Jay Deady, CEO of RTLS vendor Awarepoint, San Diego, estimates that with EHR integration, equipment tracking, and people tracking, a fully implemented RTLS can save an institution between $3 and $7 for every dollar invested. About 190 hospitals have Awarepoint's technology installed, and they have seen a return on areas ranging from ED throughput to infection prevention, he says.
"We can track the workflow and see if a piece of equipment hasn't been cleaned properly and is about to go into a patient's room," Deady says. "It's not the fault of the caregiver, who found it in the clean equipment area. But our system can fire alerts and get the equipment out of the room before the patient is infected." He says about 20 percent of equipment is not properly cleaned between uses.
Location systems can automatically document intervals of time:-when a patient was put in a waiting room, how long until the triage nurse visited, when the patient was moved to radiology or an inpatient bed. "We do all that tracking behind the scenes," Deady says. If a milestone isn't completed or is taking longer than usual, it's tracked both retrospectively, to help fix chronic workflow problems, and in real time, so that staff can intervene for the patient.
Jim Stilley, director of clinical workflow consulting for Versus, Traverse City, Mich., and former CEO at Northwest Michigan Surgery Center (profiled on the next page), says RTLS can help establish consistency. Before taking his position at Versus, Stilley supervised the installation of the company's RTLS at the surgery center. "Too many times we'd develop a perfect process, but trying to validate that it was done the same way every time was very difficult," he says. Northern Michigan did baseline data collection by having everyone wear the tags for awhile. Then Stilley worked with the staff to develop better processes, and used the RTLS to show everyone exactly where they had saved time using the new process. "People are distrustful of management, so you have to communicate the advantages," he says.
Four hospitals shared their stories of how RTLS technologies have changed the way they work:
Reforming the emergency department
When Christiana Care Health System, Wilmington, Del., implemented a real-time location system in its two emergency departments, the ED staff expected to become more efficient at tracking patients. But they also got a pleasant extra surprise: the ability to increase an already large ED volume by 25 percent without adding a corresponding amount of space.
It was tracking time intervals through the RTLS that made the difference, says Linda Laskowski-Jones, vice president of emergency and trauma services. "Everything we do interfaces with the tracking board," she says. "We can track the time we request a transfer, the time transport is dispatched, the time it arrived. Before, every one of those moves had to be entered by someone, and they weren't always updated."
Christiana Care's flagship 913-bed Christiana Hospital in Newark, Del., operates the only Level I trauma center between Philadelphia and Baltimore. In 2004, when it implemented an infrared tracking system from Awarepoint, ED volume was between 90,000 and 95,000 visits annually. Today it's about 120,000. The system tracks patients, ED staff and equipment, as well as staff from departments that frequently interface with the ED, such as radiology. Patient badges populate the patients' ED records as well as showing their location on an electronic map. "We can look at the map and get a sense of what rooms are occupied, the acuity of the patient, whether they're being admitted, whether the room is being cleaned and what type of cleaning is needed," Laskowski-Jones says.
The first spot the department wanted to improve was its service for low-acuity patients. When the department was busy, it took an average of 2.5 hours to move a patient through. When Laskowski-Jones looked at the workflow using data from the location system and analyzed the components of each task, she discovered that patients were being processed sequentially, that they were being asked the same questions by multiple people, and that the department was using the same forms to process low-acuity patients as it did for high-acuity patients, thereby collecting a lot of information that wasn't immediately relevant. Using LEAN management techniques borrowed from manufacturing, the staff began to synchronize their tasks to avoid duplication and increase teamwork. They streamlined the paperwork process.
As a result, the area is now able to see about 70 patients a day in two exam rooms, instead of 55 patients in six rooms. "It sounds unbelievable, but I look at the data every single day and we've sustained this process for seven years," Laskowski-Jones says.
Another beneficial effect of RTLS is being able to tell patients' families where they are. "Family members would come in and the triage nurse would tell them their loved one was in Room 4, but she wouldn't know that the patient had been taken for a CT scan, and the families would be startled when Room 4 was empty," Laskowski-Jones says. "Now we can tell them exactly where their loved one is."
Memorial Hospital Miramar:
Integrating with the EHR
Because the RTLS at Memorial Hospital Miramar (Fla.) is integrated with its Epic electronic health record and other clinical systems, patients can't make a move without everyone knowing. When they go to surgery, the OR system is automatically updated. Their medication records follow them, so that the Pyxis medication dispensing system is ready for them no matter where they are. The ADT system always knows where they are.