Editor’s Note: This is the second part of this feature story about RTLS achieving the quadruple goal of the “hospital of the future” St. Francis Interquest, in Colorado Springs, Colorado, part of the 160-hospital health care system CommonSpirit Health. Healthcare IT news interviewed Dr. Valerie McKinnis, chief medical informatics officer at Mountain Region CommonSpirit Health, a 20-hospital health system. Click here to read part one of this feature story.
Q. The second of your major RTLS implementations is RTLS-enabled staff announcements. What are these about, what role does RTLS play and what are the outcomes?
A. The COVID-19 pandemic has highlighted how powerless our patients often feel in our hospitals. We have learned during the pandemic, even more so than before, that patients often do not know who is coming in and out of their room. They don’t know why you’re there. They don’t know your name, or even your role.
And while masked and gowned as a hospitalist during the pandemic, I visited a patient twice a day for a week before the patient told me she had never seen the doctor. And I explained: I’ve been here every day. And when I talked to her, it became very clear that she had no idea if I was from environmental services, if I was a nursing staff, or even what my role was.
Because, again, we were all masked and clothed and going in and out of the rooms quite quickly. What that has taught me is that during the average hospital stay, even in non-pandemic times, unfortunately, especially if they are elderly, have been given painkillers or simply have the disadvantage of being flat in bed, our patients have no idea who is coming in and out of the room and why.
With the pandemic still fresh in our minds, we sought to use RTLS technology in combination with other technologies so that we could identify the name and role of each staff member who enters the patient’s room with their photo on the patient’s entertainment TV can display.
Using RTLS we were able to do this so that whenever a hospital staff member enters a patient’s room, the RTLS tag embedded in that hospital staff member’s badge sends a signal to the RTLS sensor in the patient room, which then, through complex integrations, interfaces with Epic, and then through another interface display the staff member’s photo, name and role on the large entertainment TV.
“Our patients should never be confused again. As long as they can watch TV, they can see exactly who is coming into their room and know what their role is and why they are there.”
Dr. Valerie McKinnis, CommonSpirit Health in the Mountain Region
Our patients should never be confused again. As long as they can watch TV, they can see exactly who comes into their room and know what their role is and why they are there. This information is also displayed in Epic MyChart at the bedside, through another set of integrations, allowing our patients, who may have visual impairments, to also see it directly on a stationary iPad at their bedside.
Caring for our patients in hospitals today is so complex and involves so many different people that giving me a sense of control over who is caring for me and why they are there was a fundamental problem we had to solve in the hospital . of the future.
Q. And third: RTLS tracking. This is one of the most common applications of RTLS in healthcare. Describe your implementation and the success you achieved with it.
A. In a typical hospital setting, especially the hospital I work at in Denver, a tertiary care center, the nurses and physicians I work with are expert hunters and gatherers. If you ask our people in our facilities, especially the nursing staff, they often travel several miles a day just looking for people and things.
As a hospitalist, I chase patients around the hospital to find them every day. I look for them in their room, but then I notice they are not there. And then I chase them to different locations, maybe to radiology, the pre-op, and sometimes I’m even looking for the patient and they’re actually in their bathroom, which we don’t know.
I’m not even kidding. First, we had to figure out how to find our patients, how to keep them safe, and how to know where they are in our facility. We have elderly people, we have people who have been prescribed narcotic medications, and we need to know where these people are and keep them safe. This is our number one priority in our hospitals, as well as the cumulative benefit of knowing where our patients are. increase the efficiency of their care.
When we implemented RTLS for patient tracking at our facility, we incorporated a small RTLS tag into the traditional patient hospital wristband. It weighs almost nothing, but it does have a battery. It provides active signaling to the RTLS sensors in our environment. And by using this tag, we can communicate with the sensors located throughout our facility that indicate different locations.
And in the electronic patient file we can see at a glance where the patient is currently located. I can even see in my patient list in Epic where the patient is and when they are in their room, if they are even in their bathroom. I can look from a patient list level and see, gosh, is my patient not good at radiology? Are they in their bathroom? Are they in their bed?
From that point of view alone, knowing where our patients are helps the safety of all the people we care for, as well as the efficiency of our staff. I no longer chase the patient, but return to the room again and again.
Instead, I prioritize my rounds and my direct physical time with the patient based on their location. This, as you can imagine, is also incredibly useful for hospital staff to find each other, right?
When I try to track down a nurse to talk about my patients, I can look at the department map and see: oh, actually the nurse is down the hall in another room, I’m not going to spend my time calling his or her telephone. I will wait to find them and they can wait to find me in a location that is more feasible.
I used to try to find nurses. I would send them secure messages via Epic or call their phones, trying to coordinate the rounds. And what we’re finding is that by knowing where we are in terms of our staff, we can better coordinate on high-yield activities, like multidisciplinary rounds, that really make a difference in our patients’ care.
In terms of asset tracking and management, this is huge for our facilities. And again, this seems like such a simple problem, right? How do we find our stuff and how do we know where it is in the facility and how much of it we have?
But for as long as I’ve been studying medicine, this has been a huge challenge. Historically, our clinical staff spends an incredible amount of time looking for things. I would say that our nurses waste precious hours searching for common equipment like IV pumps, wheelchairs, bladder scanners, and sometimes even sutures that our doctors need.
By tagging our equipment with RTLS tags, our employees can instantly find the right things at the right time, so they can spend their time caring for patients instead of on endless quests. From a central RTLS map on their desktop computer, they can locate all RTLS-tagged equipment in the facility.
It helps us from a high level. If they are looking for an infusion pump, they can type infusion pump into the search bar and find the nearest infusion pump location to where they are at the time. It also helps us understand how much equipment we have and where we are in terms of the total amount of equipment accounted for.
It is estimated that in most hospitals between 10% and 20% of equipment is unavailable at any given time.
So this really helps us know how much equipment we have circulating and where it is located. RTLS asset tracking also allows us to locate the patient’s personal belongings. So when the patient comes in and goes to the operating room, we can put an RTLS tag on things like their hearing aids or their dentures so they don’t get lost.
And these are really valuable items for our patients during a hospital stay. As you can imagine, things like their glasses, hearing aids, and dentures are small items that, when the patient changes locations, sometimes tend to get lost. That is incredibly disruptive and disturbing for our patients.
So something as simple as tagging assets makes a huge difference. We have also applied RTLS in a fairly traditional way with hand hygiene. Accurate monitoring of hand hygiene remains an elusive goal for most organizations. How to understand who washes their hands and in what proximity to the patient.
What we really want our staff to do is practice hand hygiene before and after every episode of patient care. And that means I have to practice hand hygiene when I enter the patient’s room and when I leave the patient’s room.
So RTLS, using precision monitoring, really helps us determine where we need to perform those hand hygiene activities and see if we’re performing them in the right location. So when I leave a patient’s room and walk down a hallway or two to do my hand hygiene, I’ve really missed the opportunities.
It tries to distribute infection control where it is needed. That’s why we use RTLS sensors for soap dispensers that integrate with our staff’s RTLS badges to develop an accurate hand hygiene monitoring system.
We also use RTLS to monitor and track the temperatures of our refrigerators for pharmacy medications and vaccinations, which is a fairly new use case that I’m proud of. The initial feedback from our doctors, nurses and other staff has been great.
One of the nurses I recently spoke with at this hospital told me that she truly believed that RTLS had helped her find joy in medicine again. That sounds funny, right? How can RTLS change your life?
But she said she feels like she’s probably saved at least one to two hours per 12-hour shift by not having to spend as much time looking for people or things, and that she’s noticed that she can do her charts more efficiently. and that she goes home on time. time at the end of her shift, which she hadn’t done in a long time. She can go back to her family and do all the other things that are important in life besides work.
That’s our goal. With a lot of these things, how can we empower our staff to do the right things for our patients, give the best care possible, improve our patients’ experience, but also make medicine fun again for our physicians ?
All you have to do today is pick up a healthcare magazine, talk to anyone in any facility, to realize that with the burden of what our physicians have to do, the joy is often missing from their daily experiences . We’ve really seen these technologies as a way to get our physicians back to caring for patients and finding the joy in medicine again.
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