Many large integrated delivery networks are trying to figure out how to achieve as much as a 40 percent improvement in efficiencies over the next five years in order to survive an expected decrease in reimbursement associated with healthcare reform. Leaders are engaging in cost-cutting efforts ranging from layoffs and restructuring to swapping brands of patient toiletry items to save pennies per unit. A major cost-reduction opportunity that is often overlooked is Real-Time Location System technology, typically because information technology resources are already overwhelmed with current projects. RTLS, however, has a proven operational and clinical improvement record in organizations ranging in size from community hospitals to large, multi-site IDNs — improvements that help staff do more with less, using efficiency gains to cut the cost of care.
IT staff may also have unrealistic expectations about the project implications of RTLS. While some RTLS technologies are disruptive to implement, other solutions have a negligible hardware footprint and require no construction or structural modification for installation, with implementation being completed in as soon as a month. All RTLS technology, however, is not the same, so a basic understanding of how the different systems operate can help organizations expedite the evaluation and selection process.
RTLS basics
RTLS involves the use of small tags that are attached to equipment, or worn by patients and staff. These "active" tags continually emit radio signals, which are detected by sensors throughout the facility. Sensors relay the signals to an application that uses the data to map location and apply workflow rules that ultimately simplify care delivery.
With the variety of technologies available in the marketplace, it is important to understand the goals for the RTLS project in order to create proper selection criteria. For example, understanding the location of an item within 10 to 30 feet requires only basic RTLS infrastructure, while detecting the entry of equipment into dirty utility rooms, or the entry of personnel into a patient room, requires a slightly more sophisticated approach. Detecting a patient-caregiver interaction in a bay requires even greater accuracy.
RTLS technology supports a variety of healthcare use cases ranging from asset management and temperature monitoring, to facilitating patient flow and caregiver workflow across the enterprise. The following represents a broad range of active RTLS scenarios. Leaders should consider their comprehensive RTLS roadmap when evaluating systems.
Asset management is more than locating equipment
While RTLS technology can reduce the time it takes to locate equipment from the typical 10 to 20 minutes to less than three, which is particularly helpful for transportation, biomedical engineering and nursing staff, a more significant return on investment can be achieved in several other ways. Maximizing equipment utilization, for example, better leverages RTLS technology since most organizations own twice the amount of equipment than required. Determining optimal asset inventory levels allows organizations to decrease replacement purchases, shift equipment to sister facilities or sell surplus assets.
If equipment is rented, it is fairly likely that such equipment is removed from patient care days before it is returned to the rental company. Additionally, some organizations lose track of some equipment, such as wound VACs, and occasionally have to reimburse the rental company for the replacement cost. RTLS technology helps expedite the return of rental equipment by sending indicators to rental staff when the equipment is removed from patient use.
RTLS technology also assists organizations that must generate an "unable to locate" list for The Joint Commission, indicating equipment that is lost. These lists often represent $125,000 or more in capital replacement costs. RTLS technology significantly reduces equipment loss by alerting personnel when equipment enters the trash, laundry chutes or egress areas.
Automated temperature and humidity monitoring
Most organizations struggle to comply with regulations for documenting the temperature of refrigerators, freezers and warmers, as well as the humidity of anesthetizing locations, sterile storage and procedure rooms. Documentation of corrective action for out-of-range conditions is even more of a challenge. Hospitals also commonly have at least one refrigerator or freezer failure per year, resulting in the loss of medications, vaccines, tissue, blood or food that can range from $1,000 to upwards of $100,000 per incident.
An RTLS automatically logs temperature and humidity and alerts personnel to out-of-range conditions so they may be addresed before loss or patient harm ensues. RTLS technology also supports the documentation of corrective action for out-of-range conditions and provides a variety of reports to support regulatory audits.
Improving patient flow in the emergency department, surgery and procedural areas
These high-volume departments experience unpredictable patient utilization, variability of illnesses and procedures, a number of caregiver hand-offs that occur in a very short period of time and a range of patient acuity. The complexity of patient care often results in missed communications, delays, near-misses, walk-outs or rescheduled procedures, unsatisfactory metrics and unhappy patients, families and staff.
A RTLS drives departmental patient flow and caregiver workflow by comparing the location and co-location of patients, caregivers and equipment with the ordered plan of care or procedure-based workflow. If an RTLS incorporates an advanced business rules engine and sophisticated analytics, the system can automatically draw conclusions about what is occurring, what should happen next and who is responsible for making it happen. Roadblocks to care progression are identified based upon best practice workflow and are quickly flagged to facilitate resolution. Typical results after an RTLS implementation include a 50-percent reduction in patient wait times, an 80-percent reduction in OR case or procedure-related calls and a 25-50 percent reduction in bed turnover times. These improved efficiencies support the care of more patients with the same resources and decreased overtime costs, not to mention improved patient satisfaction.
Enhancing enterprise-wide capacity management
The need to manage enterprise-wide patient flow and capacity is quickly becoming a business imperative, and most organizations — particularly those with large patient volumes — continue to experience challenges despite electronic health record automation. Organizations are striving to reduce discharge delays, improve bed turnover, comply with quality measures and safety goals, and optimize the satisfaction of patients and staff.
An RTLS applies a tracking engine and workflow rules to the inpatient setting, automatically measuring and displaying the location, movement and interaction between tagged patients, staff and medical equipment. Color-coded, indicator-rich geospatial maps display all the clinically relevant information that staff needs to know to quickly and efficiently treat patients, which streamlines patient flow and expedites care-team communication. Information about the patient's care plan and changing condition is instantly available, elevating roadblock awareness to facilitate clinical decision making. After a RTLS implementation, organizations often experience a one- to three-hour reduction in patient length of stay, 40-50 percent reduction in bed turnover time and a 10-15 percent reduction in patient wait times for tests and procedures. With these improvements, patients are held for shorter periods of time in the ED and PACU, care is more timely and patient satisfaction improves.
Delivering operational efficiency and a ROI
Unlike some technologies in healthcare, Real-Time Location Systems have a proven history of delivering financial and clinical returns and better positioning organizations to thrive amidst declining reimbursement. Intelligent orchestration of care delivery improves the patient, family and caregiver experience, advances safety, automates tasks so clinicians can focus on complex problem-solving, and increases the amount of time clinicians can spend at the bedside. When combined with other data sources, RTLS technology provides insight to further improve patient, clinician and asset flow, optimize patient-clinician interaction, reduce care delays and improve safety.
Merrie Wallace, RN, BSN, MN, is CNO and executive vice president of product solutions for Awarepoint.