Optimizing Inpatient Observer Care

Providing observer care to patients is challenging and costly for hospitals. A team of nursing leaders and clinicians at Massachusetts General Hospital deployed process improvement strategies to improve the clinical model for patient observation. The model aimed to provide unit staff with a standardized strategy for allocating resources and maintaining patient safety. The model was applied first in a surgical trauma unit where the team identified patients with delirium as the group requiring specific interventions.

Applying the patient observer plan in a pilot in 2013 resulted in a 46% decrease in the median hours of direct care, from 208 to 112 hours per week. Staff satisfaction of the patient observer model increased from 9% to 72% and the associated-costs remained unchanged. No increase in patient falls occurred following the implementation of the new program. Optimizing the management of patients with at-risk behaviors decreased the number of direct-care hours and increased staff engagement at no additional cost to the unit and with no increase in inpatient falls.


Rachh P, Wilkins G, Capodilupo TA, et al. Redesigning the patient observer model to achieve increased efficiency and staff engagement on a surgical trauma inpatient unit. Jt Comm J Qual Patient Saf. 2016;42(2):77-85.

Posted in Applied Research