NURS 8210 Week 8 Technology Business Case Example

Watching More Patients With Fewer Chairs at the Bedside: A Business Case for Centralized Video Monitoring in Place of Routine One-to-One Sitters

Student Name

College of Nursing, Walden University

NURS 8210: Transforming Nursing and Healthcare Through Technology

Instructor Name

Month Day, Year

Watching More Patients With Fewer Chairs at the Bedside: A Business Case for Centralized Video Monitoring in Place of Routine One-to-One Sitters

Executive Summary

Request. Approval to pilot centralized video monitoring on two medical-surgical units at the network's largest hospital for twelve months, with a decision on wider use at month thirteen.

Recommendation. Option B, a two-unit pilot, is recommended over continuing current practice or a network-wide rollout. It tests whether video monitoring can safely replace a share of one-to-one sitter hours for patients at risk of falls or of pulling out lines, while limiting the network's exposure if it cannot.

What success looks like. Fewer sitter hours on the pilot units with no increase in falls with injury, and a monitoring technician workload that stays within a stated ratio. Stop criteria are set in advance.

Decision needed. Approval of pilot funding and of the measures and stop criteria in this case, by the end of the current budget quarter.

The Problem in Organizational Terms

Across the composite four-hospital network, patients with delirium, dementia or impulsive behavior who are at risk of falling or of removing lines and tubes are commonly assigned a one-to-one sitter, usually a nursing assistant who stays in the room for the shift. Sitter hours have grown each year, and they are drawn from the same pool of assistants who help bedside nurses with bathing, turning and mobility. When sitter orders rise, units lose assistants to other work, and the requests go unfilled on the nights they are needed most.

The evidence that sitters themselves prevent falls is thin. A systematic review found very low-certainty evidence that adding sitters to usual care reduced falls, and moderate-certainty evidence that interventions including video monitoring reduced sitter use while either not affecting or reducing falls (Greeley et al., 2020). The network is therefore spending heavily on a practice of uncertain benefit, while an alternative has some evidence of maintaining safety at lower use of staff.

Options Considered

Three options were compared.

Table 1

Options Compared

Option B is recommended because published results come mostly from single-site studies, and the network needs its own evidence on falls and technician workload before committing capital across four hospitals.

How the Program Would Work

Portable or fixed cameras with two-way audio would be placed in the rooms of eligible patients. Trained monitoring technicians in a central station would each watch a set number of patients and speak to a patient who begins to climb out of bed or pull at a line, while alerting the unit to send staff. A sitter decision protocol, used by the charge nurse at each sitter request, would determine whether a patient is suitable for video monitoring or still needs a person at the bedside, for example a patient at risk of self-harm. Published programs have combined video monitoring with such a nurse-driven protocol and administrative oversight of sitter use (Burtson & Vento, 2015), and hospitals using centralized monitoring for high fall-risk patients have described it as feasible within acute care workflows (Sand-Jecklin et al., 2016; Cournan et al., 2018).

Total Cost of Ownership

Table 2 lists each cost category. Values are left for finance to supply from vendor quotes and the network's labor rates, so that the case does not rest on invented figures. The sensitivity column marks the assumptions most likely to change the answer.

Table 2

Cost Model Categories for the Two-Unit Pilot

The two high-sensitivity assumptions, the technician ratio and the share of sitter requests that can move to video, should be varied in finance's model to show the range of outcomes.

Benefits

The case separates measurable benefits from strategic ones. Measurable benefits include fewer sitter hours on the pilot units, assistants returned to direct care, and falls with injury held level or reduced. One published program reported a substantial return on investment over two years, but it was a single hospital with its own labor costs, so the network should not assume the same result (Burtson & Vento, 2015). Strategic benefits are harder to price: less dependence on a strained assistant workforce, a central station that could later support other monitoring, and a more consistent approach to sitter requests through the protocol.

Measures and Stop Criteria

The pilot would track four measures monthly on the pilot units and two comparison units: sitter hours and injurious falls, each expressed per thousand patient days, the number of patients per technician on each shift and the share of sitter requests reviewed with the protocol. Stop criteria are declared now. If falls with injury on the pilot units rise above their prior-year level for three consecutive months, or if technicians are routinely assigned more patients than the agreed ratio, the pilot pauses for review. The network should also watch for patients who were moved to video monitoring but needed a person at the bedside, recorded as incident reports.

Risks

Four risks are named. Patient and family acceptance: some families may object to a camera, so the program needs a clear script and an opt-out route. Privacy: cameras must not record, and screens must not be visible to passers-by. Technician workload: a technician watching too many patients will miss events, which is why the ratio is a stop criterion. Response time: video monitoring only works if staff can reach the room quickly when the technician calls, which depends on unit staffing, not on the camera.

Conclusion

The network is spending more each year on a practice whose benefit is uncertain, while taking assistants away from other care. Video monitoring offers a plausible alternative, supported by moderate-certainty evidence for reducing sitter use without increasing falls. A two-unit pilot with a full cost model, declared measures and stop criteria gives the executive team a low-risk way to find out whether that evidence holds here.

References

Burtson, P. L., & Vento, L. (2015). Sitter reduction through mobile video monitoring. Journal of Nursing Administration, 45(7/8), 363-369. https://doi.org/10.1097/NNA.0000000000000216

Cournan, M., Fusco-Gessick, B., & Wright, L. (2018). Improving patient safety through video monitoring. Rehabilitation Nursing, 43(2), 111-115. https://doi.org/10.1002/rnj.308

Greeley, A. M., Tanner, E. P., Mak, S., Begashaw, M. M., Miake-Lye, I. M., & Shekelle, P. G. (2020). Sitters as a patient safety strategy to reduce hospital falls: A systematic review. Annals of Internal Medicine, 172(5), 317-324. https://doi.org/10.7326/M19-2628

Sand-Jecklin, K., Johnson, J. R., & Tylka, S. (2016). Protecting patient safety: Can video monitoring prevent falls in high-risk patient populations? Journal of Nursing Care Quality, 31(2), 131-138. https://doi.org/10.1097/NCQ.0000000000000163