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Patient sitters are a somewhat controversial strategy for reducing patient falls, with many administrators arguing that the cost of paying someone to sit in a room and watch a patient all day cannot be justified. A recent study, however, suggests that patient sitters can be cost effective and significantly reduce falls.
The cost savings achieved in decreasing rates of falls with harm, both in terms of money saved and decreased severity of injury, might justify the costs associated with implementing and maintaining a sitter program, says lead author Michelle Feil, MSN, RN, senior patient safety analyst with the Pennsylvania Patient Safety Authority in Harrisburg. Feil and her co-author both have risk management backgrounds.
They analyzed data from 75 hospitals participating in the Hospital and Health System Association of Pennsylvania Hospital Engagement Network Falls Reduction and Prevention Collaboration.1 (The full study is available online at http://tinyurl.com/lyfw9tn.)
Their analysis revealed a statistically significant correlation between low rates of falls with harm and the use of sitter programs. A statistically significant correlation also was identified between low rates of falls with harm and three specific sitter program design elements: defining criteria for sitter qualifications, providing a training program for sitters, and establishing a pool of sitters.
Analysis of falls suggests that the use of sitters might be associated with a higher percentage of assisted falls and a lower rate of falls with harm, Feil explains. "The key is to have a pool of sitters and a process in place to make sure you are utilizing sitters appropriately," Feil says. "There has been research in the past that suggested sitters did not effectively reduce falls, but what they did not account for was who was in the role and whether they had specialized training. It takes time, money, and effort to implement these programs and to do it correctly."
Patient sitters also are sometimes called patient safety assistants, companions, and one-to-one or constant observers. In any case, they are staff members or volunteers assigned to provide direct observation of patients at risk to harm themselves or others.
One-on-one observation and assistance might seem like a surefire, if expensive, way to prevent falls. But Feil says research into the clinical effectiveness of sitter programs has produced inconsistent results. The cost-effectiveness of these programs is always in question, she says.
Feil’s research, however, found a statistically significant correlation between lower rates of falls with harm and the use of sitter programs, as well as specific sitter program design elements. The study also identified specific sitter program design elements that should be used to structure sitter programs. (See the story below for details on those elements.)
The data came from a state survey that was designed to evaluate the current structure and content of hospital falls prevention programs compared with evidence-based, best-practice guidelines. Hospitals were asked to report the level of implementation (no implementation, partial implementation, or full implementation) for individual falls prevention practices and falls prevention program elements across 17 categories of falls prevention practices.
The use of patient sitters was the third lowest scoring category of practices. Forty-eight of the 75 hospitals surveyed reported having sitter programs, of which 21 reported full implementation of six specific design elements of sitter programs.
"I think if cost were not an issue, more hospitals would have sitter programs, but cost is clearly an issue," Feil says. "But we can see that though it takes money to find these sitters, train them, and to pay them for their hours, a hospital also can suffer huge costs if there is a fall because a patient needed constant observation and you weren’t able to provide it."