The Problem

A large 400 bed community-owned, academic, medical center in West Texas with 15,465 discharges and 98,972 inpatient days was spending nearly $1.5M per year on sitters. While the patient population has become more acute and complex, the expense of sitters needed to be reduced. We collaborated on a solution to reduce the medical center’s sitter usage without negatively affecting patient safety or increasing patient fall rates.

The Solution

We utilized a human-centered design approach to create collaboration among teams over the course of several months via design sprints. An interdisciplinary team was created to ensure that there was adequate representation including various levels of the organization. This group was convened several times to review data, map the current state, determine success metrics and to collaborate on innovating new processes and designing a new future state for the sitter approval process. This was intended to provide a structure so that patients who required sitters to ensure a safe environment received sitters, and patients who could be safely managed through other means were able to be safely cared for without the use of sitters. The process resulted in small scale pilots which were championed by various group members.

The Results

These small scale pilots had several desirable results, first an annual cost-avoidance of over $275,000. Additionally, there was an increase in documentation compliance with the sitter screening tool which increased from 40% to 85%. Most notably, the fall rate actually decreased as sitter usage decreased from a rate of 1.4 to 1.15. This surprised several of the group members who were concerned that decreasing sitter usage would lead to an increase in falls. After testing a few models the organization adopted a standardized approach which was rolled out across all of the inpatient units which have contributed to the reduction in sitter expense, a safer patient environment and refocused the effort on the part of the care team without adding more work.

About Innovation Advantage

Dr. Bonnie Clipper founded Innovation Advantage, a healthcare innovation consultancy, after more than 20 years as a chief nurse executive. Her unique expertise was developed as a result of her work in the RWJF Executive Nurse Fellowship and hard-wired as an ASU/AONL Executive Fellow in Innovative Health Leadership. She is a trailblazer and was the first Vice President of Innovation at the American Nurses Association, where she created an innovation strategy to bring over 4M nurses into the innovation space.

As an internationally recognized nurse futurist, she was a co-author of the seminal work, The Innovation Roadmap: A Nurse Leader’s Guide and was the lead author of the International Best-Selling book, The Nurse’s Guide to Innovation. She publishes and blogs regularly on technologies impacting nursing. Her unique understanding of operations, strategy, workforce, and technology make her the perfect bridge-builder to create new workflows and processes to ensure that technology improves care and experiences for everyone.