The air is full of signals and data; Wi-Fi, radio waves and various other invisible communication modes that surround us every day. If you work in a hospital, chances are that this bombardment of invisible communication is multiplied a hundred-fold.
When that one particular piece of medical equipment is needed, and it is needed now, the luxury of guesswork goes out the window. It becomes the job of technology to make location identification and retrieval an efficient process. Finding personnel, monitoring patients or keeping a check of temperatures can all be accomplished utilizing the same technology.
With Real Time Locating Systems (RTLS), the task of accomplishing any of these goals is accelerated through the use of technology.
With the pinpoint accuracy that many systems have, the location of assets, patients and staff can be determined. Clinical workflows can be maintained and improved. In some cases, clinician hand washing can be tracked and patient response times can be monitored.
To get a better idea of the practical considerations involved in the acquisition, installation, maintenance, usage and expansion of these systems, we solicited the insights of OEMs and HTM professionals who have first-hand knowledge. We learned that these systems have multiple capabilities with even more on the horizon.
“Most hospitals initially begin deploying RTLS for asset management, where the benefits are well documented and the ROI can be quickly realized,” says Adam Peck, director of marketing for CenTrak, maker of the Clinical-Grade RTLS system.
“For example, if a nurse needs to find an available infusion pump, with an RTLS application an available pump can be located quickly. Similarly, RTLS technology can assist clinical service personnel to identify and conduct preventive maintenance on pumps, ventilators and other high value equipment,” he says. “Building upon this foundation, RTLS asset management also serves as the launch pad for a wider range of clinical applications.”
“The use of RTLS technology to automate workflows in healthcare can trim time lost to redundancy and process inefficiency so that caregivers can spend more time with patients and more patients have access to quality care,” says Jon Poshywak, vice president and general manager for TeleTracking RTLS.
“By tagging all personnel, including physicians, nurses and patients, RTLS combined with the proper patient flow software, presents the physical functions of the entire enterprise on-screen in real time, creating a virtual ‘motion picture’ of events as they happen,” he says. “Not only does this drive daily performance improvement, but it offers a wealth of data that can be analyzed for even greater improvement.”
Making the Decision
“We were initially interested in tracking of the telemetry transmitters that were being lost on a routine basis, however many other uses soon appeared and the telemetry issue was solved a different way,” says Kurt Burner, MBA, CBET, manager of the Biomedical Engineering department for the Akron General Health System.
“While searching for a system, we were also contacted by pharmacy, which was looking for a way to centrally monitor temperatures within their medication refrigerators as the hand written temp tracking sheets sometimes were not completed,” he adds.
The impetus was a little different for the decision makers at ProHealth Care.
“We had a need to replace our fleet. We worked with a company to develop our RTLS system to help reduce the fleet of IV pumps needs by having the RTLS system to locate the fewer pumps and to increase utilization,” says Rob Bundick, manager of Biomedical Engineering for ProHealth Care in Waukesha County, Wis. “This allowed us to fund the RTLS system with the funds from the savings from our IV pump fleet reduction.”
Get all the relevant stakeholders involved on an evaluation committee, suggests Peck. The committee can include representatives from IT, Nursing, C-suite, OR, ED, Security, Risk Management, Patient Safety, and Biomed. Agree on the specifications, including a definition of “room-level” and “bed-level” for the current intended use and for future uses. Determine the maximum system latency for all uses, he says. Focus on integration and scalability.
The Minneapolis Veterans Affairs Health Care System (MVAHCS) got in on the RTLS trend early in the game.
“The MVAHCS was fortunate to be an early adopter of RTLS starting in 2005, when the Minneapolis Biomedical Instrumentation Service worked closely with facility leaders and the VA Central Office to secure approval and funding to pilot the technology for the first time in the Department of Veterans Affairs,” says Michael J. Phelps, director of Biomedical Instrumentation Service for MVAHCS.
“MVAHCS biomedical engineering staff led a multi-disciplinary team to provide technology assessments and market research to gain greater understanding of the technology, write specifications that met the requirements of MVAHCS and evaluated vendor proposals for the project,” he says.
“After much competition — 24 vendor proposals evaluated — a vendor was selected for the project and installation was completed in 2007,” Phelps says.
There are several considerations during the acquisition process that can help align priorities correctly when RTLS is being evaluated.
“Start with the end in mind and look to the solution versus the technology,” Poshywak says. “Assign an owner to the system for ongoing education and management. Ensure that your service provider is certified to manage and service your RTLS infrastructure.”
Poshywak suggests that a facility seeking an RTLS system find a provider who wants a long-term partnership. That provider should objectively assess the needs of your facility and customize the optimal solution. Checking with peers to see what they are buying and their reasons is another good step.
“Calculate the ROI because your executive team will ask,” he says. “Purchase from an experienced RTLS provider to avoid surprises and factor in wiring, patient room closures, network redesign, battery replacement, etcetera.”
He says that there should be maintenance and upgrade considerations also.
“Factor in the fact that an investment in RTLS requires ongoing attention, review and care,” Poshywak says. “Batteries and devices will fail; networks will get overloaded; and people will turnover. While an RTLS system can be shared among many constituents within an organization, it’s important that there be definitive owners for activities such as maintenance.”
Once the decision is made to go with a particular RTLS system and the acquisition is made, then the correct first steps must be taken in preparation of installation.
“The first difficult challenge was the site prep required to install the system,” Phelps says. “Electrical utilities, network hardware, and other infrastructure must be assessed and modified to support the RTLS solution purchased. The support and cooperation of the Facility Engineering Service, Information Technology, Logistics, and Finance are imperative to the success of the project.”
Bundick says that educating staff on usage of the system was an early challenge. He says implementing the change in workflows that allowed for fewer devices to be deployed was another obstacle that had to be overcome.
“First was the installation of current maps and the upkeep of the maps since construction is always taking place. Then fingerprinting of floors – this is where you take multiple tags and go around and say I am here right now, then move five feet and say I am here. This is time consuming; however it adds accuracy to the tags location,” Burner says.
“Working with IT as they have to have the access points at a certain level, then controllers and down the line – also they must be aware that any changes to the wireless system can cause a ripple effect on the RFID system,” he adds.
“Our installation was seamless, as the backbone was done in new construction,” says Terry Broussard, RN, BSN, MPA, vice president of Support Services at Our Lady of Lourdes Regional Medical Center in Lafayette, La. “We did change vendors, which required some hardware change, but that went very well with little impact to our teams.”
The system that the Our Lady of Lourdes Regional Medical Center chose was a Skytron Asset Manager system using CenTrak architecture.
“That decision was made prior to my arrival, but I have enjoyed the ease with which I am able to create alerts right on our web interface for special interest projects and metrics,” Broussard says. “Basically, apart from the standard reports, we build new ones as the teams determine a need.”
“Our ability to create on-the-fly really encourages free thought and creativity, and I think it shows the immediate value to the clinical teams,” he adds. “We track everything — from beds, to pumps, to translation phones for special patients — it is all in the system.”
“Current healthcare is a compliance industry; one empty blank and surveyors often delve deeper into records for trends,” Broussard says. “Asset tracking, and automated logging, removes the doubt and permits us to show alarms response as needed. Paper logs maintained by nursing staff are virtually a thing of the past.”
More Cost Savings
Patient satisfaction can also benefit from RTLS.
“October 1, 2013, marked the one year anniversary of the Value Based Purchasing (VBP) program. The VBP program was established by the Affordable Care Act (ACA) as an incentive for hospitals to increase patient satisfaction and standards of care with a ‘pay-for-performance’ initiative,” Peck says.
“The program measures patient satisfaction through patient experience surveys (HCAHPS). Based on these survey scores, the Centers for Medicare and Medicaid Services (CMS) is able to administer either incentive payments or penalties to a hospital, based on high or low HCAHPS scores, respectively,” he adds. “In its first year, the VBP program is expected to withhold almost $1 billion in hospital penalties.”
Peck says that research has shown a positive correlation between low HCAHPS performance and above average patient readmission rates. He points to the “Hospital Readmission Reduction Program” in the Affordable Care Act, which offers to provide significant financial incentives to reduce readmission rates.
“The penalties for excessive rates were up to 1 percent of a hospital’s Medicare DRG payments in FY2013, with subsequent increases to 2 percent in FY2014 and 3 percent in FY2015,” he says.
“When the integrity of data collected lies in the use of manual log sheets for rounding verification, it can be challenging to quantify these log sheets and validate their accuracy,” Peck says. “This, in addition to the difficulties associated with implementing, monitoring and sustaining hourly nurse rounding procedures can threaten patient safety and satisfaction, negatively impacting HCAHPS scores.”
Like most technology, RTLS has continued to evolve and promises to offer more applications and refinements in the future.
“During the past year, we’ve seen a significant maturation of the RTLS market. A previously fragmented market has consolidated to just a few market leaders,” Peck says. “We’re also seeing greater demand for clinical-grade infrastructure — room, bed-level accuracy with rapid location updates and extreme battery life — to support location-ready healthcare applications like CMMS, Nurse Call and EMRs.”
The ability to leverage existing infrastructure to gain the benefit of an asset visibility application is reducing the initial capital outlay, according to Peck.
“Having the ability to leverage the existing Wi-Fi infrastructure is a benefit, but that will only provide general asset visibility. The combination of Wi-Fi locating with Gen2IR and Low Frequency RF provides the framework required for advanced asset management use cases such as PAR-level management, improved asset utilization and reduction of shrinkage – making the technology investment pay for itself in a matter of months,” Peck says.
“When combined with automated patient flow software, RTLS is the enabling technology that is making the ‘real time hospital’ a reality,” Poshywak says. “It gives managers the ability to immediately assess virtually all of the daily functions that keep the hospital moving, either from their PC, laptop, smartphone or tablet.”
“In the future, RTLS will support the orchestration of care throughout the clinical enterprise,” says Peck. “It will streamline processes, make more efficient use of scarce resources, both human and capital, will improve clinical quality while reducing preventable errors, will integrate with other hospital information systems to share clinical data across a wider range of clinical staff, and will become components of ancillary hospital functions like facility security.”
The inevitable progress of technology can add levels of efficiency to all healthcare providers, including HTM professionals. With the increased focus on every facility’s financial bottom line, and the paramount importance of patient safety, the significance of RTLS and other technologies is very real.
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