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Service Delivery Innovation Profile

Real-Time Location System Tracks Staff, Patients, and Equipment, Reducing Costs, Improving Infection Control and Room Turnaround, and Generating High Satisfaction


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Snapshot

Summary

Two hospitals (a 40-year-old flagship facility and a new 58-bed facility) that are part of the Texas Health Resources health system use a real-time location system enabled by radio frequency and infrared identification technology to monitor the location of major pieces of equipment; one hospital also uses it to monitor the whereabouts of patients and staff, and the second hospital is in the process of adding this capability. Integrated into other information systems within the hospitals and overseen by a centralized “mission control” unit, the system is used to improve various clinical and nonclinical processes, including asset management, infection control, room turnover, and transportation. It is not used in a punitive manner with staff. The system has significantly reduced annual equipment costs, room turnaround time, and staffing costs, and contributed to high levels of patient, physician, and staff satisfaction.

Evidence Rating (What is this?)

Moderate: The evidence consists of pre- and post-implementation comparisons of equipment rental costs at one hospital using the real-time location system, along with post-implementation comparisons of room turnaround times and budget allocations for equipment shrinkage (lost equipment) at hospitals that do and do not use the system. Additional evidence includes post-implementation feedback from patients, physicians, and staff on their satisfaction with various processes influenced by the system.
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Developing Organizations

Texas Health Resources
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Use By Other Organizations

The University of Maryland Medical Center uses radio frequency and infrared identification tags to track emergency medications found in crash carts.1 Oregon-based Sacred Heart Medical Center at River Bend uses them to track the location of infusion pumps and ensure that each unit remains above its periodic automatic replenishment level.2

Date First Implemented

2008
Texas Health Presbyterian Hospital Dallas (a 650-bed, 40-year-old facility) began using the real-time location system to track high-value equipment in 2008. Texas Health Harris Methodist Hospital Alliance (a 58-bed facility) has used a real-time location system to track patients, staff, and high-value equipment since opening in September 2012.

Problem Addressed

Most hospitals experience bottlenecks and inefficiencies because of their inability to track the location and recent movements of patients, staff, and equipment in a timely manner.
  • Lack of timely information: The typical hospital has no easy or timely way to accurately track the location and movement of patients, staff, and high-value pieces of equipment, such as wheelchairs, beds, and infusion pumps. For example, no mechanisms exist to quickly find out which individuals and pieces of equipment have come into contact with a patient discovered to have an infectious disease, when a patient has been discharged (meaning his or her room is ready for cleaning), or where a missing piece of equipment is located.
  • Resulting bottlenecks and inefficiencies: This lack of timely and accurate information can lead to bottlenecks and inefficiencies. Among many others, examples include delayed and inaccurate information to guide infection control processes, significant amounts of staff time spent searching for missing supplies and equipment, costly delays in returning rented equipment, and delays in initiating room cleaning after discharge, which in turn can create bottlenecks in admissions, the postanesthesia care unit, and the emergency department (ED).

What They Did

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Description of the Innovative Activity

An image of a patient wearing an RFID tag on his wrist.

Figure 1. Patients at Texas Health Harris Methodist Hospital Alliance wear the RFID tags on their wrists. Click the image to enlarge. Image courtesy of Kathi Cox. Used with Permission.

Two Texas Health Resources (THR) hospitals—a large 40-year-old facility and a new smaller facility—use a real-time location system enabled by radio frequency and infrared identification (RFID) technology to monitor the current location and recent movement of major pieces of equipment; one hospital (the new facility) also uses it to monitor the whereabouts of patients and staff, with the other hospital is currently adding this capability. Integrated into other THR information systems and overseen by a centralized mission control unit, the system is used to improve various clinical and nonclinical processes, including asset management, infection control, room turnover, and transportation. Hospital leaders prohibit its use in a punitive manner with staff. Key program elements are outlined below:
  • Real-time location system enabled by RFID technology: At the new 58-bed Texas Health Harris Methodist Hospital Alliance, all patients and staff (including the president and other senior executives) wear an RFID tag, with patients receiving a brief tutorial on the tags and the rationale for them during the admission process. Tags are also placed on high-value equipment and supplies that frequently get moved around the hospital, including infusion pumps, sequential compression devices, wheelchairs, beds, and telemetry boxes. At the 40-year-old, 650-bed Texas Health Presbyterian Hospital Dallas, tags have been placed on high-value equipment, both owned and rented, and implementation with staff and patients is currently under way. In both hospitals, monitors are placed in heavily traveled areas throughout the facility, including patient rooms, operating rooms (ORs), EDs, hallways, and public areas. These monitors receive signals from the RFID tags, thus enabling the system to know the real-time location of any tagged person or piece of equipment. (Figure 1 shows a patient wearing an RFID tag, and Figure 2 shows a staff member wearing one.)
  • An image of an employee at Texas Health Harris Methodist Hospital Alliance wearing an RFID tag on his collar.

    Figure 2. Employees at Texas Health Harris Methodist Hospital Alliance also wear RFID tags. Click the image to enlarge. Image courtesy of Kathi Cox. Used with Permission.

  • Centralized mission control overseeing multiple operational areas: Information from the system feeds into a centralized mission control unit staffed 24 hours a day by individuals who have been cross-trained to handle various aspects of hospital operations, including transportation, security, and communications. At the 58-bed hospital, 2 to 3 individuals staff this unit at any given time.
  • Integration with other information systems: The real-time location system ties into various information systems used by the hospitals, including those operated by outside vendors. For example, at the 58-bed hospital, the location system interfaces with the hospital’s capacity management system and wireless communication system (which handles all internal communications, including patient call buttons). At both hospitals, the system communicates directly to outside vendors that supply rental equipment.
  • Various uses to improve clinical and nonclinical processes: The system supports many routine clinical and nonclinical processes throughout the hospitals. Examples of how it is used in one or both hospitals appear below:
    • Asset management and allocation: At both hospitals, the system allows high-value equipment to be tracked in real time, thus reducing the risk of lost or missing items and allowing equipment to be reallocated across departments and units as needs arise. Going forward, THR leaders would like to use the system in a similar manner to share equipment and resources across the system’s many hospitals and facilities. Examples of how the system improves asset management in one or both hospitals are described below:
      • Overnight movement of infusion pumps across units: At the new 58-bed hospital, mission control staff on the overnight shift make sure each unit has the necessary number of infusion pumps available for staff arriving on the morning shift. (Each unit should have at least 24 pumps, known as the periodic automatic replenishment [PAR] level for the unit.) During the day, these pumps commonly move as patients get transferred throughout the hospital, meaning that by day’s end some units end up with too many pumps and some with too few. The system enables overnight staff to move pumps from units with excess supply to those that need them, bringing each unit up to PAR level and eliminating the need for nurses arriving on the morning shift to spend time looking for and moving pumps (a common occurrence at many hospitals).
      • Rental equipment return: At the 650-bed flagship hospital in Dallas, the real-time location system facilitates the timely return of expensive rental equipment. Whenever a piece of rented equipment is no longer needed, the nurse presses a button that automatically sends a signal to the rental company to pick up the item. The driver knows where to pick it up based on the signal from the system. The new 58-bed hospital added this capability recently, in response to growth in patient volume that has led to greater reliance on rented equipment.
    • Supply transport: After the new hospital opened, leaders noticed that supply deliveries on the units tended to coincide with peak times for patient transport, leading to frequent bottlenecks. Data from the tracking system identified these peak times, leading to the decision to move significant amounts of supply transport activity to the overnight shift so as to minimize congestion. This overnight activity does not disturb patients, as the new facility has sound-minimizing walls and supply closets and equipment storage areas that are located away from patient hallways.
    • Infection control: In the absence of the system, a hospital faced with a newly identified infectious patient typically sends out a mass notice to all employees requesting that anyone who recently came into contact with the infected patient notify the infection control department. This process depends on the (often faulty) memories of employees, along with their willingness to report honestly. By contrast, with the real-time location system, infection control staff can quickly and easily identify anyone and anything that came into contact with the infected patient during the relevant time period. (In a simulated exercise evaluating a typical short ED visit, this review identified 23 staff from 17 different departments, including nurses, technicians, paramedics, and others.) The hospital can then take whatever steps are necessary to minimize spread of the infection, including quarantining, immunizing, and/or inoculating staff and sterilizing potentially contaminated equipment.
    • Room turnover: Whenever a patient at the new hospital is discharged, the individual who transported the patient to the front door removes the patient’s wristband and places it in a discharge bin. This action automatically triggers an electronic notice that transmits the patient’s room number to the environmental services department, letting them know the room is available for cleaning. Centralized logistics staff can then see when staff responsible for cleaning have entered and left the room and hence know on a real-time basis when it is ready for a new patient.
    • Staff response to patient call button: At the new hospital, the patient call system has multiple buttons, including one for pain, one to request water, one to indicate the need to use the bathroom, and one general button for all other issues. (Patients receive education on this system from a nurse or technician when they are first oriented to the room shortly after admission.) If the patient pushes the toilet or water button, the system automatically alerts the nearest available technician, thus ensuring that nurses need not spend time handling these issues. If the patient pushes one of the other buttons, the system automatically alerts the nurse responsible for that room. If the nurse does not respond within an established time threshold, the system alerts a second nurse, with the process continuing and eventually reaching a nurse manager if no one else is available. Once someone enters the room to address the patient’s need, the system automatically turns off the call button, eliminating the need for staff to do so.
    • Identification and management of excessive wait times: Built-in rules within the system set the maximum wait time for patients in different departments. For any patient about to reach this maximum, the system sends an alert to the badge of the person in charge of that department. The manager can use this information in multiple ways. If a specific problem is holding up care for that patient, he or she may intervene to address the issue. If a systemic issue has created a backup for all patients, the manager can work with staff to address the underlying problem and alert front-desk staff of the need to explain the delay to patients and let them know how long they can expect to wait. Often acknowledging the delay and setting appropriate expectations go a long way toward keeping patients satisfied with their care.
    • Communication with family and other visitors: The system allows staff to inform a newly arriving visitor of the patient’s whereabouts. If a patient is off the unit for a test or other procedure, staff can often provide an estimate of how long the patient will be there, since they are aware of standard wait times in each area.
  • Prohibition on use for punitive purposes: THR and hospital leaders have explicitly forbidden use of the system to punish staff in any way. Consequently, staff need not fear that information from the system will be used to reprimand them, such as for spending too much time at their desks, on breaks, or at lunch.

Context of the Innovation

THR is a faith-based, not-for-profit health care delivery system with 25 owned or affiliated acute care and short-stay hospitals serving 16 counties in north central Texas that are home to more than 6.2 million people.

The impetus for the program came from leaders at the 650-bed Texas Health Presbyterian Hospital in Dallas, who decided to implement a real-time location system as a way to reduce the costs of high-value equipment, including rental equipment. This program generated significant cost savings in its first year. (Details on the program’s impact appear in the Results section.)

When the time came to plan for the new 58-bed hospital, the president of the new facility (who previously worked at Texas Health Presbyterian Hospital Dallas) decided to make the hospital a showcase of modern technology and best practices, including widespread use of the real-time location system.

Did It Work?

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Results

The system has significantly reduced annual equipment costs, room turnaround time, and staffing costs, and contributed to high levels of patient, physician, and staff satisfaction.
  • Significant reduction in annual equipment costs: The system has reduced equipment-related costs at both hospitals. At the 650-bed flagship hospital, the system generated nearly $1 million in savings the first year, including roughly $285,000 on rental equipment, $100,000 on budgeting for "shrinkage" (the common practice of intentionally purchasing more equipment than needed because of missing items), and more than $600,000 in procurement-related expenses because of better utilization of equipment. At the new hospital, the system allowed leaders to avoid budgeting any money at all for shrinkage—by contrast, many hospitals routinely add 35 percent or more to their equipment purchase budget to account for missing and lost items.
  • Faster room turnaround: At the 58-bed hospital, room turnover occurs more quickly than at any other THR hospital, averaging 40 minutes, well below the 47-minute average for the system as a whole.
  • Lower staffing costs: While hard data are not available, the centralization of communications, transport, and other operational functions requires fewer staff than the typical decentralized approach. For example, when working in separate departments, telephone operators and transporters often have significant periods of downtime. With the centralized approach, downtime tends to occur much less frequently.
  • High patient, physician, and staff satisfaction: The 58-bed hospital enjoys very high patient satisfaction rates, which leaders believe are due in part to the timely, high-quality services enabled by the real-time location system. For example, in 2013 the hospital ranked in the 95th percentile or higher on patent satisfaction ratings for the following categories directly related to the system: promptness of response to call bell, pain control, and wait time in the ED before being admitted to the hospital. Physician satisfaction with the hospital's information technology ranks in the 92nd percentile, with 10 percent of physicians specifically listing technology as one of the hospital's greatest strengths. In addition, overall employee satisfaction ranks in the 90th percentile at the hospital.

Evidence Rating (What is this?)

Moderate: The evidence consists of pre- and post-implementation comparisons of equipment rental costs at one hospital using the real-time location system, along with post-implementation comparisons of room turnaround times and budget allocations for equipment shrinkage (lost equipment) at hospitals that do and do not use the system. Additional evidence includes post-implementation feedback from patients, physicians, and staff on their satisfaction with various processes influenced by the system.

How They Did It

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Planning and Development Process

Planning and development for the real-time location system at the new hospital began roughly 1.5 years before it opened; key steps are outlined below:
  • Creating principles and related “use cases” for system: The hospital president and the project manager worked together to develop key principles for the real-time location system, including that it be used to improve patient satisfaction and the quality and efficiency of care. Consistent with these principles, the two subsequently created a series of specific applications for the system (hereafter referred to as use cases), including asset management, infection control, and room turnover.
  • Meeting with vendors as a group: The president called a meeting of all major vendors that already had relationships with THR, along with a few that did not. Roughly 100 individuals attended the session, during which the president shared her vision for the hospital, including the desire for it to be on the leading edge technologically. The president made it clear that any vendor that wanted to partner with the new facility would have to integrate their systems and products with those of the hospital. In some cases, this integration process would require competing organizations to integrate product offerings with each other, since several target use cases require different vendors’ systems to interface and communicate.
  • Selecting hardware and software: THR already used a software system throughout the organization, and leaders decided to continue working with that vendor (Intelligent InSites) to integrate the real-time location system. With respect to hardware, the project manager first worked with the information technology team to investigate available options and then issued an extensive request for proposals. This process began about a year before the hospital opened and concluded roughly 4 months later with the decision to contract with CenTrak for the RFID tags, monitors, and other needed hardware and equipment.
  • Educating staff as part of hiring process: Senior leaders made it very clear during the interviewing process that all staff would be required to wear the RFID tag and that their location would be tracked throughout the day. This communication occurred as part of a broader message about the president’s vision for the facility as a leader in cutting-edge technology and best practices to improve the lives of patients and staff.
  • Testing and implementing system in iterations, beginning with high-priority use cases: Implementation and testing occurred over a roughly 4-week period right before and after the hospital opened (since testing of some components required the presence of patients). The initial implementation featured only two high-priority use cases: asset management (chosen because it offered significant potential for an early “win” through cost savings) and real-time discharge notification (chosen because it required the integration of three different systems and hence served as an early test of the hardware). Implementation of the other use cases occurred gradually over time.
  • Training staff: Staff received extensive training on the real-time location system as part of a broader, comprehensive program held for all employees in the weeks before the hospital opened. Regular training continued after the hospital opened, with the frequency diminishing over time as staff got used to the various technological features of the new facility. Training sessions still occur on a periodic basis, typically focused on specific issues that tend to be challenging for those who do not use the real-time location system every day. For example, a recent session reviewed how to use the system to find missing equipment and run various analytical reports.
  • Forming multidisciplinary committee: The hospital created a multidisciplinary committee to oversee the system on an ongoing basis, including managing use cases and approving equipment purchases and the reallocation of assets. (A similar committee exists at the flagship facility in Dallas.)

Resources Used and Skills Needed

  • Staffing: Three staff work part-time on various aspects of maintaining the system, including someone at the corporate level who oversees the "back end" of the system and two individuals at the 58-bed hospital—one who manages the tags and related infrastructure and one who develops and executes the strategic vision for the system, including its ongoing growth and reporting/analytical capabilities. Other hospital-based staff use the system as part of their regular duties.
  • Costs: Data on upfront costs for this type of system are not available, as the costs vary significantly depending on how an organization wants to use the system (i.e., what use cases will be deployed). Upfront costs will generally be higher in an existing facility than in a newly constructed one, because older facilities tend to have features (e.g., concrete walls, wiring) that may limit the range of the monitors (and hence require more of them). In addition, installation will be more time consuming and expensive if installers must navigate around existing patients and staff (as opposed to installing the system during the construction phase). Ongoing costs include system maintenance and annual budgeting for locator tags. Hospitals can choose to use either disposable or reusable tags; those using reusable tags still must budget each year for their purchase to account for those that reach the end of their useful life and to accommodate growth in the number of patients, employees, and/or pieces of equipment being tagged.
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Funding Sources

Texas Health Resources
THR covers the upfront and ongoing costs of the real-time location system at both hospitals.end fs

Adoption Considerations

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Getting Started with This Innovation

  • Define principles and use cases: This process ensures that money spent developing the system will be targeted at areas likely to have a positive impact on hospital operations and also helps in communicating the rationale behind the system to key stakeholders, including physicians, employees, and patients.
  • Start small: Consider starting with a few high-priority use cases, particularly those likely to generate immediate benefits, such as asset management. In some cases, it might make sense to roll out individual applications in an iterative fashion as well. For example, the rollout of the asset management application could begin with the tagging of just one or a few types of high-priority assets before expanding to other types.
  • Repeatedly emphasize ban on punitive uses: Senior leaders must make it clear that the system will not be used in any way to punish individual employees. This message should be “front and center” in all communications about the program during the planning stages and the early period after implementation. Over time, the message should resonate with staff, and any associated concerns about using the system for “big-brother” purposes should decline.
  • Make sure everyone (including leaders) wears tags: All senior executives, including the president, must “walk the talk” by wearing an RFID tag at all times. This approach sends a strong message that no one is exempt and lends credibility to the pledge that the system will not be used for punitive purposes.

Sustaining This Innovation

  • Offer regular training and refresher sessions: The need for training and refresher sessions will continue for a significant period of time, as staff need regular reminders about how to use certain aspects of the system.
  • Expand to additional use cases once system proves itself: Once the limited rollout of the system demonstrates its ability to save money, improve patient care, and/or make employees lives easier, hospital leaders and staff will very likely support efforts to expand it to other areas.

Spreading This Innovation

THR is expanding the use of RFID tags for equipment, staff, and/or patients to other hospitals in the system.

Use By Other Organizations

The University of Maryland Medical Center uses radio frequency and infrared identification tags to track emergency medications found in crash carts.1 Oregon-based Sacred Heart Medical Center at River Bend uses them to track the location of infusion pumps and ensure that each unit remains above its periodic automatic replenishment level.2

More Information

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Contact the Innovator

Kathi Cox, CPHIMS
Project Consultant
Texas Health Harris Methodist Hospital Alliance
10864 Texas Health Trail
Fort Worth, TX 76244
(682) 236-3048
E-mail: kathicox@texashealth.org

Innovator Disclosures

Ms. Cox reported having no financial or business/professional relationships related to the work described in this profile.

References/Related Articles

Baum S. Texas hospital generates big data insights from RFID tags for staff, patients. MedCity News. December 4, 2013. Available at: http://medcitynews.com/2013/12/rfid-big-data-intersect-texas-hospital-pointing-future-healthcare/.

Schwartz E. Hospitals wringing big savings out of RFID, sensors. mHealth News. December 30, 2013. Available at: http://www.mhealthnews.com/news/hospitals-wringing-big-savings-out-rfid-sensors-mhealth-mobile.

Footnotes

1 Schwartz E. Hospitals wringing big savings out of RFID, sensors. mHealth News. December 30, 2013. Available at: http://www.mhealthnews.com/news/hospitals-wringing-big-savings-out-rfid-sensors-mhealth-mobile.
2 Swedberg C. PAR-level RTLS solution saves costs at Oregon hospital. RFID Journal. February 17, 2012. Available at: http://www.rfidjournal.com/articles/view?9234.
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Original publication: August 27, 2014.
Original publication indicates the date the profile was first posted to the Innovations Exchange.

Last updated: August 27, 2014.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.

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