At Presence Covenant Medical Center in Urbana, Ill., an elderly patient at risk of falling struggles to get out of bed. A certified nurse assistant 140 miles away watches the patient on a monitor, recognizes the danger and triggers a warning to attending staff. Down a hall from the patient, a nurse's phone sounds a special alarm.
The timely warning was through Remote Sitter, a proprietary monitoring system developed by Presence Health of Chicago. Tested at Covenant and expanded to three other Presence Health hospitals in Illinois earlier this year, the system has detected 161 potential falls and alerted hospital personnel without a mishap, said Laura Messineo of Presence Health.
Darlene Kate Mangaluz, a remote sitter at Presence Health's TeleHealth Center in suburban Chicago, monitors a patient at one of Presence Health's hospitals who is considered at risk for falls. Mangaluz can monitor as many as six patients in four hospitals.
Messineo is strategy and development system director at Presence Health's telehealth center in Bolingbrook, Ill., a suburb of Chicago. She said Remote Sitter currently allows Presence Health to monitor as many as 12 patients at a time at four of its hospitals. The health system plans to expand the service to all 12 of its hospitals in central and northern Illinois.
"This is a tool that allows us to provide the highest quality care and more effectively utilize our hospital clinicians," she said. "There never is a time when someone is not watching the patients."
Messineo said Remote Sitter frees hospitals from having to assign staff persons to sit full-time with patients who are determined to be at risk of falling. With the system, she said, hospitals can more effectively use floor nursing staff and reduce or eliminate the need to keep or call in a qualified employee on overtime to sit with a patient.
The hardware for Remote Sitter consists of customized telemedicine carts and two monitoring stations in the telehealth center in Bolingbrook. Each cart, about five feet tall, has a video screen, camera and sound system so that a staff person in Bolingbrook can converse with a patient in the hospital.
One monitoring station allows the certified nurse assistant to observe as many as six patients on one large screen. With the touch of a button, the sitter can speak to one patient exclusively. If the sitter believes there is a risk of a fall, she or he sends a special text message that rings the phones of three hospital staffers — the patient's attending nurse, a nurse assistant on the floor and a third person designated as the hospital-wide backup. "They know immediately that a patient might fall," Messineo said.
Messineo said the alarm sound is unique, meaning that the sitters in Bolingbrook also can pass along a nonemergency patient request &mdash a glass of water, for instance — without the risk that such messages might lead to alarm fatigue.
She said Presence Health now monitors an average of four persons at any time through Remote Sitter. The telehealth center staffs the two monitor stations as needed.
Hospital clinicians use their standard protocol for deciding whether a patient is at risk of falling, then decide whether Remote Sitter is an appropriate form of monitoring. They roll the telemedicine cart into the patient's room, explain the format to the patient and allow the monitor in Bolingbrook to make an introduction via the audio-video link. Patients also can see the monitoring person and initiate conversations.
In Bolingbrook, the remote sitters work 12-hour shifts with designated break times that always are covered by another trained co-worker. Monitors are prohibited from having their personal cell phones or any other devices or distractions while on duty, Messineo said.
She said when Presence Health tested the system at Covenant, "We logged 5,000 hours of monitoring in the pilot without any falls or any other adverse outcome."
In February and March, Presence Health expanded Remote Sitter to Presence Saint Joseph Hospital in Chicago, Presence Saint Francis Hospital in Evanston and Presence United Samaritans Medical Center in Danville.
Messineo said Presence Health developed the software for Remote Sitter with an outside vendor that has applied for a patent. She said Presence Health plans to offer Remote Sitter to other health systems once its proprietary status is confirmed.
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