The following is a guest article by Troy Foster, Senior Manager of Communications Infrastructure.
Have you ever gone to an appointment at a clinic and sat in the waiting room for exhaustive periods of time only to find out later you were in the wrong waiting area? I remember hearing a story about 5 years ago of an elderly oncology patient who showed up for their appointment at a local clinic. After checking in, she made her way to the 4th floor waiting area and sat waiting to be called. Not wanting to disturb anyone, she continued to sit and wait to be called. Finally, after almost 5 hours she returned to the registration desk only to find out that she had been waiting on the wrong floor in the wrong waiting area the entire time. I can only imagine how embarrassing this was for both the patient and staff.
Health systems are devoting more time and money into improving the overall patient experience in hospitals and clinics. Among other things, these efforts include eliminating semi-private rooms, quiet hospital initiatives, wayfinding and telehealth. One technology that is not often mentioned as a platform that can improve both patient and staff satisfaction is RTLS.
RTLS (Real Time Locating Systems) is a technology that has been utilized in healthcare systems for over 20 years. It is most commonly implemented as part of nursecall installations allowing for automatic cancellation of patient calls based on staff role and presence and the ability to locate and find staff. More recently we are seeing more facilities tagging hospital equipment that can then be tracked and located. Despite the value that RTLS adds to a healthcare facility, widespread adoption continues to be quite low. Sources estimate that fewer than 20 percent of hospitals currently use RTLS today.
For those hospitals that are currently using RTLS today, I thought I’d share some unique and creative ways I’ve seen facilities use the RTLS infrastructure and application to enhance staff workflows and/or patient care.
Patient Tracking – In order to eliminate stories like the one above that I shared, I was privileged to participate in designing a creative way to ensure patients don’t sit waiting on the wrong floor or in the wrong waiting area for long periods of time. At a large 4 story medical office building that specialized in oncology patients, we implemented RTLS across the facility. At this facility, all patients are given an RTLS badge at checkin that they wear throughout the day. We completed an integration with Epic that allowed the patient schedule for the day to flow into the RTLS system and as the patient proceeds throughout the day, we can track how long each stage of their appointment takes.
We also have some rules configured that send a proactive notification to the guest services team if a patient is located in a different area or floor 15 minutes before a scheduled appointment. I watched a patient exit an elevator and turn towards the waiting area only to have a guest services specialist approach and address the patient by name and offer to escort her to her appointment on a different floor. The patient didn’t even know she was on the wrong floor.
RTLS Notification Button – Most RTLS badges have a notification button on them commonly referred to as a “panic button”. It’s often configured to allow staff to press it in the event they need emergency assistance. While meeting with the providers to discuss ways in which RTLS may benefit their workflows, we discovered that one of their biggest challenges was disengaging from patients. Being a cancer center, the providers often had to engage in difficult and emotional discussions with patients and they struggled to disengage.
We came up with a unique solution. If the provider in one of the consult rooms (and only in the consult rooms) surreptitiously pressed the notification button on their RTLS badge, a message is immediately sent to the nurses in the vicinity. The nurse can then come in and gracefully transition the providers out while still providing the patients with someone to talk to. This has greatly enhanced the number of patients providers can see each day while still taking care of the needs of the patient.
Another creative use of the notification button allows environmental services to change a room status from “dirty” to “clean” simply by pressing the button while in the room. Across the facility work areas, a number of flat screens display a map with all rooms and a color status. Green is available, Yellow is occupied and Red is dirty. Upon completion of cleaning and sanitizing a room, anyone with the specified role of “EVS” pushes a button on their RTLS badge and immediately changes the room status to Green giving guest services immediate awareness of room availability.
Rounding – While working with several hospital inpatient units, I’ve seen rounding compliance rise significantly by using RTLS. Often in conjunction with the nursecall system, RTLS insures nurses check in on patients usually at least once per hour and can report out on compliance metrics. At an MOB I’ve worked with they have a policy that patients are not left alone in any stage of their visit for more than 15 minutes and they use RTLS to monitor and send alerts to staff if a patient wait timer exceeds this threshold.
Hybrid Wifi/IR/RF/BLE/RFID/Ultrasound – Because of the relatively high cost of deploying housewide RTLS, more and more hospitals are embracing a hybrid approach. Wifi is generally already available across most facilities and requires almost no infrastructure to add RTLS except for tags and an application layer. It is ideal for asset tracking as it can report back on a relatively small general area that a particular piece of equipment can be found. However, Wifi cannot guarantee room level staff locating which is necessary for nursecall systems to enable automatic cancelling of room alerts when a caregiver enters the room.
Most RTLS vendors now offer hybrid asset tags that work on both Wifi and room level locating technologies. This also allows hospitals to more easily phase RTLS into their environment. If nursecall is being deployed, they can include RTLS and add room level locating capabilities at the same time. If the cost of closing down rooms to add RTLS is cost prohibitive or if the timeline to complete is extensive, facilities can quickly deploy asset tags using existing Wifi capabilities.
Advancements in both the infrastructure costs and capabilities of RTLS systems continues to evolve and advance. The holy grail for many in IT leadership is a Wifi only RTLS system that is capable of room level locating but I can remember having discussions with IT leaders 15 years ago who predicted that functionality in “one or two years” and here we are today. RTLS vendors need to do a much better job of partnering with their clientele to identify additional ways facilities can add functionality to their RTLS infrastructure. I also maintain there is a lot of opportunity to explore infrastructure options and find ways to more easily and more inexpensively deploy an RTLS platform. As healthcare facilities continue to explore more creative ways to maximize the investment in RTLS, I’m excited to see what the future will bring in the RTLS space.
About Troy Foster
Troy has been working in healthcare for almost 25 years. He has worked as a consultant, vendor and internally within hospital IT. Troy has spent the past 5 years as the senior manager of communications infrastructure at Stanford Hospital. Troy’s background includes extensive experience in nursecall, secure messaging and alert/alarm middleware as well as several other communication and clinical IT systems and he has presented at numerous conferences across the country. Currently, Troy is heavily involved in the activation of a new 850,000 sq foot hospital.