"Imagine distraught family members coming in and asking 'where's my mother?'" Laskowski-Jones says. "In the past, in the time it took to get information into the ED system the patient might have been moved more than once. We would send the family to a room but their mom might be in radiology getting a CT scan. Now we have a higher level of confidence that we know where patients are."
The Newark, Del.-based hospital solved its patient tracking problem by implementing a passive tracking system using wireless infrared and radio frequency identification technology. In the 12-month period after implementation, the hospital reported a 20- to 45- minute reduction in length of stay for patients treated and released, and about 35 minutes for patients admitted, among other measurable results.
Christiana's efforts earned the 780-bed facility Health Data Management magazine's inaugural Nursing Information Technology Innovation Award.
The hospital, which is one of two in the Wilmington, Del.-based Christiana Care Health System, has plenty of emergency patients to track. Christiana Hospital's ED treated about 94,500 patients in 2005 in its Level 1 adult and pediatric trauma center.
It has 76 treatment rooms and seven triage assessment areas. Patients are seen by any of 43 attending and 53 resident physicians and the ED staff includes more than 200 emergency nurses, technicians and clerks.
No input
Keeping up with patients meant the former tracking system needed a makeover. "We needed a passive tracking solution that didn't require a staff member to input most of the information," Laskowski-Jones says, "and that would be accepted by all levels of personnel."
Laskowski-Jones began researching tracking technology in 2001, but could only find systems that required manual data entry and other staff input to maintain. The search would stretch on for two years. "I became aware in 2003 that passive technology existed," she says. "I found some that were marketed well, but there were no successful implementations."
Then one day in fall 2003, out of the blue stepped a salesperson representing three vendors of passive tracking technology: Patient Care Technology Systems LLC, Mission Viejo, Calif., which markets the Amelior EDTracker application; Versus Technology Inc., Traverse City, Mich., a supplier of tracking hardware including badges and sensors; and ADT Security Services Inc., Boca Raton, Fla., a vendor of anti-theft systems including door alarms.
Together, the three technologies seemed to meet Laskowski-Jones's criteria, so the next step was to check out existing implementations.
She assembled a group of ED leaders for a presentation of the EDTracker software from Patient Care Technology Systems. "Then we did some site visits and they all seemed very satisfied and felt the vendor came through for them," she explains.
A project steering committee including Jones, the ED nurse manager, the physician director and an I.T. representative then recommended the EDTracker system to the delivery system's leadership group. That group, comprising C-level executives, endorsed the project and agreed to fund it.
The passive tracking system cost about $690,000, but a state grant for emergency response preparedness helped defray a third of that cost, says Steve Hess, Christiana Care Health System's CIO.
The state had received federal funding for bioterrorism preparedness and had given Christiana Hospital a grant to devise ways to increase the state's readiness.
Laskowski-Jones, in turn, made a strong case that some of the funding should be used for the ED tracking project. The majority of the grant then was applied to the project, which was intended to help in mass casualty or bioterrorism events by helping track patients and health care workers who might be exposed to harmful substances.
They wear the badge
The tracking system uses infrared/RFID sensors and plastic badges embedded with tracking chips to passively monitor the location of patients and staff in real-time.
When patients arrive at Christiana's emergency department they receive a triangular badge-which measures 2.5 inches by 1 inch-that clips to their clothing. Once the badge number is activated in the tracking system, whenever patients enter a new care area the badge sends a signal to the tracking application.
Clinicians then can call up a self-developed electronic dashboard on a computer that shows the patient's location anywhere in the emergency and radiology units. Nurses, ED clerical staff and radiology technicians also wear badges that identify and record patient interaction and location.
Before its November 2004 rollout, vendor and hospital technicians installed more than 300 infrared and RFID sensors in the ceilings throughout the ED and radiology units, which combined are 50,000 square feet. Most sensors are infrared-the RFID technology kicks in when a line-of-sight signal is obstructed.
All 300 ED staff received badges and as of January more than 100,000 patients had worn the badges, Laskowski-Jones says.
To Laskowski-Jones and Hess, the project's success flowed directly from the ED clinical and administrative staffs' willingness to change how they work.
The ED triage process was redesigned to take advantage of the electronic tracking system, Laskowski-Jones notes. On arrival at the emergency department, patient conditions are assessed, and that data-along with registration information and badge number-is entered into the hospital's admission-discharge-transfer application, from McKesson Corp., San Francisco.
The system interfaces with the EDTracker application using messaging standards from Ann Arbor, Mich.-based Health Level Seven Inc.
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