REAL-TIME LOCATION SYSTEMS
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 (profiled
on the next page), 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. “Every-
thing 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. Be-
fore, 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., op-
erates 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 depart-
ments that frequently interface with the
ED, such as radiology. Patient badges
populate the patients’ ED records as well
as showing their location on an elec-
tronic 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 be-
ing 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
“We can tell
them where
their loved one
is now.”
—Linda Jones
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 be-
