Colorado hospital achieves the quadruple aim with RTLS, part 2

Editor’s Note: This is the second part of this feature story on RTLS achieving the quadruple aim at “hospital of the future” St. Francis Interquest, in Colorado Springs, Colorado, part of 160-hospital health system CommonSpirit Health. Healthcare IT News interviewed Dr. Valerie McKinnis, chief medical informatics officer at Mountain Region CommonSpirit Health, a 20-hospital health system. To read part one of this feature story, click here.

Q. The second of your major RTLS deployments is RTLS-enabled staff announcements. What are these about, what role does RTLS play, and what are the outcomes?

A. The COVID-19 pandemic really highlighted how powerless our patients often feel in our hospitals. We learned during the pandemic, even more than before, that patients often don’t know who’s 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 when I was masked and gowned as a hospitalist during the pandemic, I once rounded on a patient twice a day for a week before the patient told me she’d never even seen the doctor. And I explained, well, I’ve been in here every day. And it became quite clear in talking to her that she had no idea if I was from environmental services, if I was nursing staff, or really what my role was.

Because, again, we were all masked and gowned and coming in and out of the rooms fairly quickly. What that taught me was unfortunately, during the average hospital stay, even in the non-pandemic times, our patients, especially if they’re elderly, have received pain medications or just at the disadvantage of lying flat in a bed, have no idea who’s coming in and out of the room or why.

With the pandemic fresh in our minds, we sought to use RTLS technology integrating with other technologies to allow us to display the name and role of each staff member entering the patient’s room with their picture on the patient’s entertainment TV.

Using RTLS, we were able to do this so whenever any hospital staff member walks into 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’s room, which then, through complex integrations, interfaces with Epic, and then through another interface, displays the staff member’s picture, name and role on the large entertainment TV.

“Never again should our patients be confused. As long as they’re able to watch TV, they can see exactly who’s coming in their room and know what their role is and why they’re there.”

Dr. Valerie McKinnis, Mountain Region CommonSpirit Health

Never again should our patients be confused. As long as they’re able to watch TV, they can see exactly who’s coming in their room and know what their role is and why they’re there. This information is also displayed in Epic MyChart bedside, through another series of integrations, which enables our patients, who may have visual challenges, to see it directly on a fixed iPad at the side of their bed, as well.

The care of our patients in hospitals today is so complex and involves so many different people that really even just giving them a sense of control of who’s taking care of me and why are they here was a fundamental problem we had to solve for in the hospital of the future.

Q. And third, RTLS tracking. This is one of the most common uses of RTLS in healthcare. Please describe your implementation and the success you’ve achieved with it.

A. In a typical hospital environment, certainly the hospital that I work at in Denver, which is a tertiary care center, the nurses and doctors I work with are expert hunters and gatherers. If you asked our people in our facilities, especially the nursing staff, they often clock several miles a day just looking for people and things.

As a hospitalist, I’m chasing the patient around the hospital to find them on daily rounds. I look for them in their room, and then I find they’re not there. And then I chase them around to various locations, maybe down 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 joking. First of all was solving for how do we find our patients and keep them safe and know where they are in our facility. We have elderly people, we have people who’ve received sedating medications, and we need to know where these people are and keep them safe as our first priority in our hospitals, as well as the cumulative advantage of knowing where our patients are just to increase the efficiency of their care.

When we implemented RTLS for tracking of our patients in our facility, we embedded a small RTLS tag into the traditional patient hospital wristband. It weighs almost nothing, but it does have a battery. It gives active signaling to the RTLS sensors in our environment. And using this tag, we can interface with the sensors, which are located throughout our facility, which denote different locations.

And we can see at a glance in the electronic health record the current location of the patient. I can even see looking in my patient list in Epic where the patient is and when they’re in their room, if they are even in their bathroom. I can look from the level of a patient list and see, gosh, is my patient down in radiology? Are they in their bathroom? Are they in their bed?

Just from that standpoint, being able to know where our patients are helps improve the safety of all the people we take care of, as well as the efficiency of our staff. I am no longer chasing the patient, going to the room over and over again.

Instead, I prioritize my rounds and my direct physical time with the patient based on their location. This is also incredibly useful, as you can imagine, for hospital staff to find each other, right?

If I am trying to track down a nurse to talk about my patients, I can look on the unit map and see, oh, actually, the nurse is down the hall in a different room, I’m not going to spend my time calling his or her phone. I will wait to find them and they can wait to find me in a location that is more achievable.

In the past, I would try and find nurses. I would be sending them secure messages through Epic or calling their phones, trying to coordinate with rounds. And what we’re finding is just being able to know where each other are in terms of our staff helps us be able to coordinate with those high-yield activities like multidisciplinary rounds, which 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 an easy 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 in medicine, this has been a daunting challenge. So historically, our clinical staff spend unbelievable amounts of time looking for things. I would say our nurses spend precious hours wasted in pursuit of common equipment like infusion pumps, wheelchairs, bladder scanners, and sometimes even sutures needed by our physicians.

The tagging of our equipment with RTLS tags enables our staff to immediately find the right things at the right time so they can spend their time caring for patients rather than on endless scavenger hunts. From a central RTLS map on their desktop computer, they can locate any RTLS-tagged equipment within the facility.

It helps us from a high level. If they’re looking for an infusion pump, they can type infusion pump into the search bar and locate the closest location of an infusion pump to where they are seated at that time. It also helps us understand how much equipment we have, where we are in terms of our total numbers of equipment that are accounted for.

It has been estimated that in most hospitals between 10% to 20% of equipment can’t be found at any given time.

So this really helps us know how much equipment we have that’s in circulation and where it’s located. RTLS asset tracking also helps us locate the patient’s personal belongings. So, when the patient comes in and they’re going to go in 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 precious items to our patients during a hospital stay. If you can imagine, things like their glasses, hearing aids and dentures are things that are small items that as the patients move locations, sometimes have a tendency to get misplaced. That is incredibly disruptive and upsetting for our patients.

So, something as simple as asset tagging those makes a huge difference. We’ve also used RTLS in a fairly traditional way with hand hygiene. Accurate hand hygiene monitoring remains an elusive goal for most organizations. How to understand who is washing their hands and in what proximity to the patient.

What we really want our staff to do is to do hand hygiene before and after each episode of patient care. And what that means is I need to be doing hand hygiene as I enter the patient’s room and as I exit the patient’s room.

So RTLS using precision monitoring really helps us isolate where should we be doing those hand hygiene activities and to see if we’re doing them in the right location. So, if I am exiting a patient’s room and walking down one or two hallways to do my hand hygiene, I’ve missed the opportunities, really.

It’s trying to partition that infection control where it needs to be done. So, we are using soap dispenser RTLS sensors that integrate with our staff RTLS badges to develop an accurate hand hygiene monitoring system.

We’re also using RTLS to monitor and track our refrigerator temperatures for pharmacy medications and vaccination, which is a pretty novel use case I’m proud of. The early feedback from our physicians and nurses and our other staff has been amazing.

One of the nurses I recently spoke with at this hospital told me she really believed RTLS had helped her find the joy in medicine again. That sounds funny, right? How could RTLS change your life?

But she said she feels like she saved probably at least one to two hours per twelve-hour shift by not having to spend as much time looking for people or things and has been able to notice she’s getting her charting done more efficiently and is getting home on time at the end of her shift, which she had not done for a long time. She is able to get back to her family and do all the other things that are important in life in addition to working.

That’s our goal. With a lot of these things: How do we enable our staff to do the right things for our patient, give the best care possible, improve the experience of our patients, but also make medicine joyful again for our clinicians?

All you have to do today is pick up any healthcare magazine, talk to anybody at any institution, to realize that with the burden of things our clinicians have to do, joy often is absent from their daily experience. We really looked at these technologies as a way to get our clinicians back to caring for patients and finding the joy in medicine again.

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