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Virtual Sitter Program Helps Bedside Nurses Monitor Patients

COVID-19 led to health care staffing shortages, and bedside nurses have felt the strain. Many bedside nurses share too few in-room sitters, even as their patient loads have increased. This made it harder to adequately monitor patients and prevent falls or self-harm – especially when there are multiple high-risk patients on a unit.

Technology may be able to help. UAB Nursing leadership and Health System Information Services (HSIS) rolled out a Virtual Sitter program that enables a single sitter to monitor up to 12 patients, allowing bedside nurses to work more efficiently and focus on clinical care.

Nationwide, the number of lower-wage health care technicians dropped the most among health care professions during the peak of the COVID-19 pandemic, and their relative employment numbers have recovered the slowest. The limited number of patient care technicians (PCTs), nursing assistants, and other support staff has been felt by bedside nurses and charge nurses across UAB Medicine.

“Most of the time, a 36-bed unit might be reasonably monitored by two to four PCTs and six or seven nurses, but it only takes a few high-fall-risk patients to upset the balance,” says Tele-ICU Nurse Manager Paul Malito, RN, MHA, BSN. “Take away just one PCT for in-room monitoring and you are shifting multiple time-consuming tasks per patient to a bedside nurse. A nurse may then have to borrow a sitter from another part of the hospital, and the stress quickly multiplies.”

Malito and Terri Scarborough, senior director of Nursing, saw an opportunity to use technology to restore some balance in UAB Medicine’s Tele-ICU and Tele-Acute Nursing units. HSIS helped them implement the Virtual Sitter solution, by which audio-visual technology is used to make beside care more efficient.

How It Works

Through the Virtual Sitter program, a specially trained sitter remotely watches patients who are most likely to fall or otherwise harm themselves, and these sitters can quickly communicate with charge nurses to have those patients temporarily watched in person as necessary.

“It is frustrating when the whole unit is overworked because, for instance, a patient recovering from anesthesia is momentarily out of sorts and needs to be told to sit back down several times — and that happens regularly,” Scarborough says. “Nurses may be understandably hesitant to request a sitter and instead bear the burden of those types of patients who just need an extra set of eyes on them. This Virtual Sitter is that extra set of eyes – 12 extra sets.”

Malito says Virtual Sitters can reduce falls by up to 30%, and that’s why such programs are rapidly becoming part of the standard of care at high-performing hospitals, along with tele-ICU and tele-acute nursing units.

“It’s important for nurses to know that this is a positive innovation, in that we aren’t taking away current capacities but instead are making them more efficient,” Malito says.

Program Rollout

Rolled out in September and facilitated by HSIS, the Virtual Sitter program currently is able to watch 12 patients around the clock. Scarborough expects that figure to grow, however, because 256 UAB Medicine rooms already are wired with the technology that enables Tele-ICU and Tele-Acute Nursing services, and it can be used for virtual sitting, too.

Carts are available for rooms that are not wired. Three carts currently operate at UAB Hospital, with another three at UAB Hospital-Highlands, but 36 will be available within the next several months. The equipment gives sitters the ability to observe and interact with patients via audio and/or video and sound an in-room alarm when necessary.

The sitters are trained and managed by Malito’s team. At the beginning of every sitting session, virtual sitters introduce themselves to the patient, and they receive details from the nurses and make notes about what each patient is allowed to do safely. The sitters are required to take a break every two hours to prevent fatigue. Data specialists with the Tele-Acute and Tele-ICU Nursing units have been cross-trained to back up the sitters.

As patients’ conditions change, they may alternate between having an in-room sitter and Virtual Sitter. If a Virtual Sitter needs to sound the alarm three times in 30 minutes, the patient is referred back to the Resource Management Center (RMC) for an in-room sitter. Open communication among Virtual Sitters, RMC, and the assistant nurse manager is important for seamless care.

Nurse-Driven Effort

One goal of the rollout is learning which patients are well-suited for Virtual Sitter. As nurses start using the program, they may call upon Virtual Sitter in cases where they previously might not have considered a sitter at all. Scarborough says the program is well-suited for older patients who can respond to redirection but may become confused occasionally. “They may forget they are at the hospital and decide to hop up or instinctively pull at a line or tube,” she says.

The Virtual Sitter also could relieve an in-room sitter in the case of a violent patient who otherwise would require two people in the room at all times. “We can now place one sitter outside of the room safely and allow the Virtual Sitter to be the in-room presence,” Malito says.

The existing process for requesting a sitter will not change, but Scarborough says nurses can tell the RMC if a Virtual Sitter might suffice. Malito and Scarborough encourage nurses to take the lead on calling for virtual sitting as they feel they need it, either by notifying the RMC or calling the Tele-ICU Operations Center.

“Nurses can really take an interest and help shape this program,” Malito says. “The entire acute care network should expect Virtual Sitters to become more available to them in the coming months.”

If you have questions or feedback about Virtual Sitters, please email Paul Malito at pdmalito@uabmc.edu.