Do Sitters Make a Difference?

February 1, 2012 | Healthcare Risk, Quality, & Safety Guidance


One-on-one continuous observation is a commonly used intervention to prevent patients from harming themselves or others when in the hospital. Generally, continuous observation is used for patients who have been deemed to have psychiatric issues or who are at a high risk of falling, eloping, or interfering with tubing or intravenous lines (Harding; MONE; Nadler-Moodie et al.). Other, more specific examples of patients who are typically assigned sitters are included inWho Gets a Sitter? In years past, chemical or physical restraints were often used to control these types of patients and prevent them from harm, but many organizations, including the Joint Commission, recommend very selective use of restraints; in turn, many facilities have used sitters in an attempt to mitigate the risks associated with these patients.

While it is estimated that almost all hospitals use sitters, there is little evidence that sitter use is effective in decreasing falls and other adverse events (Rochefort et al.). ECRI Institute PSO, a federally certified patient safety organization (PSO), has received reports of events, such as falls, that have occurred while sitters have been in patient rooms. Some studies have found marginal value in adding sitters (Boswell et al.; Cardell et al.), but many others have identified negative or inconclusive results related to sitter use (Harding; MONE; Salamon and Lennon; Tzeng et al.).

In addition to the fact that they may offer only limited value, sitter programs have been shown to be expensive for facilities to run. As such, many organizations have debated whether such programs are worthwhile, especially in light of the lack of evidence that they are useful. An in-depth look at issues surrounding patient-sitter programs for continuous observation is detailed below.

Many hospitals look at the facility’s internal processes to identify value, both financially and in terms of patient or worker benefit, when determining how to cut costs. Constant observation sometimes falls onto...

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