Mission pilots patient-observer system to reduce fall injuries

ON THE LOOKOUT: Noelle West, a certified nursing assistant at Mission, keeps watch over patients at risk of falling at the monitoring station. Photo by Clarke Morrison

With technology developed for the video gaming industry, Mission Health is piloting a groundbreaking observation system designed to prevent costly patient falls.

The Cerner Patient Observer allows technicians to watch vulnerable patients remotely, talk to them and call for help when they attempt to get out of bed and risk hurting themselves in a fall. “It’s a very unique project,” says Randy Burkert, manager of the Mission Health Center for Innovation, which spearheaded the effort.

A three-month study conducted in Mission Hospital’s neurosciences unit found that the average falls rate — as measured per 1,000 patient days of care — dropped from four per month to zero with the new system.

Burkert says hospital officials were introduced last year to a concept for a new technology utilizing a sensor found in Microsoft’s Xbox gaming system by Pionetechs, a software development company. Pionetechs partners with Cerner, Mission’s electronic medical records provider, he explains.

“They thought there could be applications within the health system,” Burkert says. “What was apparent was that this could be used to help with a common problem across the industry of patients falling while they’re in the hospital for other care.”

The Kinect sensor is a key component, he adds. “It’s the actual camera,” Burkert says. “If you’re familiar with the gaming system, Xbox has this camera where you’re the controller and it’s monitoring your movement, and the video game developers create games that use your body to monitor what you see on the screen and interact that way. [Developers] took it and [created] something specifically for a health care application.”

Burkert says patient falls are a big and expensive problem. According to a study by The Joint Commission, which accredits health care organizations, a fall with injury costs an average of $14,000.

“The falls rate across the country is very high,” he says. “It’s bad for a lot of reasons. Nobody wants to come into the hospital, period, and when they do, for whatever they need, the last thing they want to do is experience a fall and then have more complications.”

With the help of the Cerner Patient Observer, one technician can monitor six or more patient rooms from a single remote station. The technician uses the system’s 3-D cameras and software to create “motion zones” around the patient’s bed or chair. When motion is detected in an alert zone, the system alerts the technician, who can quickly intervene and remotely redirect the patient through a two-way radio.

Noelle West is one of the certified nursing assistants at Mission assigned to the patient monitor. She’s on the lookout for patients who become agitated and look as if they might try to get out of bed. The new technology allows her to communicate with them to find out if they need assistance. Many times just asking the patient to stay in bed does the trick, she says.

“Our core focus is looking at falls and fall prevention,” West explains. “If they are reaching for the rail, if they act like they’re agitated or looking for something, it’s really helpful to be able to talk into their room and the patient be aware that there is somebody there to help them or they’re on their way.

“Nursing staff is really becoming dependent on this. They’re relying on an extra set of eyes,” she continues. “We don’t want patients to fall. … It [also] helps because the family can go home and be assured that somebody is with their mom or their dad. I think it’s going to improve this nursing unit and other units.”

Josh Lewis, nurse manager for the neurosciences unit at Mission, says the ability to interact directly with the patient is crucial.

“If the monitor tech detects some behavior that we might consider unsafe, nine times out of 10, they can talk to the patient and de-escalate that behavior,” he says. “They can also simultaneously call a CNA or an RN to go straight to the room and intervene if necessary. I think it’s worked really well. It’s a unique, innovative way to deal with a problem that every hospital is challenged with. None of us wants a patient to become injured while they are under our care, but nobody has the resources to keep one-on-one caregivers at the bedside at all times. So this is a nice way to deal with that.”

In the study, the neurosciences clinical team developed a fall-risk algorithm to identify the highest-risk patients admitted to the unit. Patients meeting specific criteria and identified as candidates were informed of the new technology and monitored during their stay.

With six cameras operating during the three-month pilot study, Mission staff monitored 8,615 patient hours. That’s the equivalent of $103,380 in one-to-one sitter costs that were avoided by use of the observer system.

Burkert notes that the Cerner Patient Observer doesn’t retain a digital record of patients.

“What we are doing is live video streaming,” he says. “We are not recording anything that the patient’s doing. We are not capturing video and storing it somewhere. The intention is to have that live video interaction with the patient as needed.”

Mission is working to expand the technology, with a goal of having 72 cameras in patient rooms this summer, Burkert says.

“This is a technology we could deploy in our regional hospitals and have it all monitored from a central location on the Mission campus,” he says.

Burkert believes the Cerner Patient Observer is breaking new ground when it comes to preventing patient falls.

“There are technologies at other health systems that are similar but not quite the same,” he says. “I think the technology that we are demonstrating here, in particular with the functionality with the 3-D camera and the depth sensing as well as the advanced alerting, is unlike what any other health system has. It’s a product that we hope will become commonplace one day in the health care setting.”

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