt, 2008). From the literature, sitters are most often used (a) for patients with behaviors that are potentially dangerous (e.g., agitated, wandering, suicidal) or that may interfere with medical therapies (e.g., pulling out lines and tubes) and (b) for patients at high risk of having a fall and fall-related injuries (e.g., Donoghue, Graham, Mitten-Lewis, Murphy, & Gibbs, 2005;Rausch & Bjorklund, 2010;Tzeng et al, 2008;Worley et al, 2000). Despite limited evidence about their effectiveness for preventing falls or other adverse events (Jaworowski et al, 2008;Rausch & Bjorklund, 2010;Torkelson & Dobal, 1999;Tzeng et al, 2008), an estimated 99% of U.S. hospitals use sitters, and the annual costs of sitter use have escalated in the last decade (Rausch & Bjorklund, 2010;Worley et al, 2000).…”

Reducing sitter use

“…Experts point out that constant observation isn't evidencebased practice, and there are no data to show that it's cost-effective. [1][2][3][4][5] Empowering nurses to decide on proper patient care has helped lower hospital costs and staff frustration. The "no sitter order" had positive results at Pardee Hospital, compelling evidence for all facilities to limit the use of therapeutic companions.…”

A comparative study of patient sitters with video monitoring versus in-room sitters

“…They are also used for patients who are unable to follow directions or are non-compliant, are at risk to falls, are elopement risks, are violent, have impaired vision and hearing and are deemed to be at risk of removing medical devices. [3][4][5][6][7][8][9] Although most commonly used in hospitals in the United States (U.S.), the practice has been described in hospitals in Saudi Arabia, Australia, Scotland Canada, and Taiwan. A survey of 102 hospitals revealed that all used some form of sitters to provide direct patient surveillance.…”

“…Costs have been estimated using paid salary dollars, patient length of stay, and estimated savings related to the prevention of adverse outcomes. [3,8] A classic study identified the cost-benefit of a sitter shift at $3.76, with a cost of a sitter at $160.00, resulting in a net expense of $156.24. [9] This study provided the groundwork for future studies.…”