Locating infusion pumps and other assets quickly has been a perennial problem for hospitals. So it's little wonder more and more institutions are exploring real-time locating systems (RTLS). But as many who have kicked the tires on RTLS technology have found, prices can be steep. Yet the real issue is whether these systems deliver a return on investment in terms of saving staff time from searching for needed equipment. Here an expert from the ECRI Institute gives a tutorial on key issues to consider when evaluating RTLS for your facilities and how to measure ROI.
Real-time locating systems (RTLS) have been slowly gaining momentum in health care. RTLS has been heavily marketed, promising better utilization of equipment, improved efficiencies and a positive return on investment (ROI). But hospitals have been cautious to utilize the technology because it is complex and expensive; many health care organizations are waiting for the early adopters to prove or disprove the marketed claims.
In this article we'll look at one case involving the use of infusion pumps—a commonly tracked item in hospitals—to illustrate how RTLS can meet the claims of better utilization, and improved efficiencies and ROI.
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.
Understanding the basics about the system components is important since there is a lot of variability in the design between the different vendor products, which could affect their implementation (e.g., cost, functionality, installation time). The systems should be assessed during the procurement and purchasing phases; however, delving into the specific details falls out of the scope of this article. For more information, see ECRI Institute's Health Devices journal's guidance articles "Real-Time Locating Systems: Tracking Down the Right Solution for Your Facility" (September 2009) and "Asset Tracking: What It Is and Whether It's Right For You" (October 2006).
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.
For the remainder of the article, we will consider a hospitalwide implementation involving the location tracking of infusion pumps. Infusion pumps are an ideal medical device to track. They are ubiquitous within the hospital, and yet, a pump often cannot be found when one is needed. Consequently, clinicians may hoard them. ECRI Institute's research indicates that some take extreme measures such as hiding pumps above ceiling tiles. This leads to a host of issues such as over-procurement, time wasted looking for pumps, delays in treatment, increased rentals, and cleaning and infection control concerns.
ECRI Institute recently undertook a major project to evaluate vendors in the RTLS marketplace, which incorporated a combination of on-site hospital visits, telephone interviews and laboratory-based assessments. (Our findings will be published in the September 2010 issue of Health Devices.) The following examples arise from the user perspective portion of our research.
Search time adds up
One of the first benefits mentioned by hospitals during our interviews is the soft ROI involving 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, our 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.
Barbara Majchrowski, MHSC, P.Eng., is a Senior Project Engineer in the Health Devices Group at ECRI Institute, Plymouth Meeting, PA. Contact her at email@example.com.
This article first appeared in the June 2010 issue of Materials Management in Health Care.
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