NUR 5820 Module 6 Business Case Example

Video Monitoring Instead of Some Sitters: A Business Case for the Medical-Surgical Division with Costs, Payback and a Recommendation

Student Name

Master of Science in Nursing (MSN), Thomas Edison State University

NUR-5820: Financial Management in Nursing Practice

Mentor Name

Month Day, Year

Video Monitoring Instead of Some Sitters: A Business Case for the Medical-Surgical Division with Costs, Payback and a Recommendation

Executive Summary

The medical-surgical division, which includes our telemetry unit and three other adult units, used 21,600 hours of one-to-one sitter observation last year at a cost of about $625,000. Most sitters watch patients at high risk of falling or of pulling out lines because of delirium or dementia. This business case proposes a centralized video monitoring system covering up to twelve patients at a time, staffed around the clock by trained monitor technicians who can speak to patients through a two-way camera and alert the unit. Assuming video replaces 60% of sitter hours, the division would spend about $40,000 a year less than it does now, recover the $96,000 equipment cost in about a year and a half, and likely reduce falls. The recommendation is to approve the system, with a twelve-month evaluation and clear criteria for which patients still need an in-person sitter.

The Problem

Sitter use has grown each year. Earlier analysis of the telemetry unit's January budget found that 410 sitter hours in a single month created most of the unit's unfavorable quantity variance. Across the division, sitter requests often cannot be filled, so charge nurses pull technicians from their assignments, leaving other patients with less help. Patients who fall suffer harm, and falls also add cost. Pappas (2008) used patient-level cost records at one hospital to price complications that nursing care can prevent, and urged that they be followed unit by unit when staffing is planned. Falls are among the events our division tracks, and last year's rate on the four units remained above the hospital's target.

Options Considered

Three options were considered. Option A is the current practice: in-person sitters for every patient who meets observation criteria. Option B adds centralized video monitoring for patients whose main risk is falling or wandering, while keeping in-person sitters for patients at risk of suicide or violence, patients who need hands-on redirection and any patient the nurse judges unsafe for video. Option C would replace sitters with bed and chair alarms alone. Option C was rejected early: alarms alert staff only after the patient has begun to move, contribute to alarm fatigue and do not allow anyone to speak to the patient, so they cannot substitute for observation.

Under both options, the charge nurse remains responsible for deciding which patients need observation. A short screening tool, completed at admission and each shift, will guide that decision: patients at high risk of falling or wandering without self-harm risk are candidates for video; patients at risk of suicide, those who are violent and those who repeatedly attempt to remove critical devices need an in-person sitter.

Costs and Savings

The table compares the annual cost of Options A and B. Sitter hours are priced at the fully loaded patient care technician rate of $28.94 an hour. Video monitor technicians are priced at $30.32 an hour, the monitor technician rate with differentials and benefits, and staffing one station around the clock requires 9,955 paid hours. The equipment, including twelve portable cameras, a monitoring station and installation, costs $96,000 and is depreciated over five years. Annual software and maintenance is $14,000.

On these assumptions, Option B costs $585,007 a year compared with $625,061 for Option A, a difference of about $40,000. On a cash basis, before depreciation, annual operating savings are about $59,300, so the equipment pays for itself in about 1.6 years.

Not every saving is captured in the table. Patient care technicians released from sitter assignments return to their usual work, which supports the unit's own hours per patient day standard and reduces the quantity variances described in the earlier variance analysis. That benefit is real but is not counted, so the estimate is conservative.

Evidence on Effectiveness

The financial case would mean little if video monitoring were less safe. Evidence is encouraging, though mostly from before-and-after studies. Sosa et al. (2024) compared 9,034 patients at high risk of falls at one academic center over eleven months before and eleven months after adding two-way video monitoring to in-person sitters. Fall rates fell from 3.5% to 2.7%, and after adjustment, admission in the video period cut the odds of a fall roughly in half. Patients who fell had a median adjusted hospital cost of $1,969 more than those who did not, and the authors estimated annual savings of more than $800,000 for a similar hospital. Sand-Jecklin et al. (2016) described implementing centralized video monitoring for high-risk patients on several units and discussed its feasibility and practical demands, including technician training and criteria for which patients are suitable. Neither design proves cause, so our evaluation must measure falls carefully.

Sensitivity and Risks

The case depends on how many sitter hours video can replace. The break-even point, where Option B costs the same as Option A, is about 54% replacement. If only 40% of hours were replaced, Option B would cost about $85,000 more a year than current practice; at 75%, it would save about $134,000. Avoided falls would add to savings: if the system prevented ten falls a year, the direct cost avoided at the Sosa et al. (2024) estimate would be about $20,000, before counting injuries or longer stays. Other risks include patient and family concerns about privacy, which require clear consent and signage; technicians overwhelmed by too many feeds; and nurses relying on video for patients who need hands-on care. These will be managed with a maximum of twelve feeds per technician, written patient selection criteria reviewed by the charge nurse each shift and a policy that any nurse may request an in-person sitter without approval.

Recommendation and Evaluation

The division should approve Option B. Implementation would begin on the telemetry unit and one medical unit, then extend to the other two after three months. The evaluation will track monthly sitter hours and cost, video hours, fall and injury-fall rates per thousand patient days, line removals, unfilled sitter requests and staff and family feedback. If at twelve months sitter replacement is below 54% or fall rates have risen, the division will revise patient selection or return to the previous model. The proposal is made first for safety, and on these figures it should also save money.

References

Pappas, S. H. (2008). The cost of nurse-sensitive adverse events. JONA: The Journal of Nursing Administration, 38(5), 230-236. https://doi.org/10.1097/01.nna.0000312770.19481.ce

Sand-Jecklin, K., Johnson, J. R., & Tylka, S. (2016). Protecting patient safety: Can video monitoring prevent falls in high-risk patient populations? Journal of Nursing Care Quality, 31(2), 131-138. https://doi.org/10.1097/ncq.0000000000000163

Sosa, M. A., Soares, M., Patel, S., Trujillo, K., Ashley, D., Smith, E., Shukla, B., Parekh, D., Ferreira, T., & Gershengorn, H. B. (2024). The impact of adding a 2-way video monitoring system on falls and costs for high-risk inpatients. Journal of Patient Safety, 20(3), 186-191. https://doi.org/10.1097/pts.0000000000001197