A look at RTLS technologies in terms of achievable ROI based on a whole-hospital approach to RTLS, and the business intelligence afforded by location visibility
by Ekahau
With the Real-Time Location Systems (RTLS) market estimated to reach $4 billion by 2022, healthcare facilities will continue to invest in active RFID (Radiofrequency Identification) technology in order to improve patient experience and care outcomes. While there are many technology options on the market, it is important to understand the most impactful use cases,
RTLS, RFID and GPS solutions belong to a family of technologies referred to as location-based services (LBS). Location-based services are leveraged in many industries –social media, manufacturing, oil and gas, retail and healthcare. Most users are familiar with GPS-based smartphones applications which offer an outdoor locating platform. Indoor location tracking is provided by RTLS solutions, using radiofrequency identification (RFID) technology and existing Wi-Fi networks in enterprise buildings.
Today, the most popular and widespread use cases for RTLS go beyond basic asset tracking and search/find map features. An emerging breed of cost-effective and advanced RTLS solutions are being used to improve staff safety, meet regulatory documentation requirements, drive caregiver productivity, automate workflows, ensure security and prevent loss and improve patient experience tied to reimbursements.
In addition, many of the savings and productivity gains require a whole-hospital RTLS network to deliver ROI. Many dedicated, non-Wi-Fi systems provide a high degree of location accuracy for niche applications. These systems are rarely deployed hospital-wide as they are cost-prohibitive due to the cabling requirements; therefore, much of the value of location-based business intelligence, workflow savings and automation is lost to facilities considering these solutions.
RTLS in healthcare
Healthcare organizations are moving away from partial RTLS deployments that focus on super-fine shelf-level accuracy (primarily used in pharmacy tracking applications) and are instead concentrating on whole-hospital adoption of RTLS in order to improve operations and patient experience. Trends indicate that hospitals want to do more with less and that their RTLS investment is no exception to this philosophy. Enterprise-wide RTLS adoption reduces the cost of care by tracking a broad variety of workflows related to caregivers and common care tasks, automating workflows where possible to remove manual efforts and improving patient safety along with experience.
Big data and cloud computing are the most significant trends driving the need for whole-hospital RTLS adoption beyond basic asset tracking. By leveraging the right RTLS solution, hospitals can take location data and analyze trends that transform operations. RTLS provides a means of revealing business intelligence otherwise unseen and untapped. A premium is now placed on usability, ease of integration to third-party applications and RTLS solutions that consume little management time and expense.
Each RTLS provider offers benefits and deficiencies, depending on a facility’s use cases. By leveraging RTLS solutions, healthcare facilities can eliminate costly manual processes and reduce the time that employees spend on administrative tasks while preventing capital equipment losses, theft and under-utilization resulting in over-ordering.
Location-aware messaging
Routine workflows and administrative tasks often require process changes and managerial oversight and take time to implement hospital-wide. In other words, change is a challenge. For example, adopting a best practice such as hourly nurse rounding can significantly improve patient satisfaction scores but it requires enforcement and monitoring by Chief Nursing Officers (CNOs)3. This effort could be minimized with an automated, timed reminder system to monitor patient activity — or inactivity — with RTLS. In many healthcare facilities, nurses must multi-task a variety of responsibilities or must peer into patient rooms and use their best judgment before rounding, reducing the likelihood of rounding efficiency. Improving caregiver-patient interaction can be as simple as a button push on an RFID tag. Rounding is simplified and improved with RTLS monitoring and reminder text communications based on patient activity or nurse call button pushes.
Caregivers can communicate using location-aware messaging that sends notifications to an individual patient or groups of patients based on their status or location, direct from RTLS tags or badges. Patients in waiting rooms can be queued using a RTLS badge with a text feature. The text feature can tell them where to go based on timing or location, eliminating unnecessary waiting. These systems can also send an alarm to an ED manager if a patient has exceeded wait time benchmarks, impacting Joint Commission compliance. With the healthcare industry‘s continued adoption of RTLS for patient queuing, waiting rooms could become obsolete.
In long-term care facilities, caregivers can send RTLS pre-program medication reminders that appear on resident wristbands or buzz residents. These automated reminders can be customized so that residents receive the message any time their location changes, (e.g., as they’re leaving their room). Residents (or possibly even caregivers) can also press a tag button after medicine is administered to record the time when medication when administered for integration into a patient’s record. RFID badges with a text feature offer many possible workflow adaptations to create strong hospital ROI.
Patient monitoring
Monitoring patients is labor-intensive. Caregivers need to be available to help those with the most needs but also keep watch over all patients. Real-Time Location Systems with messaging capabilities allow patients to use RTLS badges or wristbands as nurse call buttons on-the-go. Patients can stay ambulatory and caregivers can remotely monitor their patient at all times. By empowering more capable patients and allowing them to pick-up their own X-rays and perform other basic tasks, caregivers have more time to serve those most in need, making the best use of existing staff.
Some new RTLS tags are built with motion detectors. These solutions offer location-based ‘geo-fencing’, to alert caregivers when a patient wanders nearby a stairwell or restricted areas. Badges with LEDs and buzzers can trigger an alarm –customizable for silent or auditory — telling the patient to avoid entry into a dangerous zone. In addition, caregivers can receive geo-fence alarm notifications showing the patient’s location, a faster way to identify and respond to a patient safety issue than coordinating with security teams or scanning video surveillance systems to find the patient’s location.
Automating temperature
Temperature and humidity play a key role in infection control. The average hospital owns and maintains hundreds of food, blood, bone, tissue and medication refrigeration units. The storage of pharmaceuticals, tissues, organs and other items in refrigeration units are critical to hospital workflows and patient safety from infection. Also, humidity is an important factor to minimize infection. For example, ORs should not have a relative humidity (RH) below 40% because the risk of infection can increase above this point, potentially impacting surgical procedures and patient safety. If temperature and/or humidity levels are compromised, a hospital can violate Joint Commission recommendations and increase risk to patients.
Today, most hospitals use manual logs, also known as the ‘clip board’ method, to track temperature or humidity. This manual tracking requires professional staff to complete the repetitive yet important task of ensuring temperature and humidity compliance. But manual temperature logs are also susceptible to human error; allowing professional staff to concentrate on less administrative tasks would optimize this record-keeping. RTLS solutions can automatically and wirelessly detect temperature and humidity breaches. Some solutions even proactively alarm via on-badge texts and alarms as temperature or humidity come closer to breach thresholds and trigger an audible buzz in the sensor itself so that those near the refrigerator can act before a breach occurs.
Forensics
Ensuring fire safety is one of the most frequently cited deficiencies documented by the Joint Commission4. That is why some RTLS software programs offer post-event analysis such as a ‘breadcrumb trail’. This feature allows hospital administrators and first responders to replay recorded event movements that show where people and assets moved over a period of time. Real-time forensics allows healthcare facilities to establish emergency plans, tag staff and then run simulations that determine emergency response effectiveness. Viewing real-time movement histories also allows managers to calculate the time spent on tasks and compare areas of the facility with the most- and least- efficient emergency response times to create future improvements. Advanced RTLS software can help hospitals lower equipment capital expenditures and rentals. With real-time visibility, managers can track equipment, prevent loss or theft, monitor par levels and utilization (dwell times vs. time in use), optimize equipment availability and improve patient throughput and healthcare operations.
Tracking
The average hospital invests approximately $200,000 in equipment (acquisition value) for each staffed bed and $3,000 in equipment per patient discharge5. Second only to staffing costs, hospitals spend a significant portion of their capital budgets on vital medical equipment6. The average hospital owns or rents a total of approximately 35,000 SKUs of equipment at any given point; it makes sense that supply chain costs consume as much as 40% of total operating budgets. Inventory optimization can account for 10% of overall savings. With such a large amount of the hospital’s budget spent on medical equipment, hospitals cannot afford the cost of poor asset management expenditures. Without an effective asset tracking solution, asset and equipment management becomes a guessing game.
Most hospitals re-order missing — or misplaced – equipment. Missing rental equipment must be replaced for hospital use; in addition the lessor also must be reimbursed for the missing equipment. Ineffective equipment management means that the hospital will end up paying for one piece of equipment three times. Beyond the loss of assets, the impact of lost hospital productivity due to lost and missing equipment is substantial and can delay basic processes such as hospital discharges, admissions and transports.
Advanced RTLS solutions allow caregivers to find staff assets quickly and essentially ‘see through walls’, saving the time it takes to look in every closet and room for a wheelchair, wound vacuum, IV pump and other equipment. Caregivers simply log into the RTLS software and search by using a web browser on a campus-wide map to find what they need. Caregivers can view assets on real-time floor plans and search for a particular asset, a group of assets such as “all IV pumps,” or use a combined search such as “IV pumps located in the third floor OR” without having to waste time walking around to find equipment.
Using location-based intelligence, hospital administrators can focus on their problem areas to prevent the estimated $4,000 of equipment per bed that is lost or stolen in the average hospital annually. This means that a 300 bed hospital could be losing $1.2 million dollars of equipment each year7. Yet even with the significant equipment losses occurring each year, most hospitals continue to live with the inefficiencies of an un-monitored, manual equipment tracking system.
Some caregivers may hoard equipment to ensure their patients receive quality care. This is a systematic response to ineffective asset management that can be avoided by employing RTLS. Many hospitals find that assets can be accidently dumped in laundry chutes, lost or removed from campus altogether. RTLS can help prevent these losses by sending an alert if equipment accidentally or illegally leaves the premises. Alerts can be sent based on entry into pre-programmed restricted ‘geo-fenced zones’ (e.g., entryways/exits) and an alarm automatically sent to security teams via text, email or page to prevent equipment losses before they occur.
Automation
The newest breed of RTLS solutions automate work order management and work confirmation via tag button press. By automating equipment related workflows, equipment utilization rates increase over time and common tasks such as sterilizations and cleaning, repairs and scheduled preventative maintenance are optimized. If equipment requires immediate attention (e.g., cleaning), caregivers can trigger a service request by pressing an asset tag’s button. And if equipment leaves pre-programmed zones (e.g., restricted departments/floors) or moves closer to exits, alerts can be sent to prevent theft and loss before equipment leaves the premises.
Automated alerting based on location-awareness streamlines workflows. For example, some RTLS software allows managers to monitor and receive an alarm when equipment levels are under par (especially in critical areas such as an Emergency Department (ED)). When equipment par levels are low, in certain locations based on equipment dwell times and presence detected in rooms, RTLS software can send alerts to pagers, email addresses, badges and mobile devices so that administrators can prevent over-ordering, reduce inventory. Administrators can even improve speed of cleaning by increasing staffing levels on certain days, but not on others based on the par level business intelligence. The systems can also drive healthcare revenues such as categorizing patient queuing to reduce wait times, improving bed management and shortening the time it takes to complete basic processes like a transport or discharge. RTLS can also improve productivity and lower the cost of ensuring safety while improving safety overall. Ultimately, it is not just about tracking things; it is about creating a positive effect on productivity with measurable results.
Typical RTLS hospital ROI is achieved in six to 12 months, when asset tracking is used in tandem with other applications.
RTLS offers many benefits when deployed hospital-wide, including increasing revenues and operational productivity while reducing OPEX, CAPEX, and other expenditures. RTLS can drive an increase in revenue through workflow optimization, patient queuing and patient satisfaction.
Operational productivity rises due to RTLS’s capabilities for creating a safer environment for staff and producing good ROI. OPEX can decrease due to improved workflows, patient monitoring, automated temperature and humidity monitoring and forensic replay. CAPEX also decreases due to the efficiency of RTLS for equipment tracking, automating maintenance and equipment utilization rates through business intelligence software.