By Deborah Tuke Bahlman, RN
Hide and seek
A decade ago, Portland's Providence St. Vincent Medical Center surgeons and other surgery staff had numerous challenges knowing where their patients were, the phase of care they were in, or even whether they had arrived in the facility. Multiple phone calls and/or a walk through the department were required just to obtain this information. This not only resulted in delayed surgeries, but also pulled staff away from patient care activities at the bedside.
In 2001, Providence St. Vincent decided to expand its main operating room, pre-op, and post-op areas by 100% to accommodate increased volume and capacity demands. The 523-bed facility had to come up with a solution that would enable staff to quickly and easily find patients, their status, and equipment without compromising care and time with the patient.
Real time locating (RTLS) to the rescue
To solve the issue, the hospital installed ORTrackerTM, a real-time location system from Awarepoint®.
RTLS is software used by hospitals and health systems to automate real-time tracking and monitoring of the location of patients, clinicians, and assets. The system improves business processes, enables workflow automation, supports hospital efficiency, supports patient safety and infection control practices, and facilitates continuous process improvement.
When patients arrive at the hospital, a watch-sized badge is placed on their wrist next to their arm band. Registrars enter the badge number into the tracking system. The badge continuously transmits infrared signals to sensors mounted on the ceilings of all areas where patients could walk or be moved to including registration, waiting lounges, operating suites, post anesthesia care units (PACU), and short stay units (SSU). The sensors wirelessly communicate the location of patients to the tracking system.
The information is displayed on large flat screens located at nursing stations and surgeon lounges. Clinicians can access the information securely via the hospital's intranet or wireless network.
The integrated system records the exact time of every milestone, enabling the facility to analyze and change processes when necessary to improve quality, efficiency, and patient service.
Seeing is believing
The hospital had a pre-existing RTLS system for the emergency department (ED) setting, but not for the OR. The hospital CEO assigned Deb Bahlman, RN, MS, regional surgery information systems manager, to be in charge of all technology for the surgery expansion project.
Before she began researching possible solutions, Bahlman happened to receive an email from a consultant discussing a facility in Ohio that had recently deployed an RTLS application to track and locate ED patients and assets.
Providence St. Vincent sent five surgery leaders to visit the Ohio hospital. Although the solution was designed specifically for the ED, the group felt that the technology would work at Providence because the workflow and fast pace of the ED resembled the OR environment.
Providence staff and the vendor spent 18 months analyzing workflow data and designed a system to improve workflow and overall communications using the ED system as a foundation .
Ready, set, go
In 2002, the hospital began piloting the RTLS application, starting with the asset tracking piece to gain some insight and experience with this new technology before using it for patient tracking. The RTLS system gets a live feed from the surgery scheduling system. It also communicates with nurse call and the wireless in-house phone systems, providing clinicians the ability to know a person's location anywhere across the surgical department, view the unit's current and planned volume in one glance, and rapidly locate and communicate with each other about their patients.
The patient tracking system also enables Providence St. Vincent to check the availability or status of all its preoperative, operative, and recovery beds. When a patient is discharged or transferred from one area to another, for example, the RN assigned to that patient clicks a button on the nurse call system, indicating to housekeeping that the recently vacated bed needs to be cleaned. This alerts the pre-op, post-op, and recovery room charge nurses viewing the tracking system that they shouldn't assign the bed until housekeeping presses a button showing that it has been cleaned and is ready for the next patient.
Before Providence St. Vincent surgical services began using the system, it handled an average of 80 surgical patients a day. Baseline metrics revealed that each patient required an average of 11 phone calls during their visit. The nature of those calls, which lasted about 15 seconds each, ranged from nurses asking colleagues and staff whether patients had arrived, where they were in the hospital, what room they were in, whether an anesthesiologist had seen them yet, whether they were ready for surgery, etc.
Sometimes, staff would inadvertently direct family members to the wrong area, inconveniencing visitors and creating an embarrassing situation when employees were unaware that patients had been moved or transferred to another room or bed.
Since going live with RTLS in 2003, Providence St. Vincent has reduced inter-department phone calls by 82%, saving 4.5 hours a day or a total of 1,125 hours in 2008
Over the past decade, surgical patient volume at Providence St. Vincent has risen from an average of 80 cases per day to ~ 90. RTLS has enabled the hospital to cover the increased space easily and efficiently with the same number of employees it had in 2002 when employees phoned each other, wrote down patient locations on a white board, or walked through the department and visually checked rooms searching for patients, open beds, and mobile equipment. Trying to perform those tasks manually or by phone or on foot over an area twice its previous size would have resulted in extreme inefficiencies and severely disrupted care.
Other benefits received include:
- Improved overall communication among staff and surgery patient families by making information about patient and asset location and status available to all who need it through the Intranet
- Increased monthly add-on case volume by an average of 49 surgeries
- Decreased OR turnaround time from surgery stop to next surgery by 23%
- Improved timely administration of preoperative antibiotics for patients undergoing total joint procedures by 53%
- Boosted average staff satisfaction score from 2.65 to 4.26 points on a 5-point scale
- Generated accurate baseline and measurement data throughout the patient visit that the facility can use to identify clinical and operational areas for improvement
- Reduced time required to source and ensure moveable medical equipment is available before or at the time of surgery
- Enabled clinicians and staff to access location and status of patients round the clock
- Assigned and matched staff to meet needs of post-operative patients with 100% accuracy according to an individual's acuity level
- Ensured staff can immediately notify and direct families to the location of a patient after his or her surgery has been performed
To further enhance return on investment, Providence St. Vincent will integrate the RTLS software with its electronic medical records sometime in the future after the new EMR is up and running. The integration will give clinicians using the patient tracking system easier and faster access to laboratory results, medication lists, and other critical data, enabling them to provide better, faster, safer, and more efficient care.
As providers wrestle with declining reimbursement rates, regulatory mandates, and quality improvement initiatives from third parties, the pressure on them to improve operational efficiency, patient flow, and physician and patient satisfaction will grow and accelerate. For Providence St. Vincent, real-time patient and asset tracking technology is a key to improving care, revenue, productivity, and cost management.
Source: Deborah Tuke Bahlman, RN, is regional manager of surgery information systems at Providence Health & Services, a Portland, OR-based health system that includes 27 hospitals and 214 physician clinics.