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Systematic Review: One to One Observation

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One-to-One Observation: A Systematic Review

Prepared by:
Evidence Synthesis Program (ESP) Center West Los Angeles
VA Medical Center
Los Angeles, CA
Paul G. Shekelle, MD, PhD, Director

Recommended citation:
Shekelle PG, Greeley AM, Tanner EP, Mak SS, Begashaw MM, Miake-Lye IM, Beroes-Severin JM, One-to-One Observation: A Systematic Review. Washington, DC: Evidence Synthesis Program, Health Services Research and Development Service, Office of Research and Development, Department of Veterans Affairs. VA ESP Project #05-226; 2019.



Download PDF: Complete Report, Executive Summary, Report, Appendices

Introduction

Preventing adverse events in hospitalized patients is a priority goal of patient safety programs. In-facility falls and in-facility suicide are 2 priority conditions that are thought to be preventable. One-to-one sitters or constant observation is an intervention that has long been used, rooted in tradition: staff that are immediately at hand can help prevent a fall or redirect a patient from engaging in a harmful act. However, one-to-one sitters is a costly intervention, and evidence that it is effective is uncertain; hence, VA policymakers asked for an up-to-date review to inform policy and practice.

Key Questions

KQ1. What is the effectiveness of patient sitters (one-to-one observation, patient safety companions, etc) for reducing falls?

KQ2. What is the effectiveness of patient sitters (one-to-one observation, patient safety companions, etc) for reducing suicide or self-harm?

KQ3. What is the effectiveness of patient sitters (one-to-one observation, patient safety companions, etc) for reducing wandering?

KQ4. What is the cost-effectiveness of one-to-one observations compared to usual care for patients at risk of falls, suicide, or wandering?

See also

One-to-One Observation: Systematic Review (Management eBrief)

Greeley A, Tanner E, Mak S, et al. Sitters as a Patient Safety Strategy to Reduce Hospital Falls: A Systematic Review. Annals of Internal Medicine. 2020;172(5):317-324. DOI: 10.7326/M19-2628


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