UVM Medical Center changed its policy on patient observation. Some staff worry about patient safety.

In June, UVM Medical Center quietly rolled out a new policy dictating how its staff watch over patients who are at risk of hurting themselves while they’re in the hospital.

Sitters, or clinical patient safety attendants — CPSAs — stay with patients who need supervision. Patients who might fall, wander or pull out IVs are often assigned sitters, as are those who are at highly suicidal or epileptic. Often, licensed nursing assistants fill this role, too.

But, a new hospital policy limits LNAs from filling the role, Annie Mackin spokesperson for UVMMC told VTDigger.

The change is to keep LNAs staffed on more “direct” patient care needs, Mackin wrote.

Instead, the hospital is prioritizing remote patient monitoring — essentially, a video monitor on wheels connected to a remote observer watching many patients at once — or dispatching designated observation staff, not LNAs, when necessary.

But staff are concerned about the gaps left by that system.

“There have been patients that I personally thought, ‘I don’t feel safe having this patient in my assignment without a CPSA with them,’ ” Saer McCliment, an LNA at the medical center, told VTDigger.

Previously, an LNA could fill in as a sitter as part of their regular duties, which are under the supervision of a nurse and include much of a patient’s daily living care.

“Lately, not only has that really not been available, but we’ve been told that there are only allowed to be a specific number of CPSAs working in the hospital at any one time,” McCliment said.

The hospital now staffs 17 CSPAs each shift for all 14 inpatient units and the emergency department, according to Brett Rhodes, another UVMMC LNA. His floor alone can need up to five CSPAs at a given time, he said.

Remote monitoring doesn’t work for many of the patients who need it, they said, adding that many of the patients at risk of pulling out IVs or wandering off are experiencing psychosis or dementia. Hearing a disembodied voice through a remote monitor’s video screen can exacerbate those patients’ paranoia and confusion.

“That’s just not safe or fair for them,” McCliment said.

On Aug. 20, representatives from two of the UVM Health network’s labor unions sent a cease and desist letter to the network’s labor relations director, formally requesting the hospital pause the June changes to its observation policy. The change impedes the bargaining for new contracts both unions have been undergoing since April, the letter stated. The support staff union, which includes LNAs, has been working on an expired contract since mid-August.

The unions’ letter also detailed that if an LNA is pulled from their regular duties to provide patient observation, the hospital has not been able to fill in with additional LNAs to cover their tasks, resulting in a unit being short staffed

The authors also wrote that nurses’ input regarding remote observation and sitter practices are “reportedly no longer being appropriately considered and, in some cases, are being disregarded.”

Mackin stressed that the hospital is still assigning in-person sitters for some very high-risk patients. “Patient safety remains our top priority, and making workforce roles clear helps us use our resources efficiently while continuing to provide high-quality, affordable care,” she wrote.

The changes come as part of a sweeping series of expense cuts the UVM Health network, the medical center’s parent organization, is pushing in order to make ends meet as it faces dramatic drops in revenue largely due to a reduction in what it charges the state’s largest private insurer BlueCross BlueShield and a law prohibiting big markups on the price of pharmaceutical drugs.

The network expects to lose more than $14 million across the system in the coming fiscal year, which begins Oct. 1, according to its August budget presentation to the Green Mountain Care Board. UVM Medical Center is expected to operate at a $43 million loss.

Already, the network has proposed $140 million in cuts to expenses for the coming fiscal year, and still it needs to make more.

“We do recognize that current challenges may require us to implement operational changes more quickly and more frequently than employees and unions have historically experienced. We value the unions’ partnership as we navigate these challenges while recognizing the pace of change may be difficult at times for staff,” Mackin wrote in a statement. She added that the changes are within UVM Health’s “contractual authority to adjust staffing assignments.”

Staff worry that patients are facing the consequences of this change.

Rhodes said he knew of five incidents in which patient safety had been compromised because patients didn’t have an appropriate sitter. He worried that the lack of sitters means patients in the ICU may be overly sedated in order to avoid worse complications.

“This would never have been a problem before they instituted that policy,” he said. “They are rolling the dice on safety.”

Much of what LNAs do inherently guards against many basic safety risks, according to McCliment.

“We help patients get up to the bathroom. We help them bathe and dress. We help them eat all their meals and take vital signs, get ready for bed. We help them move around safely in bed and out of the bed in the hospital,” they said. “We’re the people that are physically in the room with the patients the most.”

Patients’ needs don’t decrease just because there are fewer staff, they said.

“Someone who needs to go to the bathroom won’t wait 15 minutes for you,” McCliment said. “They just get up and go. And if they need help walking, or if they’re a fall risk, they can fall, which is extremely serious.”

This story was originally published by VTDigger and distributed through a partnership with The Associated Press.