Beyond constant observation: How H.A.L.O is scaling its ‘virtual sitter’

When a patient is at risk of a falling, pulling off their oxygen mask, or wandering off an inpatient unit, Canadian hospitals assign a “bedside sitter” to provide continuous one-to-one observation. Titles vary by organization – personal support worker (PSW), healthcare aide, clinical assistant or patient safety attendant – but the responsibilities are the same.

The role is a vital safety measure, and it has become a costly one since COVID. On a fully loaded basis, a sitter runs a hospital roughly $35 to $40 an hour.

Because the need for constant observation is rarely budgeted for, shifts are filled on overtime an estimated 25 to 40 percent of the time. It also may take several hours for the sitter to arrive.

H.A.L.O Inc. (“HALO”) offers hospitals a way to sustain the same level of patient safety without absorbing the high cost or waiting for someone to arrive. Rather than staffing one sitter for a single patient, HALO pairs its bedside device with a large team of trained ‘virtual safety observers’ who deliver continuous observation for roughly one-third the cost of a sitter on regular time. A single HALO observer can safely monitor up to 12 patients at once from company’s 24-7-365 virtual monitoring hub in downtown Toronto, supported by proprietary software that flags behavior putting a patient at risk of harm.

When a patient requires intervention, HALO’s virtual observer speaks to the patient through the device’s two way audio-video screen; if that is unsuccessful, the observer alerts the patient’s nurse directly on a dedicated HALO phone carried by the frontline staff.

HALO doesn’t replace nursing judgement. It gives nurses a second set of eyes that never leave the room and a direct line for the moment those eyes see something worrisome.

The approach was invented in Canada, for Canadians. HALO grew out of the thoracic surgery and pre-lung-transplant ward at University Health Network (UHN), where nurse practitioner Marijana Zubrinic – now HALO’s chief nursing executive – and Dr. Shaf Keshavjee – now HALO’s chief medical officer – built the first prototype in 2015.

The idea came from the bedside rather than a technology roadmap: from watching skilled teams stretched thin and safety events climb. A decade later, it has become a fully operational spin-out company purpose-built for Canada’s single-payer system.

Steady momentum across the Canadian marketplace: HALO now operates in 34 healthcare sites nationwide. At UHN, where HALO is deployed across roughly 50 inpatient units, the organization has saved an estimated $17 million over seven years and reduced the need for one-to-one constant observation by an average of 40 percent – capacity redirected to direct patient care.

At a hospital in Western Canada, HALO contributed to a 75 percent reduction in high-risk patient falls in its first year of use.

That evidence is driving adoption. Unity Health Toronto, Waterloo Regional Health Network, Niagara Health, Oak Valley Health, St. Joseph’s Healthcare Hamilton and Georgian Bay General Hospital have all signed on in the past year, and deployments at Sunnybrook Health Sciences Centre and Jewish General Hospital in Montreal are planned for late 2026.

A province-wide rollout in Newfoundland and Labrador supports 11 hospitals and six long-term care homes, where HALO has proven especially valuable in rural and remote communities that struggle to staff continuous in-person observation.

Beyond observation – HALO as a source of clinical intelligence: What sets HALO apart is not only the observation, but the documentation record the virtual safety observers create. Every patient redirection, every alert to nursing staff and every potential safety event flows through HALO’s platform, generating a continuous record of how a patient is doing.

Those analytics help organizations understand patient care needs, spot trends, and make better informed operational decisions.

At UHN, Unity Health Toronto and St. Joseph’s Healthcare Hamilton, HALO documents patient status in real-time directly in the patient’s electronic medical record, giving the care team visibility into what is happening at the bedside with no additional system to log into. The result is not a static log but a live window into how a patient is behaving over the course of a shift.

If a nurse can see in real-time that the virtual observer has needed to intervene with a patient less and less over successive shifts, that downward trend may signal the patient is improving and can be weaned off of constant observation sooner.

Nurses have always read those signals. What changes is that the trend is now documented and visible to the entire team, so the case for stepping down can be made with evidence rather than impressions passed along at handover. Multiplied across dozens of inpatient units, that helps hospitals direct observation resources to the patients who genuinely need them.

Over a two-study period at UHN, HALO’s virtual observers identified 54,716 safety concerns and managed more than 8,400 through two-way audio redirection alone – moments that might otherwise have pulled a nurse away from another patient mid-task.

For patients on high-flow oxygen, HALO observers identified thousands of desaturation events, prompting patients to reapply their oxygen masks and escalating to the nursing team.

The future of patient safety – from virtual sitter to virtual nurse: HALO’s ambitions extend beyond virtual constant observation. The company is now building on its platform with a solution purpose-built for virtual nursing. The target is not the hands-on work at the bedside, but the administrative load stacked on top of it.

Nurses spend a substantial share of every shift on documentation, admission paperwork, medication reconciliation and discharge teaching. It is necessary work, and it steadily draws on attention and time away from patients.

Virtual nursing addresses that load directly. A registered nurse working remotely – a colleague on the same team, holding the same license and the same professional accountability – takes on the tasks that do not require hands at the bedside. Picture a virtual nurse completing a patient’s discharge: walking them through their medication instructions, answering questions, confirming they understand their care plan, unhurried, while the bedside nurse attends to the patient who needs physical care.

Patient education, medication reconciliation and admission documentation can be supported the same way. The model does not reduce the bedside team. It returns to that team the hours of administrative work quietly consumes and lets nurses practice closer to their full scope.

The model is furthest along in the U.S. where virtual nursing now runs in hundreds of hospitals. Early adopters report shorter length of stay, faster discharges and relief from the capacity pressures that ripple across a hospital when bed flow slows down due to these administrative tasks.

HALO’s progress reflects a broader shift in Canadian healthcare toward centralized, data-driven models that support clinical teams without compromising safety. What began as one nurse’s response to a run of preventable safety events now spans 34 sites and addresses three of the healthcare system’s most urgent priorities: digital transformation, patient safety and sustainable staffing.

From an extra set of eyes at the bedside, to actionable intelligence in the hands of nurses, and now toward a future of virtual nursing, HALO is charting a path where technology does not replace clinical care but protects the time nurses have to deliver it.

For a healthcare system under real and sustained strain, that may prove to be exactly the kind of made-in-Canada innovation the moment demands.