Watching without walls: a scoping review of electronic sitters for preventing falls and fall-related injuries among hospitalized patients

Background Falls are among the most frequent and costly adverse events in hospitals, and conventional one-to-one sitters are resource-intensive with uncertain effectiveness. Electronic sitters offer a scalable alternative, but their characteristics, outcomes, and implementation determinants remain poorly mapped. This scoping review synthesizes the literature on electronic sitters for preventing falls and fall-related injuries among hospitalized patients. Methods This scoping review followed established methodological and reporting guidelines. Five databases (CINAHL, Emcare, MEDLINE, Scopus, and Web of Science) and manual searches were conducted to identify studies published between January 2016 and July 2026, using the Population–Concept–Context framework to determine eligibility. Of 1,806 records identified, 25 studies met the inclusion criteria and were analyzed thematically. Results Electronic sitter technology platforms included Ocuvera, AvaSure systems, SMART AI Patient Sitter, Verso Vision, Oxehealth, Artisight-enabled virtual patient observation, Virtual Nurse, Epic Monitor systems, Uniden baby monitors, and continuous or remote video monitoring systems. Most systems used standard cameras with continuous, centralized, human-led observation; a minority incorporated AI-assisted detection. Monitoring ratios ranged from 6:1 to 15:1, with 11:1–15:1 reported most frequently, and one system's maximum technical capacity reaching 16:1. Among 22 studies reporting falls, significant reductions ranged from 25.1% to 79%, whereas injurious-fall reductions were significant in only four of ten studies. AI-augmented systems achieved 97.4%–98.4% detection sensitivity, and sitter hours declined by 10%–91%, with projected savings up to US$3.2 million. Facilitators included multidisciplinary governance, structured training, and eligibility algorithms integrated into electronic health records, while barriers included limited device supply, staff resistance, and technological limitations. Conclusion Electronic sitters represent a promising adjunct to conventional fall-prevention practice, offering potential—though inconsistently demonstrated—resource benefits rather than a clear cost-effectiveness advantage. Deployment must address existing implementation challenges and proceed safely and ethically.