New tracking systems improve patient flow
New tracking systems improve patient flow
ED managers save staff time, increase satisfaction
The ED at Beth Israel Deaconess Hospital in Boston has reduced its average length of stay from 6.5 hours to six hours for all patients, and from 4.5 to four hours for nonadmitted patients, since the installation of a wireless tracking system for patients, staff, and equipment.
At St. John Medical Center in Tulsa, OK, patient flow also has improved, thanks to its new tracking system.
ED managers say systems like these can help solve some of their most pressing problems.
“Several years ago, we recognized that we needed a very robust electronic tracking system for our emergency patients,” notes John Halamka, MD, an emergency physician and chief information officer (CIO) at Beth Israel Deaconess Medical Center and associate professor of emergency medicine and the CIO at Harvard Medical School in Cambridge, MA.
It was not just a question of determining how many patients they had, but how long they had been there, whether lab or X-ray results were back, whether they had a bed available, and if not, how soon one might be available, Halamka explains.
“It needed to be work flow-centric enough to manage the entire flow of the ED: pharmacy, lab, admitting, all in one place,” he says.
For Halamka, that solution came in the form of the PanGo Locator system from PanGo Networks in Framingham, MA.
How the systems work
The PanGo system used at Beth Israel Deaconess is commonly referred to as a Wi-Fi (wireless) RFID (radio frequency identification) system.
“We use RFID tags, which makes it very easy to deploy,” Halamka says. RFID badges, about half the size of a pager, are put on the patients, as well as on critical high-use equipment such as ventilators, intravenous pumps, and electrocardiograms. Physicians and nurses also wear the badges.
The system’s dashboard is on a 50-inch plasma screen in the charting area. “It is also available via the web on any desktop in the ED core area,” adds Halamka.
While patient names are shown on the plasma screen, only initials are shown on the computers, to preserve confidentiality.
The Patient Care Technology tracking system at St. John, instituted in January 2003, is manufactured by Versus Technology of Traverse City, MI. It uses infrared badges, which are read by sensors in the ceilings of the ED.
“We assign a badge number to each new patient, clip it onto them, and it tracks them through their entire visit in the ED,” says Connie Leonard, BSN, CEN, director of the ED.
The web-based software application is visible on computers throughout the ED. It shows a schematic of the department, where the patient is, a detailed look at what the patient’s complaint is, and what labs and radiology studies have been ordered. Tracking badges also can be put on charts and major pieces of equipment within the department.
Systems have limitations
As with any new technology, there still are bugs that need to be worked out of these systems.
“We’ve had it for about a year, and it has worked fairly well,” Halamka says. “But currently, the image is granular down to the level of the room, but not to an area of, say, 1 foot by 1 foot. But if I’m looking for a ventilator, do I really care exactly what part of the room it’s in?
The system has to be implemented carefully, he adds. “We use Wi-Fi in our hospital for data, voice, and for geolocation,” Halamka notes.
When there are multiple Wi-Fi uses, he explains, a wireless network must be configured densely to ensure efficiency.
At St. John, there were problems early on with the badges cracking easily and the batteries falling out. The staff started taping the badges themselves, but in the last six months, Versus has modified the badges with an extra strip along the bottom to prevent them from cracking.
“I suppose in some places that have this system, badge loss is also a problem, with patients walking out with them, but we’ve been able to manage that pretty well,” Leonard says.
Each member of the staff is assigned a badge and is responsible for taking care of the badge and always wearing it while at work.
Positive response from staff
Some sources indicated that staff might object to the Big Brother aspect of the system, but this has not been the case at either hospital.
They don’t use the system in a punitive way, Halamka points out. “Before we could do any tracking of individual staff, we had to get buy-in from the nurses and the docs,” he continues. “We explained it would be used strictly to evaluate work flow — and not in any kind of job evaluation.”
At St. John, “our physicians and nurses use them by choice,” Leonard adds. “We asked them if they wanted to do it.”
Halamka says his system has been a timesaver. “We estimated that before the system, doctors and nurses spent 10% of the average shift looking for patients, equipment, or each other,” he says. “We’ve eliminated that, and staff satisfaction has gone up.”
He adds that the total costs for ED automation over the past five years have been less than $250,000.
“The badges themselves are under $20,” Halamka notes.
Sources/Resources
For more information on using tracking systems, contact:
- John Halamka, MD, Associate Professor of Emergency Medicine, Chief Information Officer, Harvard Medical School, Cambridge, MA, 1135 Tremont St. E., N6, Boston, MA 02120. Phone: (617) 306-9886. E-mail: [email protected].
- Connie Leonard, BSN, CEN, ED Director, St. John Medical Center, 1923 S. Utica, Tulsa, OK 74104. Phone: (918) 744-3364. E-mail: [email protected].
For more information on tracking systems, contact:
- PanGo Networks, 959 Concord St., Suite 100, Framingham, MA 01701. Phone: (508) 626-8900. Fax: (508) 626-8901. E-mail: [email protected]. Web: www.pangonetworks.com.
- Versus Technology, 2600 Miller Creek Road, Traverse City, MI 49684. Phone: (231) 946-5868. Fax: (231) 946-6775. Web: www.versustech.com.
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