RTLS-1x410Photo courtesy Versus.
By Michael Bassett

Sentara Williamsburg Regional Medical Center in Williamsburg, Va, knew it had a problem when one of its beds went missing. And it wasn’t just any bed—this was an expensive bariatric bed that one would think would be hard to miss.

The question Sentara needed to ask itself, says Sentara IT Manager Stephanie Middleton, was how many times do beds go missing, or wheelchairs disappear, because when that happens it has impact on staff and patient flow, and—if the equipment is never found—it has obvious financial implications.

So in early 2012, Sentara installed a real-time location system (RTLS) to help it automatically identify and track the location of objects in real time. And the implementation of RTLS for asset tracking has been so successful, Middleton says, that Sentara plans to move ahead with RTLS to help it track patient flow as well.

Growth Potential

According to a survey by research firm KLAS Enterprises LLC, Orem, Utah, as of early 2012 between 10% and 15% of hospitals were using RTLS. And of the hospitals responding to the survey, 95% said their use of RTLS resulted in operational efficiency gains.

The Awarepoint Asset Tag helps staff locate, and monitor the movement and status of, a variety of equipment across the organization.The Awarepoint Asset Tag helps staff locate, and monitor the movement and status of, a variety of equipment across the organization.For example, 75% of hospitals using RTLS found that it improved equipment utilization and staff efficiency, while other benefits of RTLS included better documentation (19%), improved alerts and reporting (19%), and saving time by quickly finding assets (11%).

Today, says Carlene Anteau, MS, RN, vice president of product marketing for RTLS provider Awarepoint, RTLS applications “run the whole gamut, from temperature monitoring to basic asset tracking, to extensive asset tracking, all the way to tagging patients and staff and understanding patient flow.”

The vast majority of hospitals used RTLS for things like asset tracking, Anteau says, while only a very small percentage of hospitals are using advanced RTLS applications related to situations like patient flow.

RTLS has been around for a couple of decades, says Barry Cobbley, director of sales engineering for RTLS provider Versus (which installed the Sentara system). He points out that over much of that period his company’s top application has been nurse call automation, which enables hospital department managers to do things like measure a nurse’s time spent with patients, assess response times to patient calls, and identify staffing bottlenecks. “That’s changing,” he says, “but probably about 10% of hospitals have it for that purpose alone.”

Now, Cobbley says, asset tracking seems to serve as the entry point for hospitals looking to participate in the world of RTLS. “It’s pretty simple to wrap your arms around the concept,” he points out.

Return on Investment

When customers approach RTLS providers like Versus or Awarepoint, Anteau says, they—like Stephanie Middleton at Sentara—are probably interested in doing some asset tracking to improve their operational performance, or to reduce the cost of providing care or of capital expenditures.

Awarepoint will perform a return-on-investment (ROI) analysis to demonstrate to the provider the potential value of an RTLS solution, Anteau says, which can include, for example, improving the utilization of assets, or eliminating or reducing capital equipment purchases for replacement purposes.

“So we’ll look at the trends,” she says. “What’s the size of the fleet in terms of assets, and how much loss is occurring?” She points out that, on average, hospitals probably utilize their equipment at a rate running between 30% and 40%, which means they typically have about twice the number of assets they actually need.

“It’s pretty rare if we can’t demonstrate that [RTLS] can generate a positive ROI,” Anteau says.

Middleton says that Sentara uses RTLS to track about 300 pieces of equipment such as beds, wheelchairs, and Alaris pumps, “and our environmental services folks really saw the impact on their workflow.” Before RTLS, environmental service staffers would go from floor to floor checking to see whether patients had been discharged so they could retrieve pumps, transport them to their department, and clean and disinfect them.

“They would go through this process every 2 hours,” she says. “Now they don’t have to do that because the system will tell them when and where they have a dirty pump.”

The University of Florida Health Shands Hospital in Gainesville uses Stanley Healthcare’s RTLS solution for asset tracking and temperature monitoring. According to Joel Cook, director of healthcare solutions for Stanley Healthcare, Shands’ emergency department not only improved staff efficiency and patient satisfaction, it “experienced a 98.8% reduction in hours spent searching for missing items, and a 99.3% reduction in occurrences of lost items.”

Branching Out

While asset tracking serves as an entry point for organizations looking to implement RTLS, once those organizations experience what RTLS can do with assets, they might start to consider more advanced RTLS applications.

That’s what happened with Sentara, Middleton says. “Our plans now are to branch RTLS out even more so we’re not only doing asset tracking, but other applications as well, like patient tracking.”

Ekahau’s real-time location system software for asset tracking reports par levels and equipment utilization and shortens equipment search times and PMs, sending work orders to Ekahau badges as text messages.Ekahau’s real-time location system software for asset tracking reports par levels and equipment utilization and shortens equipment search times and PMs, sending work orders to Ekahau badges as text messages.“A few years ago hospitals would reach out to us asking about basic asset tracking use case models,” says Leila Nouri, vice president of marketing for RTLS provider Ekahau. “They might have had a couple of hundred wheelchairs that they wanted tagged so that they could help their nurses find them faster and hopefully not lose any.

“Now what we’re seeing are whole hospital approaches to RTLS,” she observes. “Because the real value lies in what you can do with RTLS software. You can really look at things like utilization rates for different types of equipment, by different zones, and by different users, so that you really get into workflows as they relate to patient wait times, throughput, and therefore revenue.”

These are hospitals that probably have high-volume operating rooms and emergency departments, and are trying to figure out ways in which they can improve efficiency in those areas,” Anteau says.

Additionally, Anteau points out that with healthcare reform, areas like patient satisfaction are becoming an increasingly important metric when it comes to determining reimbursement levels, “so hospitals are asking questions like, ‘How do I make patient wait times shorter?’ or ‘How do we improve the patient experience while we’re improving throughput?’ ” RTLS can help help answer some of those questions, Anteau says.

Implementing RTLS

RTLS can be implemented using a variety of technologies such as infrared, ultrasound, or Wi-Fi. Each has its own benefits and drawbacks. For instance, using Wi-Fi could allow a hospital to leverage its existing infrastructure in order to implement RTLS. Yet, at the same time, since Wi-Fi has to pass through walls, it could involve some limitations related to accuracy.

The Versus IR-RFID badge with call button.The Versus IR-RFID badge with call button.Middleton says that when Sentara started investigating the possibility of implementing RTLS, the facility wanted to take advantage of the Wi-Fi infrastructure already in place, but found that it didn’t provide the accuracy desired. Sentara ended up going with the Versus solution, which combines infrared with RFID (radio frequency identification). This combination, Middleton says, “gives us accuracy down to patient level, so that we know what patient is in what room, in one bed.”

In contrast, Ekahau’s Nouri says that there are real advantages in leveraging a Wi-Fi system. “On a broader scale, there are a few of us who use the existing Wi-Fi structure,” she says. “Most hospitals have pretty robust systems—they happen to be the earlier adopters of Wi-Fi, and they’ve continued to upgrade. We can get room-level accuracy out of a Wi-Fi-only system, and then if you want to get to a bay, bed, or chair-level accuracy, we can add wire-free infrared readers.”

A big advantage in using existing infrastructure, she says, is that installation takes a “matter of days,” since there’s no need to install a dedicated system

Awarepoint’s RTLS system uses sensors—based on underlying ZigBee technology—that are plugged into standard electrical outlets to create a wireless mesh sensor network encompassing the medical area in question. Each asset that is to be tagged is equipped with a battery-powered RFID tag, with the idea being that the signals emitted from each tag can be received by a number of sensors, which then collectively pinpoint the location of the asset.

According to Awarepoint’s Anteau, it takes about 60 days to get an RTLS asset-tracking application up and running in most organizations. When a hospital wants to get into more sophisticated tracking involving clinical and patient flow, things get a little more complicated. “We’ll go on-site, observe process flows, ensure that the rule and business logic built into the system matches the organization’s process, and work on integration with the EMR,” she says. “A lot of the value in driving patient flow with RTLS is knowing what the big picture is—knowing not only where the resources, staff, and patients are, but what the context of all those interactions is. How do we drive the process in order to expedite it? That all takes a fair amount of work.”

No matter what the technology, in the end they all have the objective of determining the location of assets or individuals—or both—as accurately as is needed, and those technologies will succeed if they are suitably matched with the right applications, and fail if they’re not.

Through the years, there have been plenty of improvements made on the hardware side of RTLS, Cobbley says, ranging from better-quality tags to more durable batteries. “And there have been a lot of [companies] entering the market that have provided alternative technologies that can provide location data, such as ultrasound or infrared, that can resolve location to a really accurate level. They’re all interesting, but at the end of the day, it’s not just the hardware and software, but how it is deployed and rolled into an organization. That’s where the rubber meets the road. You can do nine things right, but if that last thing is wrong, there is no value in the whole proposition.”

The Future of RTLS

According to Jay Deady, Awarepoint CEO, we are now transitioning into the third generation of RTLS as facilities move away from strict focus on asset tracking and temperature monitoring and toward a greater emphasis on workflow logic and advanced business rules and analytics. “So you can look at larger pieces of data in order to make assumptions about what’s going on,” Anteau says. “If I know a patient, a staff member, and a piece of equipment are in the same room at the same time, what does that mean? Are there downstream implications we need to be tracking?”

There is a “sea change” happening, Nouri says, as hospitals become “more open to RTLS—particularly with increasing electronic health record adoption—and analytics derived by knowing location, in order to feed a broader big data business model. So if there are big data initiatives going on, some of the more strategic hospitals are thinking of RTLS as the missing piece of that sort of pie. RTLS can provide something pretty unique.”

As for the future, Anteau looks at RTLS as something that will continue to evolve since healthcare organizations are always looking for ways to enhance care, whether that’s through using RTLS to monitor hand hygiene or drive throughput throughout an enterprise and not just the operation room or emergency department.

“There’s even talk now of using RTLS to facilitate aging in the home by making it easier for families and providers to monitor patient status in the home,” she points out. “I think the uses of RTLS are practically infinite.” 24×7

Michael Bassett is a contributing writer for 24×7. For more information, contact jbethune@allied360.com.