Managing Eating Disorders on a General Pediatrics Unit: A Centralized Video Monitoring Pilot

Patient Characteristics and Supervision Costs

The study included 37 consecutive admissions (NA = 23 and CVM = 14) with 35 unique patients. Patients were female, primarily non-Hispanic White, and privately insured (Table 1). Median supervision cost for the NA was statistically significantly more expensive at $4,104/admission versus $1,166/admission for CVM (P < .001, Table 2).

Balancing Measures, Acceptability, and Feasibility

Mean LOS was 11.7 days for NA and 9.8 days for CVM (P = .27; Table 2). The mean number of days to weight gain was 3.1 and 3.6 days, respectively (P = .28). No patients converted from CVM to NA supervision. One patient with SI converted to CVM after SI resolved and two patients required ongoing NA supervision due to continued SI. There were no reported refusals, technology failures, or unplanned discontinuations of CVM. One patient/family reported excessive CVM redirection of behavior.

This is the first description of CVM use in adolescent patients or patients with eating disorders. Our results suggest that CVM appears feasible and less costly in this population than one-to-one NA supervision, without statistically significant differences in LOS or time to weight gain. Patients with CVM with any NA supervision (except mealtime alone) were analyzed in the CVM group; therefore, this study may underestimate cost savings from CVM supervision. This innovative use of CVM may represent an opportunity for hospitals to repurpose monitoring technology for more efficient supervision of patients with eating disorders.

This pediatric pilot study adds to the growing body of literature in adult patients suggesting CVM supervision may be a feasible inpatient cost-reduction strategy.^9,10 One single-center study demonstrated that the use of CVM with adult inpatients led to fewer unsafe behaviors, eg, patient removal of intravenous catheters and oxygen therapy. Personnel savings exceeded the original investment cost of the monitor within one fiscal quarter.⁹ Results of another study suggest that CVM use with hospitalized adults who required supervision to prevent falls was associated with improved patient and family satisfaction.¹⁴ In the absence of a gold standard for supervision of patients hospitalized with eating disorders, CVM technology is a tool that may balance cost, care quality, and patient experience. Given the upfront investment in CVM units, this technology may be most appropriate for institutions already using CVM for other inpatient indications.

Although our institutional cost of CVM use was similar to that reported by other institutions,^11,15 the single-center design of this pilot study limits the generalizability of our findings. Unadjusted results of this observational study may be confounded by indication bias. As this was a pilot study, it was powered to detect a clinically significant difference in cost between NA and CVM supervision. While statistically significant differences were not seen in LOS or weight gain, this pilot study was not powered to detect potential differences or to adjust for all potential confounders (eg, other mental health conditions or comorbidities, eating disorder type, previous hospitalizations). Future studies should include these considerations in estimating sample sizes. The ability to conduct a robust cost-effectiveness analysis was also limited by cost data availability and reliance on staffing assumptions to calculate supervision costs. However, these findings will be important for valid effect size estimates for future interventional studies that rigorously evaluate CVM effectiveness and safety. Patients and families were not formally surveyed about their experiences with CVM, and the patient and family experience is another important outcome to consider in future studies.