Patient safety remains a strategic goal and of societal importance for better health care. Direct observation remains an ineffective and expensive means of providing for patient safety. The nursing quality team found that using assessment tools helped to objectively categorize which patients are at risk. Defining patient volume, actual productive sitter usage, and assessing demand for patients in psychiatric crisis and patients at high risk to fall in the form of average daily census provided an easy-to-translate, familiar unit of measure to compare patient volume to demand and utilization. The sitter utilization case was unable to provide correlation of sitter use to decreased fall rates, elopement, or assault behaviors. Currently, there is no research to suggest the use of constant observation reduces the risk of patient harm related to their risk for falling or harming themselves.