Patients used to wait as long as two hours to see a physician at Nor-Lea Medical Clinic. Workflow issues and the size of the clinic were leading to long waits and unhappy patients.
However, the use of real-time location system technology, known as RTLS, led to significant insights into the practice and ways to improve performance at the Lovington, NM, clinic. Now, wait times have nearly been eliminated at the practice, which has five nurses and 20 physicians.
Organizations adopting RTLS need to be very clear and upfront with staff when announcing the decision to implement the technology, not just about what it does, but also about how it will be used, said chief operating officer Dan Hamilton during an educational session at HIMSS17. At Nor-Lea, providers and employers believed the system would be tracking them. That was accurate, but with a couple caveats.
Two maintenance people and an information technology staffer installed the RTLS system from Versus. Others asked what they were doing and told they were installing cameras to watch what people do. Even though they were making a joke, and only wireless sensors were being installed, the damage was done, and anxiety levels were high.
One of the core benefits of RTLS is to enable clinicians and staff to quickly be able to locate each other. To ease fears of Big Brother watching over everyone, Hamilton made a contract with providers and staff. If the RTLS system detected someone doing something wrong, there would be no punishment—but colleagues were free to call out others for poor behavior.
Collecting data on how the practice operates, how the staff do their jobs, and how staff and patients move around the facility was critical to Nor-Lea at the time because patient wait times to see physicians could be as long as two hours. One major reason for such delays in care was because the clinic was poorly designed with long hallways and waiting rooms that were located far from exam rooms. The goal was to get average wait times down to 10 minutes, Hamilton explained.
Data from the RTLS system found that nurses were doing administrative tasks more than real nursing—they were coordinating care for doctors, ordering medications, scheduling same-day appointments, printing lab and X-ray results and scanning them into the electronic health record, conducting prior authorizations, and spending lots of time on the phones. Nurses also were being pulled aside to administer immunizations and injections.
Hamilton realized the practice was paying nurses $28 an hour for doing more administrative than nursing work, when the practice could pay $12 an hour for medical assistants, and that’s what they did.
Another improvement brought by analysis of findings from RTLS technology was to enable staff to communicate with each other via TV monitors located in strategic locations in the practice. Nurses used to write information on the status of patient care on small adhesive notes taped on the doors of exam room. Now, monitors show physicians a color-coded status of patients, such as when they are in the room waiting and how long they have been waiting so the doctors know which room they should go in first, and that helps reduce patient wait times.
Doctors also have a button on a badge to push and inform a nurse that they are ready for a patient, and then they push the button again when they are finished with the visit, so the nurse can come in and complete the encounter. “Physicians are happy because they no longer are chasing their staff,” Hamilton said.
Nor-Lea also is using RTLS to look at room utilization and room turnover, along with collecting and analyzing patient flow.
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