Reducing sitter use in acute medicine while maintaining safety and quality

Abstract

Background and objective: Sitters are commonplace in acute care facilities throughout the country. Sitters are used to provide close observations and ensure safety for patients who are at risk for falls. These patients suffer from cognitive impairment, inability to follow instructions, and causing harm to themselves or others. The literature shows that one requirement for an effective sitter process is the use of an assessment tool. Sitter usage at the Louis Stokes Cleveland VA Medical Center (LSCVAMC) has escalated to the point that sitters are causing an overall shortage of nursing staff.  This shortage causes excessive overtime, staff burnout, and reduces the quality of patient care provided to non-sitter patients. The purpose of this case-control descriptive pilot study was to reduce sitter usage on an inpatient acute medicine unit, by implementing the Patient Attendant Assessment Tool (PAAT), without reducing patient safety and quality of patient care. The PAAT was developed and utilized by a Midwest hospital for data collection and to assess the need for sitters.

Methods: Patients were placed into the Pre- and Post-implementation cohorts, according to the order of their admission. Pre-interventional data was collected from the study group, using the Sitter Justification Form, the 24-hour nursing report and the electronic medical record. The intervention consisted of staff education on the use of a new tool, the PAAT. Following implementation of the tool, the data was collected and analyzed using the SPSS 20 for windows (SPSS.INC), over an 8-month period.

Results and conclusions: Sitter usage was reduced without reducing patient safety or quality of care, with the implementation of the PAAT. Among individuals having at least one sitter day, patients in the post intervention group, were less likely to have as many sitter shifts (n = 343, 58.0%) as compared to patients in the Pre-interventional group (n = 451, 75.9%) (Chi Square = 42.88; df = 1, p < .001). As can be seen, there was a significant decrease in the number of sitter shifts after the implementation of the PAAT, as compared to the pre-interventional group. There was a slight increase in the quality of patient care.