Piedmont Fayette Hospital, Fayetteville: Most Wired
Piedmont Hospital, Atlanta: Most Wired
Palmetto Health, Columbia: Most Wired

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[Most Wired for 2010] via HealthCare IT News

To briefly explain the technology, RTLS wirelessly tracks the location of tagged assets or individuals in real-time wherever the facility has installed coverage. While RTLS is a complex technology, it can be simplified into three basic components: 1) the tags that are affixed to the tracked item or person; 2) the platform, which is the infrastructure consisting of readers and network components; and 3) the end-user software application that allows the users to see the tracked assets or people on a computer or mobile device.

Most RTLS products are “active” systems rather than “passive” systems, which simply means that the tags have a battery in them and they can send out a wireless signal saying where they are. While radio signals are used by many vendors as the transmitting method, other methods are also used such as infrared and ultrasound signals.

RTLS can be installed, for example, in clinics, emergency departments, operating rooms or throughout the entire hospital. Currently, the majority of implementations in health care are hospitalwide and used for equipment location tracking (e.g., infusion pumps, specialty beds, wheelchairs). Departmental-based implementations that employ RTLS for workflow visibility and efficiency are also in place, but are less common today.

Search time adds up

One of the first benefits is the ability to simply find a pump when you need it, whether the pump is required for use on a patient or whether it is due for its periodic preventive maintenance. One hospital spent two months on a benchmarking analysis and found that it took on average 22 minutes to find an infusion pump. After the implementation of RTLS, it took on average of two minutes to find a pump. Another hospital told us that, after their RTLS installation, they saved about 100 hours a month searching for rental equipment, including infusion pumps. The time saved by staff could then be used for more meaningful tasks.

Many hospitals are utilizing RTLS to achieve par-level management and ensure that a pump is always available for clinical use. For example, a hospital can determine the number of pumps that are required in a clean equipment room. Should the number of pumps fall below this number, the RTLS software sends an alert to the appropriate individuals (for example, equipment services) and triggers a work process that replenishes the clean equipment room with enough pumps.

A more sophisticated application that some hospitals are undertaking is utilization monitoring. Utilization allows a hospital to calculate when a pump is in use versus when it is unavailable for use. This helps to determine the effective usage of the pump inventory and can influence capital purchases and work processes. Utilization monitoring can be accomplished by vendors in different ways.

For example, utilization can be strictly based on software rules. Rules can be created to say that if a pump is in a patient room, assume that it is in use. Similarly, if the pump is in the soiled utility room, the pump is dirty and therefore is unavailable for use. Once the pump is in an area designated as clean, the pump’s status can again change to available for use. Some vendors accomplish utilization calculations by interfacing with the pump directly. The interface determines whether it is powered on or off. In this situation, if the pump is on, it is an indication that the pump is in use.

It is important to understand that using RTLS to determine device utilization requires more advanced capabilities from the technology (higher resolution, interfaces with the pump). Purchasers should be aware of the hospital’s objectives and factor this into the selection process.

Further, several hospitals that we interviewed mentioned the benefits derived when a recall is issued on a pump. One health system related its experiences with an infusion pump recall that required clinical engineering intervention (each pump needed an upgrade). One of the health system’s two campuses had installed RTLS while the other had not. The campus without RTLS required a few weeks to complete the recall action, whereas the campus with RTLS only took a few days to complete the recall. The health system considered this a patient safety benefit.

From the above, we can start to see how the benefits of improved efficiencies can be realized. As clinicians start to trust the technology and realize the positive changes to work processes and availability, actions such as hoarding become unnecessary. As a result, staff satisfaction improves.

Calculating hard savings

In addition to the soft ROI already discussed, hard ROI with real dollar savings can arise from various areas—the most common being rental savings and decreased capital expenditures. RTLS is expensive. The initial cost is not trivial. However, interviews with hospitals revealed that despite the large installation costs, hard ROI is achievable within about one to three years.

The tangible hard-dollar savings accomplished through rental savings can be significant. One hospital’s rental needs for infusion pumps decreased by half. Another hospital stated that their entire rental costs went from $250,000 a year to $100,000 a year. Such decreases can be achieved on two fronts. First, savings can be gained by limiting the number of rentals needed with better utilization. Second, when the rented equipment is no longer needed, it can be readily found and returned so that the daily rental costs incurred can be controlled.

Savings are also gained through fewer capital purchases. While not every medical device has the potential to be over-purchased, infusion pump over-purchasing can be due to the perceived need for additional pumps when they are poorly utilized. Determining the utilization of pumps (how many pumps have not been turned on or have been “available” for extended periods of time) can help to discover where excess inventory is negating the need for additional pump purchases. In one real-world example, a hospital administrator received a request for 100 additional pumps. An investigation into the RTLS metrics showed that this purchase was unnecessary, saving the facility roughly $300,000.

The examples related to infusion pumps are merely a snapshot of what RTLS can do for a hospital. RTLS has many different use cases and applications. It can be used for workflow improvement initiatives such as those in emergency departments and operating rooms, for automatic documentation, and temperature monitoring, to name a few. And, as the technology establishes a foothold in health care, new applications are surfacing such as hand hygiene programs and bed management.

When considering this technology, health care facilities need to not only account for the strengths and weaknesses of the vendors’ products, but also the effect RTLS could have on work processes and the hospital’s overall objectives.

[Real-time locating systems: Measuring the benefits] via Matmanmag.com

For more information on the RTLS Outcomes offered by First Signal, please visit our Outcomes page, here.

The report — titled “Handhelds in Healthcare: The World Market for PDAs, Tablet PCs, Handheld Monitors, & Scanners” — considered all handheld devices and made predictions for certain health care categories.

For example, the report found that total sales for patient-monitoring products reached $5.3 billion in 2009, accounting for 64% of the market share for handheld devices.

It also found that the administrative devices market — which includes PDAs, smart phones, tablet PCs and inventory/medication scanners — generated about $3 billion in 2009 for a market share of 36%.

The report identified several drivers of handheld device growth in the health care market, including:

• An aging population;
• Cost restraints;
• Government incentives;
• Medical error reduction initiatives; and
• A shortage of medical professionals (Lewis, InformationWeek, 7/2).

The report also predicted that incentives from the 2009 federal stimulus package will continue to drive increased sales of handheld devices in the health care sector, noting that the incentives “are getting health care organizations to think about IT purchases, and they are helping to make the argument for better electronic data entry” (Byers, CMIO, 7/1).

“The flood was devastating,” says Dave Lenart, P.E., Director of Facilities and Materials Management. Columbus Regional’s entire basement, containing much of the hospital’s medical and lab equipment was filled floor to ceiling with contaminated water, mud and silt. The first floor also sustained heavy damage from standing contaminated water and mud. Veronica Kagley, Technology Coordinator adds, “Every system critical to the support and operation of the hospital that was in the basement was destroyed.”

Initially, everyone believed it would be a year to two years before the hospital was back up and running — that’s what it had been for other hospitals that have sustained similar damage. “We’re one of only two hospitals within an hour’s drive from here,” Lenart explains. “A long recovery simply wasn’t an option. Our entire staff pulled together. We worked long hours and engineered what fixes we could. We re-opened our doors five months after the flood.” Columbus Regional’s outstanding achievements have been recognized by many, including Today’s Facility Manager, which honored Dave Lenart as the 2010 Facility Executive of the Year for his dedication, forethought and ingenuity during the cleanup and restoration process.

What may be surprising to some people is that insurance and FEMA only covered three quarters of the costs related to infrastructure and systems. “We were very blessed, though,” says Kagley. “We had many vendors, Versus included, offer to cut costs and do what they could to help bring our systems and services back online.” Today, the Versus solution is back, helping Columbus Regional’s staff automate patient flow throughout the facility.

Versus opted to provide the latest software viewing and reporting capabilities, with room and patient status, alerts and notifications (such as wait time alerts or notification that a patient has returned from radiology). “It was the right thing to do — provide Columbus Regional with the most current software version,” stated HT Snowday, CTO Versus. “They are now better prepared for enterprise expansion — something they were interested in before and this will make them more flexible as they continue to add other RTLS solution applications.” The Versus Advantages solution currently provides enterprise asset tracking and is integrated to Rauland-Borg’s Responder IV nurse call system.

“The value of the Versus system is not only inherent, but also perceived,” says Kagley. “It helps with patient satisfaction, and it was one of those systems that was missed that the staff really wanted back.” Columbus Regional had tremendous successes with the Versus solution when it was first implemented in 2005. For example, they reduced ED patient wait times by 63% and ensured equipment was available when and where it was needed. Columbus Regional also helped housekeepers and other staff members feel safer in their behavioral health units by giving them Versus badges, with the ability to call for assistance at any time. Staff receiving the alert knew who needed help and where that person was.

“There was never any doubt that we would bring the Versus Advantages solution back,” says Lenart. “Our staff relies on Versus for hands-free communication and location information. Versus eliminates the realm of uncertainty, so there’s no void in terms of location — no questioning.”

Full Article: [Versus Advantages RTLS Is Live (Again) at Columbus Regional Hospital] via MarketWatch

Fox News highlights some of the advantages of patient/infant tracking that several hospitals across the nation have begun to implement. If you would like more information on how this system can benefit your facility, Contact First Signal!

Although a relatively minor clinical concern in a nurse’s day, relatives tend to call to check on patients right when nurses are first beginning their shift, when they are trying to hear reports and check in on their patients for the day.

To make the process simpler, nurses at Chilton Memorial Hospital in Pompton Plains, NJ, decided to designate a specific time for relatives to call.

The decision is part of the organization’s larger Transforming Care at the Bedside initiative, says Joanne Reich, VP and chief nursing officer at Chilton. The TCAB initiative is sponsored by the Robert Wood Johnson Foundation and the New Jersey Hospital Association with a goal to improve the quality of care on medical/surgical units.

“Our emphasis is on nursing staff taking a critical look at their care environment and how they can increase their satisfaction and effectiveness in care delivery,” says Reich. “Nurses have many interruptions, so they have been working on increasing time at the bedside.”

Nurses began tracking the number of calls they were receiving from families of patients and discovered the calls used up a significant amount of time and called them are away from the bedside just as they had started assessing their patients or receiving reports.

Having a designated time for families allows patients and families to coordinate the best time in the morning for them to call. Nurses now can plan their mornings better. They can accomplish what they need to do at the start of the shift, and they can ensure they are ready with the information needed when they know the call is coming.

The change was supported by leadership and has worked very well. “Nursing leadership recognizes the leader within each nurse,” says Reich, “and that each nurse is a professional and can bring to the table what they feel works best.”

Nurses also revamped how patient call bells are treated. In a collaborative project with other disciplines, such as physical therapy and respiratory therapy, the hospital created a “no pass zone.”

“It’s a commitment by all of the staff that if patient call bell is lit, no one will pass that room,” says Reich, “without going in and introducing themselves and seeing what’s the patient needs.”

Often, the staff member will be able to help the patient, such as by refilling a water pitcher, which increases patient satisfaction. If the staff member can’t help, he or she quickly takes the issue to the patient’s nurse.

Reich says the next project nurses are tackling will examine patient environment. This more in-depth project requires consideration of different concepts and ideas to determine what is best for patients and what is needed to implement the ideas.

“They want to ensure the patient environment is prepared in the manner that works best for patients,” says Reich. “They’re examining if patients have what they need in the way of water, tissues, food tray, etc. Our goal continues to be providing quality, personalized care to each of our patients. ”

[Nurses Find Simple Ways to Improve Satisfaction] via HealthLeaders

So say the findings of a white paper published today by Voalté, a Sarasota, Fla.-based developer of point-of-care communications software for iPhones and BlackBerry devices. “Smart Hospitals – Embracing Smartphones at the Point of Care” highlights communication inefficiencies within hospitals that cause confusion and reduce effectiveness. It concludes that smartphones offer a comprehensive and easy-to-adopt solution.

Researchers have found that ineffective communication wastes as much as $12 billion nationwide each year, and that frustrations with outmoded systems can lead to nurse dissatisfaction and, ultimately, exacerbate the hospital staffing shortage.

But “smartphones offer a solution to many of today’s healthcare communication issues,” the study finds. “With PC-like functionality and advanced capabilities, smartphones provide a single interface to make calls, send texts, manage schedules, organize tasks, view online literature, and receive alerts. Most clinicians are already familiar with smartphones and the devices easily integrate with hospital networks, providing a solid platform for application developers. Mobile healthcare applications allow physicians and nurses easy access to medical information, bringing faster, more informed decision-making to the point of care.”

For a typical, 500 bed, acute-care hospital, communication problems between physicians and nurses create an annual $4 million economic burden, the white paper reports, and often needlessly increase the length of hospital stays.

Worse, poor communications can adversely impact care. Noisy overhead paging systems can cause nurses to miss calls – particularly when working within patients’ rooms. In addition, most point-of-care staff are saddled with multiple devices – a nurse may carry a pager, PDA and a mobile phone, with each device providing specific functionality and generating its own alarms. The nurse can’t prioritize alarms according to criticality, so a pager buzzes the same tone when a patient wants ice or for a code blue alert.

Due in part to these inefficiency and communication problems, nursing dissatisfaction is on the rise. According to a recent study of 43,000 nurses from 700 hospitals, more than 40 percent of U.S. nurses reported being dissatisfied with their jobs – three to four times higher than the average worker.

The problem can be self-perpetuating, the study finds. “Nursing shortages and communication problems negatively impact patient safety and increase patient dissatisfaction.This in turn can affect a hospital’s overall rating and reputation, which can drive down HCAHPS and Press Ganey scores and directly impact a hospital’s ability to stay profitable and recruit talented staff.”

As smartphones grow increasingly feature-rich and easy-to-use, the devices offer a solution to many of these serious communication shortfalls.  Their functionality make them tantamount to “a miniature computer that combines phone, e-mail, texting, and Internet service.” And since they’re already in common use, the learning curve that usually occurs when new equipment is introduced to a workplace would prove minimal. (According to a study by Manhattan Research, 64 percent of U.S. physicians own smartphones and analysts predict penetration will increase to 81 percent by 2012).

[Smart Hospitals: Embracing Smartphones at the Point of Care] via Voalté

Integrated Wireless Telephone

Healthcare Outcomes

While most hospitals have focused on promoting quality care at their facilities to help decrease costs, quality care will take on a somewhat different meaning under the new healthcare reform law: Hospitals will feel the pressure to maintain continuous quality improvement or risk being penalized under reform incentives scheduled over the next several years, according to a PricewaterhouseCoopers’ Health Research Institute report titled “Health Reform: Prospering in a Post-Reform World.”

According to the report, the new law can be expected to impact hospitals in three main areas:

• Hospital readmissions. Starting in October 2012, hospitals will be financially penalized by Medicare if they demonstrate “excess” readmissions within a 30-day period when compared to the “expected” risk-adjusted levels of readmissions. The readmissions are based on the measures for acute myocardial infarction, heart failure, and pneumonia.
• Hospital payments based on value based purchasing (VBP). Starting in 2013, hospitals will be paid according to a Medicare VBP program schedule, in which payments will be made based on hospitals’ quality measure outcomes. VBP will measure hospital efficiency, patient satisfaction, and quality of care. These outcomes will be collected beginning October 2012.
• Penalties for hospital acquired conditions (HACs).Beginning in 2015, 1% of payments will be subtracted from hospitals with the highest rates of HACs—essentially those falling into the bottom quartile of hospitals when compared to the national average. This could result in a nationwide reduction of $1.5 billion in payments over the next 10 years.

The message hospitals need to pay attention to is “don’t get stuck in the bottom quartile, and work towards continuous quality improvement,” according to the report. The bottom quartile will change from year to year as the quality performance of hospitals change. However, at least 1,000 hospitals will end up in the bottom quartile—regardless of the quality provided.

Beginning in 2013, high scoring hospitals under VBP will receive a higher payment of 1%—which rises to 2% in 2017 and beyond. In addition to the direct financial impact, the reform law will require that an organization’s quality metrics be publicly available and accessible.

In addition to the direct financial impact, hospitals also could feel the impact of consumerism. For years, healthcare has lagged behind in making information easily accessible to consumers, but this has been changing.

According to a 2009 PricewaterhouseCoopers consumer survey, individuals are using the Internet as a source for making decisions. Online content was found to edge out physicians as an information source: For instance, 48% of consumers said they use health websites to find information to make decisions about their healthcare.

Within this consumer realm, hospital quality information will move “beyond the organization and government websites” to health websites and consumer advocacy sites, the researchers note.

In addition, making more quality information available to consumers could impact a system’s perception in the community and payers’ contracting strategies with them. More informed decisions by patients could lead them away from organizations listed as “poor performers”—or those in the bottom quartile of hospitals.

For the typical hospital, being on the bottom quartile in terms of quality could mean millions of dollars lost annually. For instance, for a 300-bed community hospital with $50 million in Medicare inpatient net revenue, failure to improve on hospital readmissions (a loss of about $96,780), failure with VBP (a loss of $750,000), and ending up in the lowest quartile for HAC ($500,000), would create a drop of $1.35 million in income.

In addition to Medicare, hospitals also will have to learn to live with cuts in Medicaid. Hospitals that care for high numbers of uninsured and Medicaid patients currently receive extra funding from Medicare and Medicaid under the disproportionate share program. But in 2014, Medicare DSH will be reduced 75%—the same year that the insurance exchanges and individual and employer mandates go into effect.

[How Quality Will Pay for Hospitals Under New Reform Measures] via HealthLeaders

The new systems helps St. Michael’s find equipment that needs maintenance. In the past, nurses have had to spend time away from patients searching for lost equipment, hospital executives said. The hospital’s biomedical engineering team, who are charged with servicing and maintaining the equipment, are also challenged when they can’t find the equipment they’re assigned to manage and maintain.

“We do have a lot of equipment that disappears such as wheel chairs, IV pumps and heart monitors, and nurses spend a lot of time looking for equipment,” said Angelo Schittone, VP and CIO at Saint Michael’s.

The tracking technology will provide cost savings in other ways. The cost benefit is twofold, Schittone said: “One is we’re able to track equipment so that our technicians can service them more efficiently, which saves in a technician’s time. The other benefit is the equipment is actually maintained on a regular basis so that the equipment should last longer because it’s maintained better,” he said.

The tracking system can help nurses schedule patient care with greater efficiency as they move among departments for testing, Schittone said.

Real-time location tags on patients let nurses know, for example, if a patient is out of his or her room taking a radiology exam when a tray of food has to be delivered, Schittone said, so they take the food up when the patient returns.

[Hospital Tracks Equipment With Real-Time Ultrasound System] InformationWeek

Real-Time Location Tracking

Healthcare Outcomes