Benefis Health System in Great Falls, Mont., has bucked the trend of nonprofit health systems. Its operating margin has been solidly in the black since 2002 and achieved this despite a heavy reliance on government payment, which accounts for 76 percent of its payer mix. Benefis is one of the few health systems in the nation to break even on Medicare, which it first achieved in 2012 and has maintained ever since. These efforts have led to $400 million in reinvestment in the health system. Terry Olinger, president of Benefis' Acute Care Group, describes one such investment, which has paid off in terms of better patient safety and reduced costs.
Question: In 2015, you identified patient sitters as a problem Benefis needed to solve. What is that problem?
Terry Olinger: Part of our financial success is due to a focus on productivity. Each year we set a goal for cost reduction, and we know where the big opportunities are. In 2015 this led us to a focus on sitters and falls. We were averaging about six sitters per day, the cost of which can add up quickly. To cover a single patient room using a nurse assistant at $15 per hour costs $360 per day, $2,500 a week and $131,000 a year. Our nursing leaders would routinely cite the costs of sitters as a reason for missing their productivity targets. At the same time, we also had concerns about our high fall rate; in 2015, we had a total of 259 falls, of which 49 involved an injury.
Q: So what was the solution?
TO: We had heard about video monitoring of at-risk patients, so we did some research in clinical journals and trade publications like Becker's. So we contacted AvaSure, the vendor, and arranged to go see its AvaSys TeleSitter Solution in action at Sacred Heart Medical Center in Spokane, Wash. We knew that Sacred Heart's parent system, Providence Health & Services in Renton, Wash., had gone all in on the system, so we wanted to find out what it could do for us. The premise is simple. One technician in a remote station can watch as many as 12 patients simultaneously on a large, split-screen video monitor, with the ability to directly intervene through two-way audio if a patient begins to engage in risky behavior. Frankly, I was skeptical about the system. Would a patient with delirium or just coming off of anesthesia somehow react positively to a disembodied voice telling him to stay put? But here's the thing: It just works, and in fact the nature of the voice being disembodied has a soothing aspect, and does halt the patient long enough for help to arrive.
Q: So you were sold, what came next?
TO: Our immediate, back-of-the-envelope calculation found that for a modest investment of around $250,000, we could purchase six of the room units and replace six sitters with one monitor tech. Together with a modest reduction in falls, we could anticipate the system paying for itself in a couple of months. We wound up purchasing 12 of the units. The system can be a mobile cart, a permanent in-ceiling fixture or a semi-portable wall-mounted device. We opted for the less expensive wall mount, which can be moved around, but the mounting device must be in each room you use it in. The other costs are for software to connect the signal from the room unit to the monitoring station and additional software that allows for data collection on utilization and monitor tech performance evaluation. And it did pay for itself as quickly as we thought it would.
Q: What kind of clinical results are you seeing?
TO: We have seen far fewer falls, especially fewer falls with injury, which are now a third of what they were. And we are using it for a number of other purposes, including to protect staff from aggressive patients and visitors and for behavioral health — in particular suicide ideation. We used to have to have sitters with every suicide ideation patient, which could be a problem in terms of danger to the staff and a source of agitation for the patient. Now we have an eye — or a camera — on these at-risk patients. One additional feature I like is a Stat alert alarm that is sounded when audio intervention fails. It is a very loud alarm unlike any other in the environment, and an unmistakable trigger to staff for the need to start running. Our response time to the alarm nine seconds on average.
Q: What's next?
TO: We have since purchased additional units, and we see video monitoring use expanding to other care settings. It works, and it makes sense from both a patient safety and efficiency perspective.
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