Jul 26 2023
Patient-Centered Care

Hospitals Find Harmony Through Virtual Sitting Programs

Healthcare organizations are relying on virtual sitting programs to keep patients safe and support bedside nurses.

Hospitals need to monitor patients in their rooms to keep them safe — watching for everything from unusual restlessness to hidden stashes of forbidden snacks and beverages.

But labor shortages and financial constraints have made in-person monitoring increasingly difficult. In response, a number of healthcare organizations have adopted virtual sitting, which deploys remote technologies to safeguard their patients and connect care teams.

“Using virtual patient observation was certainly a financial decision for us, but more important, it made sense from a safety perspective,” says Jonathan Witenko, system director for virtual health and telemedicine at Lee Health in southwest Florida. “The cost of putting someone at the bedside and the difficulty of finding the people to do the job were prohibitive. Technology gives us a scalable way to keep more patients safe.”

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Why Healthcare Organizations Are Using Virtual Sitting

Virtual patient sitting or observation is part of the growing use of technology in healthcare to increase staff productivity while maintaining or improving patient care, says Lynne Dunbrack, group vice president for IDC’s Public Sector practice, which includes IDC Health Insights.

The major concern is fall prevention, Dunbrack says. “Injuries from falls can complicate recovery, and care for falls may not be reimbursed by payers as they are considered a ‘never event’ by the Centers for Medicare and Medicaid Services.”

The traditional healthcare model of one clinician interacting with one person in a physical location is too inefficient to serve hospitals or patients well, adds Dr. Joe Kvedar, immediate past chair and senior clinical adviser to the American Telemedicine Association.

“The breakthrough in virtual sitting is that one person can safeguard many patients, and that has tremendous potential,” he says.

Technology investments and the cost of finding and training the observers are the chief barriers to adoption of virtual sitting, Dunbrack adds. Some of that expense can be mitigated by also deploying tools to involve family members and remote consultants in the patient’s care, she says.

For Kvedar, the primary hurdles to acceptance of virtual sitting are patient privacy concerns and quality control. “We need guidelines for training and for implementation. You probably don’t want one person watching 24 squares on a screen,” he says.

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Lee Health Strengthens Virtual Sitting Program

Lee Health launched its initial implementation of Caregility’s platform and mobile patient monitoring carts in 2021, Witenko says. The health system had been exploring the potential of remote patient observation long before that, including a pilot program using security cameras.

“We started looking into virtual observation eight or nine years ago, but the technology and the workflows for things such as nurse call and escalation systems weren’t ready yet for a clinical setting,” he says.

The Caregility carts are equipped with microphones, speakers and high-resolution camera systems that include movement sensors and infrared low-light capabilities. Trained virtual safety attendants monitor about six patients at a time, with iObserver software providing access to audio and video from the hospital room along with the patient’s medical record. Attendants can speak with the patient, summon a nurse or aide to help, or raise an alarm in an emergency.

READ MORE: Understand how virtual nursing programs help hospitals overcome staffing shortages.

Virtual patient observation has led to lower fall rates and fewer incidents of patient self-harm, and has also reduced costs, Witenko says. “It’s been a massive success from the perspectives of both patient and staff satisfaction,” he adds.

Lee Health now uses virtual observation in all six of its hospitals and plans to expand the deployment into its skilled nursing centers, Witenko says. Staff members are also investigating the potential use of artificial intelligence technology in the program.

Because uninterrupted power and internet connections are critical for virtual observation, Lee Health has built in redundancy in both its network and power sources, Witenko says.

Buy-in from the medical staff, organizational leadership and patients is also essential for the success of a virtual observation program, he says.

“Overcommunicate with everyone, especially the patients,” Witenko says. “Make sure they’re notified about how the system works and how it helps them.”

Joanathan Witenko Quote


Parkview Health Safeguards More Patients

Parkview Health recently finished installing cameras in the inpatient rooms of its 10 hospitals in northeast Indiana and northwest Ohio, connecting them to a digital care center, and enabling virtual sitting and nursing throughout the system, says Michelle Charles, the senior vice president and chief nursing informatics officer for virtual care.

“This is a way we can use technology to bring the technician or the nurse to the patient virtually in order to supplement and add resources to inpatient care,” Charles says.

About 700 Axis Communications cameras are networked with Parkview Health’s Epic electronic health record system, which provides data, analysis and predictive modeling for the remote observers, Charles says.

The virtual sitting program is primarily staffed by nonclinical employees with extensive training in what to look for and how to respond to patient behaviors. Each of these virtual technicians monitors about 10 patients at a time and has direct communication with the in-person nursing staff on the patient’s floor.

Parkview Health uses the same technology for its surveillance nurses, who monitor patients at risk for sepsis or deterioration, and to streamline admission and discharge processes, she adds.

“Our fall rates, which have always been low, are the lowest they’ve been in two years,” Charles says. “Using the technology in all prongs of the program, we’ve also decreased our sepsis and mortality rates.”

Parkview Health is still optimizing its virtual care approach by continuing to educate clinicians about the program’s value, evaluating processes and technologies, and making changes accordingly, Charles says. The organization is also exploring new possibilities, such as using mobile carts for the program, she adds.

“I have been a nurse for 35 years, and there has always been a labor shortage,” Charles says. “We have to reimagine healthcare in a way that makes technology work for us, to keep the patients safe and give clinicians valuable time and assistance to do their jobs.”

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UMass Memorial Health Sees Growing Potential

The explosive growth of telehealth triggered by the COVID-19 pandemic created an opportunity for Worcester, Mass.-based UMass Memorial Health to establish a virtual patient observation program, says David Smith, the health system’s associate vice president for virtual medicine.

“We had been working with Caregility to use mobile video carts to maintain patient care as we closed down in-person services during the pandemic and needed to move virtual medicine into the hospital setting,” Smith says. “As the COVID-19 surge subsided, we looked to repurpose some of the technology. We had discussed virtual monitoring to address staff shortages, and this gave us the tools to bring that program live.”

UMass Memorial Health has taken a measured approach to virtual patient observation. In fall 2020, it began rolling out the program to acute or critical care units in three of its five central Massachusetts campuses, says Debbie Turner, director of applied clinical informatics.

“It’s hard to predict how a patient can be successfully monitored, whether its virtual observation, in-person or checks every 15 minutes,” Turner says. “We have patients who transition on and off virtual observation as their needs change.”

At UMass Memorial Health, three staff members monitor up to 18 patients total, with each having primary responsibility for six patients. Each of these technicians is an experienced personal care assistant who spends part of the week working in person on the hospital floor, getting to know the staff and patients, Turner says.

RELATED: Reduce healthcare burnout with data-driven automation.

From their remote posts, technicians can respond to unusual patient behavior with interventions ranging from just listening to alerting the onsite staff by cellphone. The virtual observation program averages 8,000 interventions a month, Smith adds.

The Wi-Fi-based Caregility carts enable virtual observation at a relatively low cost, but system continuity is a prime consideration, Smith says. UMass Memorial Health is exploring a cellular data connection as an affordable backup during network or application outages.

Smith and Turner agree that starting small and understanding how a virtual observation application will work in the organization’s specific infrastructure is crucial.

The team at UMass Memorial Health initially underestimated the amount of computing power necessary for the program’s video feed and had to replace some desktop hardware. They also worked with Caregility to throttle down the video bandwidth used by the application, Smith says.

UMass Memorial’s virtual patient observation program will continue to grow with strategic deployments for patients who can most benefit, Turner adds. “This is one more tool in our toolbox to help keep patients safe,” she says.


The average total cost to a health system, regardless of injury, when a patient falls in the hospital

Source: JAMA Health Forum, “Cost of Inpatient Falls and Cost-Benefit Analysis of Implementation of an Evidence-Based Fall Prevention Program,” January 2023
(digital composite): Stígur Már Karlsson/Heimsmyndir (patient left), ZeynepKaya (patient sitting), MartinPrescott (doctor top right), Stígur Már Karlsson/Heimsmyndir (patient bottom)/Getty Images

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