How the North Texas VA Improved Patient Safety and Reduced Costs With Virtual Sitters

Passionate and committed, the virtual sitters at the VA North Texas Health Care System, are not just entry-level, front-line health care workers—they are the unsung heroes who, despite being virtual, forge genuine and heartfelt connections with the veterans under their care. Tiffany Villamin, nurse manager, shared a compelling story during her presentation at the 2023 ANCC National Magnet Conference^®, underscoring the indispensable role these virtual sitters play in ensuring the success of the hospital's virtual sitting implementation. When news of an impending ice storm loomed last winter, these compassionate individuals proactively reached out to Villamin, sharing that they had packed sleeping bags in their trunks and were en route to the hospital to support the veterans and the bedside staff for as long as the crisis lasted.

The VA North Texas Health Care System, a large health system with 13 facilities and more than 700 beds, represents a virtual sitting success story. After adopting this technology, the health system reduced inpatient fall rates by nearly 20% and reduced hourly patient sitting costs by nearly 90%.

This hospital is not alone in facing challenges with patient safety and falls due to labor shortages and escalating costs. It is well established that virtual sitting is superior to one-to-one sitting for patient safety and fall prevention. As virtual sitters can monitor up to 12 patients simultaneously, they also significantly reduce costs compared to dedicated staff at each bedside.

Reducing the Persistent Problem of Patient Falls

Several years ago, inpatient falls became a care improvement focus for VA North Texas as they were expending a significant amount of nursing resources on one-to-one sitters while still experiencing high fall rates.

Falls are costly. Patients injured in falls often require additional treatment and prolonged hospital stays. A recent 8-hospital analysis of over 10,000 patients falls cited by JAMA showed that a fall with any injury is associated with a cost increase of $36,776 and doubles the length of stay.

VA North Texas implemented a virtual sitting program with 2-way video and audio capabilities to connect in-room patients to virtual caregivers. At the heart of the program is a centralized monitoring hub featuring 4 virtual safety attendants who can oversee a total of 48 cameras to reduce patient falls.

An important aspect of virtual sitting is assessing patients individually to determine whether virtual sitting will meet their needs. Conditions that are typically well served by virtual sitters include general safety concerns, such as drug or alcohol withdrawal, confusion, agitation, and elopement risk; failure to follow safety instructions, such as leaving the unit without notifying staff; and high fall risk.

Results: Lower Staff Costs, Fewer falls

Since VA North Texas adopted its virtual sitting program, the health system has freed up front-line staff for direct patient care, an important improvement to overall care delivery and staff satisfaction. By decreasing 1:1 sitter usage, the program allows for better staffing and resource utilization for the entire facility, saving an average of 83 full-time equivalents per month–an annual savings of $3.4 million.

The virtual sitting program enables caregivers in the centralized monitoring hub to have eyes on 12 patients at a time, a huge efficiency gain over one-to-one sitting. As a result of the gains, VA North Texas now has costs of $3.05 per virtual sitting hour, as opposed to an average of $26 per hour for one-to-one sitters–a savings of nearly 90%. Costs are inclusive of both the staffing and technology.

Additionally, fall rates have decreased almost 20% throughout the project. They are now at a fall rate of 1.7/1000 patient days, well below national averages of 3-5/1000 patient days. Shortly, VA North Texas plans to expand the program to the Emergency Department and the mental health department to prevent workplace violence and keep suicidal veterans safer.

For health systems, one-to-one sitters represent a costly drain on resources that do little to improve patient safety. With virtual sitting, health systems such as VA North Texas have created better patient outcomes while delivering staff cost savings that can be invested back into direct patient care.

About the Author

Lisbeth Votruba, MSN, RN, is a third-generation nurse with decades of experience working with intelligent virtual care systems, and is the chief clinical officer of AvaSure.