The authors conducted a national survey of 355 general medical/surgical hos
pitals to assess constant observation (CO) practices. The authors assessed
overall use, expense, staffing patterns, funding strategies, and cost-savin
g interventions. Virtually all responding hospitals (N=102) reported using
some form of CO. Several hospitals reported significant decreases in CO exp
enditures after the implementation of cost-saving interventions (the larges
t annual decrease reported was $340,000). Cost-saving interventions include
d utilizing consolidated bed spaces, relocating patients near nursing stati
ons, placing at-risk patients in bed enclosure devices, and regularly assis
ting patients to the toilet. In addition, less costly personnel were hip-ed
, and volunteers and/or patient family members provided CO (or were require
d to assist with the cost of CO). Finally, hospital staff were educated abo
ut the costs and the appropriate use of CO. They were also taught to recogn
ize and effectively treat delirium.