Real-Time Location, Real Process Improvement

If you’re going to roll out a real-time location system (RTLS) to track equipment and people throughout a hospital, your ideal starting point is a new facility fresh for the outfitting with transmitters and tags. Such was the opportunity before Our Lady of Lourdes Regional Medical Center in Lafayette, La., in the mid-2000s. The 186-bed, 420,000-square-foot center opened in June of 2011, the culmination of five years of planning to replace a fading facility built more than six decades earlier.

Today, fully settled in its new home, Lourdes uses RTLS to track more than 1,300 of the approximately 4,000 items in its medical equipment inventory and about 300 employees out of a staff of 1,200. That’s just for starters, as the implementation is an expanding work in progress, says Terry Broussard, VP of support services, who co-led the rollout once the move was complete.

According to the research firm KLAS, only 10 to 15 percent of hospitals were using RTLS in 2012. But industry watchers expect the technology to proliferate soon, as 95 percent of the hospitals responding to the KLAS survey said their use of RTLS had yielded gains in operational efficiency. Allied Market Research says healthcare is the top industry investing in RTLS, spending around $25 billion a year in the U.S.

“We went through a triage prioritization of both assets and staff as to whom and what would be tagged first,” following an evaluation of the hospital’s various critical processes, explains Broussard. “I got intimately involved in RTLS because I headed patient care services at the time and every nursing assistant would have a staff tag.” Tied for first or close behind were nurses, respiratory therapists, physical therapists, food services personnel, housekeepers and clinical engineers.

The head of central supply spearheaded the asset rollout—tagging everything from one vacuum cast cutter to 16 translation cellphones to every patient bed, gurney and wheelchair—while Broussard “became the poobah over the staff tags,” he recalls. “I’m the contract owner for the site here under plant operations, and he works under system-level leadership so we collaborate a lot.”

The parent organization to which Broussard refers is the Franciscan Missionaries of Our Lady Health System, which drew from its previous experience deploying RTLS in three of its other facilities to place Lourdes near the front of the pack of RTLS adopters in healthcare.

Whereabouts & Conditions

Lourdes initially chose a single vendor to provide both hardware and software. But, during implementation, the hospital settled on a two-supplier solution to garner greater ability to pinpoint the exact location of tagged products and people.

Upon receiving signals sent by CenTrak infrared emitters mounted around the facility, staff badges and asset tags transmit 900 MHz signals to radiofrequency identification (RFID) readers. The readers, functioning as wireless network devices, route information to the hospital’s server, where the data are interpreted by Skytron asset management software.

Employees granted password-protected access to the database can see not only precisely where a given asset is located—a major timesaver in its own right—but also obtain such useful details as whether a device is up and running or down from service, as well as if it’s scheduled for preventive maintenance or subject to a recall. They also can receive alerts when, for example, a busy wheelchair bay needs to be replenished.

Meanwhile information from the staff tags enables tracking and documentation of various performance and efficiency measures. For example, a nursing manager can call up a display showing how much time nurses, both individually and as a group, spend with patients. The manager also can instantly see which bedside a nurse on rounds is visiting, and then use the nurse-call system in the room to “call an audible” if the nurse is suddenly needed elsewhere.

Asked about staff acceptance of the “Big Brother” factor inherent in employee tracking, Broussard says he has heard very few objections along those lines. He credits the parent organization’s pre-move communications efforts and orientation sessions, which built enthusiasm around efficiency gains and teamwork opportunities.

Minor Objections

Brittney Wilson, a clinical informatics nurse at an unaffiliated community hospital in Georgia, and a self-proclaimed technology advocate—she blogs as the Nerdy Nurse—has one bone to pick with RTLS.

“Sometimes a nurse checks on a patient without going all the way inside the room,” she explains. “The nurse says, ‘I promise, I checked on that patient’ while the computer says, ‘Oh, no you didn’t. I have no record of it.’” The worst part of this scenario, says Wilson, is not the frustration of the nurse. It’s the need to have a sensor ping a staff tag. “This can force the nurse to inconvenience the patient, entering the room unnecessarily not to improve care but to satisfy the computer.”

An industry observer from the RTLS vendor side points out that, when a hospital heavily invests in the technology only to run into formidable roadblocks during rollout and implementation, the problem can usually be traced to “upside-down” internal communications. “Sometimes you see end-users letting their IT people lead them on what they should purchase and how they should use it,” he says. “It should be the other way around, with the end-users telling the technical people what they’d like to do. It’s good to get clinical informatics folks involved, where they can be a bridge between the clinicians and the technical people.”

At Our Lady of Lourdes, Broussard is planning ahead and hopes to soon add a duress button to the employee tags to instantly summon help in a medical or security emergency and functionality for monitoring hand-washing compliance. He also wants to incorporate wristband tags for patient tracking.

The return on investment to date is a challenge to measure, Broussard says. While he can’t share numbers, he says “a lot of people are saying it’s not as profound as we’d like it to be.” However, the organization has put the full investment into the system but only one-quarter of the equipment and one-quarter of the staff are on the system. “So, when they look at the ROI on just that one-quarter, and multiply it by four as if we were tracking everything, I believe my peers can see how positive our return on RTLS is going to be in the long run.”