March 15, 2014 – Hospitals are using the current generation of real-time location systems to do more than locate things, or even people. While only 10 to 15 percent of hospitals have an RTLS installed, according to a survey released last year by KLAS Research, Orem, Utah, they're using the data generated by the systems to reform workflows-saving time, money, construction costs, and the need to hire extra staff. They're even increasing the efficiency of collecting co-pays at discharge.

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, 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:

Christiana Care: 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.

"It's an amazing feat that all the ancillaries are in sync with each other," says Sharon Boothe O'Connor, a systems analyst with parent system Memorial Health Care who provides support for the Versus RTLS that the hospital in 2004 in its brand-new building. The RTLS is used for many types of movable equipment, including pumps and computer cards, and for staff and patients.

Implementation went smoothly because the RTLS was part of the new construction, and because 75 percent of the staff was new to Memorial Health System and didn't have to unlearn any old habits. "They loved it and embraced it," O'Connor says.

In addition to clinical efficiencies, the RTLS is generating hard-dollar returns in at least two ways. First, patients have to turn in their locator badges as part of discharge, and the hospital paired badge collection with the collection of any co-pays that are due at discharge. Co-pay collections went up 60 percent. Second, the RTLS makes it easier to track which type of bed patients are in, and capture the correct charge when they're moved from the courtesy lounge to an inpatient bed.

Boca Raton Regional Hospital: Quicker Response, Better Care

Boca Raton Regional Hospital's new RTLS improves care by allowing nursing staff to respond to patients more quickly, and letting supervisors track patient contacts.

"It's enabled nurse call to be to be much more personal," says Chief Nursing Officer Melissa Durbin. "We can run reports and see how quickly a call was answered, and we can escalate the call to the appropriate person." The unit clerk decides whether the patient needs a nurse for medication administration, or a patient care assistant for ice or help to the restroom.

The 375-bed hospital had been considering a replacement facility, but when that fell through, it decided to pursue replacing its aging nurse call system. The new one, from Critical Alert Systems, Jacksonville, Fla. (formerly known as Intego), was installed in 2010 and included RTLS capabilities for staff, patients and equipment. CIO Robin Hildwein liked the way that the infrared-based location system piggybacked onto existing nurse call wiring.

The biggest challenge was getting the infrared locators in the right places, so that the system registered accurately. "Originally, we had auto-cancel turned on, so that the call would automatically be cancelled when a caregiver responded," Hildwein says. "But the locator signal was so strong that if the caregiver was just outside the room, it could cancel the request because it would assume the caregiver had come in." She spent several months rectifying the problem, aided by an engineer from Intego.

The solution was to lower the signal strength of the locators and install an additional one near the bed in each room. Because the badges can't be detected by two locators at once, caregivers were only registered if they were picked up by the locator near the bed. Now there are locators down the center of each hallway, plus two in each patient room and one in each room's bathroom. "Now we have very high reliability," Hildwein says.

Northwest Michigan Surgery Center: Controlling the Chaos

The staff at Northwest Michigan Surgery Center in Traverse City Mich., knew when they were having a bad day, but a real-time location system is helping them understand them exactly why-and how to fix it.

With about 20,000 procedures a year, the center is one of the largest freestanding surgery centers in the country. "It's controlled chaos, so having visibility into exactly what the chaos is gives us more control," says Brett McGreaham, supply chain manager. A staff survey in late 2011 revealed that post-operative patient flow was a huge source of stress.

"There was a lot of dissatisfaction with the workload and the efficiency expected," McGreaham says. "We wanted to raise morale and productivity in the post-op area. "

In May, the center installed a RTLS from Versus, also in Traverse City, to track the movements of staff and patients. It pays a monthly fee partially based on patient volume, that's equivalent to about half an FTE, McGreaham estimates. The largest hardware investment was six flat screens that show staff and waiting families where the patients are. The system uses infrared light picked up by sensors in each surgery bay. The RTLS interfaces with an EHR system from SourceMedical, Wallingford, Conn., to trade such information as patient name, date of surgery, surgeon, and type of anesthesia. The center doesn't have a dedicated I.T. person, but McGreaham was able to handle the installation without formal training.

Once implementation was complete, it became simple to gather data on how long patients spend in each stage of surgery, and to anticipate when they'd be ready for the next stage. Managers could easily see where surgeries spiked and staff accordingly. While McGreaham has not computed a formal return on investment, he notes that the center is handling a higher volume of procedures but hasn't had to hire as many staff as it anticipated.

The surgeons hold a majority interest in the center, and couldn't be required to wear the tracking badges. About 90 percent do, though. "Most of the staff saw the value after a week or two," McGreaham says. "Some of the physicians were more combative. But their peers are seeing more efficient days. We tell them, if you don't want to wear badge it's fine, but then you can't complain about your efficiency or turnover times."

McGreaham plans to apply data from the RTLS more systematically in the next year to make procedures more efficient. Meanwhile, the change is visible. "We used to have a huge book of who was where on the unit clerk's desk, with everyone hovering around trying to see it," he says. "Now we have all that stuff on the boards."

This story originally appeared at Health Data Management.

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