FREE Health Data Management e-newsletter 
Keeping the ER on Track
Health Data Management Magazine, September 2006
"We did everything new all at once-the Big Bang theory," she says. "It was quite a change going from a little 18-bed emergency department to a 53-bed megaplex that is very high tech and very electronic."
Advertisement
For the first time Long Beach Memorial could run reports to show how its emergency department was performing, Nachreiner says. The bad news was that it found it wasn't meeting its operational goals.
"We knew our volume was growing, and we knew we weren't efficient in our care," Nachreiner says. "But we didn't know how inefficient we were because we didn't have ways to collect data, other than chart review.
"The new system gave us a huge baseline of data," she explains. "It gave us a snapshot of the department any time we chose to look. It told us how long people were waiting for more than 15 different milestones."
Long Beach Memorial's goal, for instance, is that patients see a triage nurse within 15 minutes of arriving at the hospital. In examining early data from the tracking system, Nachreiner found that patients were actually waiting an average of one hour and 20 minutes.
"This is a parameter that is very important to emergency departments across the country, and until then, we didn't know where we stood," she says.
The hospital formed a committee to look at triage procedures. They redesigned the triage area and added an extra triage nurse during busy times. Having hard evidence about the problem won them support from management for their efforts and the extra resources that they needed to get the waiting times down, Nachreiner explains. Today, patients wait an average of nine minutes before seeing a triage nurse.
The patient tracking system also enabled Long Beach Memorial to set and meet a goal of having "fast track" patients-those with colds, flues and other easily handled problems-be in and out of the emergency department in two hours.
When they started the project, these patients were going through in about four hours. "There is really no reason for our fast track patients to wait half a day with a splinter or some other minor problem," Nachreiner says. "The tracking system gave us the data we needed to refine our processes. Data is power, and this system provides all the data you could possibly use to help your team pick out where the major problems are and put your resources where they are needed the most."
Tracking patients
As soon as patients arrive at Long Beach Memorial's emergency department, they are given badges that emit infrared signals, similar to a television remote.
The badges, which are placed on the patient's clothing, send signals every three seconds to sensors placed throughout the ceiling of the emergency and radiology departments. The sensors forward the signals to hardware devices that convert them into the badge numbers the EDTracker software understands.
Nurses and physicians sign into the system when they arrive and receive badges to wear for their shift or visit.
If the data being transmitted indicates that someone has changed location or that a provider has entered a patient's room, the software creates a time stamp and logs the change or encounter into the system. In this way, staff using the system can also see which providers are taking care of a patient.
The infrared technology requires a clear line of sight for the badges and sensors to communicate. The signal sometimes is blocked-for example, by a patient's bed sheet or a piece of equipment-which is when the RFID technology takes over.
The badges can transmit RFID signals to the sensors and automatically do so if the infrared transmission is blocked. The badges and sensors used by Long Beach Memorial are from Versus Technology, Traverse City, Mich.
Hospitals around the country are working to establish business cases for implementing patient tracking systems, which is one of health care organizations' top priorities for using infrared tracking and RFID, says Nicholas D. Evans, global lead for emerging technology at BearingPoint, a McLean, Va.-based consulting firm. A recent BearingPoint survey of 313 health care organizations found that more than 70% viewed RFID in particular as an emerging technology that would improve health care processes.
"We find that the emergency department is often the first area of focus," he says. "In a busy setting, these technologies can help staff know where the patient is, improve patient flow and improve patient satisfaction."
Patient tracking systems can run about $200,000 for a medium-sized emergency department, but costs vary depending on the type of tracking devices used and the area that needs to be covered, according to a spokesman for Patient Care Technology Systems.
So far, Long Beach Memorial's emergency department has not been asked to do a return-on-investment study on its system, Nachreiner says. "The benefits have been very obvious."
Rapid growth
Long Beach Memorial's emergency department has gone from seeing about 100 patients a day three years ago to seeing about 240 patients a day, and that leap would have been much more difficult without the patient tracking system, Nachreiner says.
In addition to providing data, the tracking software can be credited for some of the overall time savings and increased efficiencies, she says. Previously, nurses and other staff members had to take the time to manually enter where they had taken a patient. At one point, the old system had had become so unreliable that the ER staff reverted to keeping track of patients by writing their status and location on a large grease board.
Today, 75% of the information accessible through the system flows in from the communication between the badges and the sensors. The other 25% comes from interfaces with other computer systems.
The tracking system sends and receives information from a registration system, a laboratory system, a picture archive and communication system, and a bed tracking system for the overall hospital, according to service support supervisor Oscar Villarreal, who oversees information technology in the emergency department.
Checking up
This enables physicians and staff members the ability to check on laboratory results, radiology reports, and more using the software, which has become the emergency department's main information system, Villarreal says.
The system provides a view of the emergency department's activity at a glance, and staff members are able to click on a patient's name to get all of the information they need to provide the next step in the care process.
"Moving patients manually in the old system was exhausting," says Steve Shrubb, an R.N. in the emergency department. "With the new system everything is driven by the badges, which makes it much easier."
Patients are safer thanks to the system, he believes. "We have a visual map of the department at our fingertips, and acuity is readily identifiable," adds. "We are able to spread acuity through different areas of the department."
And while today the emergency department is shaving minutes off processes instead of hours, Nachreiner says, the improvement the system enables is ongoing.
For more information on related topics, visit the following channels:
