Roughly ten years ago, PeaceHealth installed a real time location system (RTLS) platform to help track nurses and equipment in the three-state Pacific Northwest health system. Since then, officials say, the health system has cut its “doctor to bed” time for patients in half, and reduced the length of stay by almost 15 percent.
All from a tiny tag that lets you know where a person or piece of equipment is located.
RTLS technology has come a long way in the past decade, both in sophistication and innovative ways for its use in healthcare. Led by industry giants like Stanley, Ekahau (recently acquired by AiRISTA), Versus Technology, Intelligent InSites and Sonitor, it’s become a must-have for health systems executives eager to get a handle on everything from patient and staff engagement, facility traffic patterns, asset management and even security.
“This has made a huge impact on our ability to provide medical care,” Marne Owens, program manager for information technology for the Hospital Corporation of America (HCA), a 165+-hospital network in the United States and United Kingdom, said during a recent webinar on RTLS uses. Among the many benefits, she noted, has been a 75 percent reduction in time spent searching for equipment.
Source: Department of Veterans Affairs
RTLS systems in action
Nowadays, RTLS systems are known more for the analytics platform than the actual tag, tracked by wireless technologies like RFID, Wi-Fi, Bluetooth, ultrawideband, GPS and even sonar. Data collected by the tags — location, speed, stationary time, temperature — is collected and processed by various departments within the health setting.
- At Memorial Sloan Kettering’s new Josie Robertson Surgery Center in New York City, officials integrated Versus RTLS technology throughout the 16-floor short-stay surgical facility, which sees some 40-50 patients per day. Connecting with Epic and Allscripts systems, the platform collects 30 points of data and powers 39 Glance-and-Go electronic whiteboards, providing information on patient wait times, surgery schedules, bed availability, staff identification and location, and alerts when a room is ready to be turned over.
- The Northwest Michigan Surgery Center in Traverse, City, Mich., ties its RTLS system into an app, the iCare Patient Tracker, that enables friends and family to keep track of a patient undergoing a procedure at the outpatient surgery center.
- At Trinitas Regional Medical Center in Elizabeth, N.J., nurses dealing with combative patients can signal a Code Gray simply by tapping their RTLS-enabled badge, which locates them for security.
- At the University of Maryland Medical Center, RFID tags are used to keep track of emergency medications in crash carts and to alert staff when medications expire or the carts need to be restocked.
- And at Florida Hospital Celebration Health in Kissimmee, officials used Wi-Fi RFID tags developed by Stanley Healthcare to measure traffic patterns in certain areas and develop workflows for staff that reduced excessive travel.
A Use Case for RTLS
At PeaceHealth, executives first wanted to use the technology to improve care coordination for nurses. That included giving them an easy means of finding equipment.
“It’s always nice to know where everything and everyone is,” Doug Duvall, the health system’s lead systems analyst, recalls thinking. “That was just the tip of the iceberg.”
Officials of the non-profit health system, which operates medical centers, critical access hospitals, clinics and laboratories in Washington, Oregon and Alaska, saw the RFID system developed by Versus Technology as an improved nurse call system. In time, the health system found a treasure trove of information in the data captured by those tags, and was able to improve nurse call response times and cancellations, decision-to-admit times, pre-admission testing (PAT) lines in anesthesia, and patient flow and communication in the Emergency Department.
“It’s always nice to know where everything and everyone is. That was just the tip of the iceberg.”
Duvall estimates the system saved hundreds of thousands of dollars almost immediately, reducing time spent searching for lost or misplaced equipment, speeding up response times for nurses and doctors, improving inventory and cutting patient length of stay. And while clinicians were at first wary of the “Big Brother” aspect of the technology, he says they quickly caught on to the benefits.
“So much time was wasted,” he says. “Just in efficiency and workflow improvements, (the technology) paid for itself.”
Five Drivers for RTLS Use
While health systems are finding new ways to use RTLS seemingly every week, five uses stand out as the primary drivers for the technology platform.
Registration staff can identify available rooms and clinicians, reducing the patient’s stay in a waiting room. An electronic whiteboard matches patients to rooms, enabling doctors, nurses and lab technicians to quickly see where they should be and where they should be going. The platform also charts the length of stay in each room for providers — ensuring that a patient’s care guidelines are met — and patients, alerting staff when a room is empty or ready for a new patient.
RTLS can be used not only to see where staff and patients are and where they’re going, but to improve operations in crowded areas — such as the Emergency Department or Surgery — or map out clinician workflows. Health systems have even used the platform to study traffic patterns to reduce excessive travel by nurses and staff, and to help in the design of new facilities before construction even begins
“So much time was wasted. Just in efficiency and workflow improvements, (the technology) paid for itself.”
Privacy and security
In Labor and Delivery, Mother and Child and Neonatal Intensive Care Units, RTLS platforms are used to match each child with his or her parents and corresponding care team members, to eliminate any chance of a newborn being matched with the wrong parent or any abduction attempts. In behavioral health units, the tags help staff keep track of lost or wandering patients (including those with dementia). And throughout the hospital, they can be used whenever a staff member is threatened by an unruly patient or a visitor.
Tags on equipment ensure that nothing — wheelchairs, thermometers, specimen bottles — is lost, misplaced, stolen, hoarded or tossed out with the trash or mixed in with the laundry. The platform can also be used to track how often certain devices are used and where, so that needed equipment can be monitored for wear and tear and placed in high-use areas within the hospital. Tags can also be placed in temperature-sensitive areas, such as refrigerators, to ensure they’re properly heated or cooled.
RTLS platforms in patient rooms can help patients locate nurses or other staff, or point them in the right direction when they need to go somewhere. If a patient is out of the room, the technology can be used to locate him or her for visiting family members or staff. The technology can also be used to improve housekeeping, meal delivery and other services.
RTLS Benefits for Providers, Patients
At HCA, Owens sees the benefits in staff satisfaction and efficiency — which, in turn, translates into “dramatic” increases on a health systems’ Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, a key benchmark for measuring patient satisfaction.
“We can’t talk about the patient experience and enhancing patient satisfaction without first talking about the clinical experience,” she said.
Perhaps nowhere is RTLS more valuable than in helping and protecting a health system’s tiniest patients. Stanley Healthcare, which beefed up its portfolio when it acquired AeroScout in 2012, offers a Hugs infant protection and Kisses mother-infant matching platform that tags newborns and their parents. The technology platform ensures that newborns are matched with the right parents and care team no matter where the infant is in the hospital.
“We can’t talk about the patient experience and enhancing patient satisfaction without first talking about the clinical experience."
Another solution, Pedz - now called Stanley Healthcare Pediatric Protection - is designed for a health system’s pediatric departments.
All are designed to be inauspicious until they’re needed.
"We work it into the workflow of the hospital," Allison London Brown, Stanley Healthcare’s former chief commercial officer, said in a 2012 interview — shortly after the Hugs system was credited with alerting a Los Angeles hospital to a woman who’d posed as a nurse and was trying to leave with an infant in her tote bag. "We want to be high-tech, but low-key, so that we blend into the environment."
Both Owens at HCA and Duvall at PeaceHealth say RTLS technology is limited only by the imaginations of those within healthcare, and they expect many more examples of the technology being used to benefit both clinicians and patients.
Imagine, for example, an RFID tag integrated with a wearable, and not only identifying the patient and his/her location but relaying real-time vital signs to the patient’s care team, or a nurse being alerted to a patient in distress and immediately given information on the nearest doctor and crash cart. Or an ER nurse armed with information that enables him or her to tell when a new patient can be escorted to an exam room and seen by a doctor.
After all, that iceberg can be pretty big.