Nov 17, 2015Toronto regional health-care provider Mackenzie Health recently completed a yearlong first phase of a pilot project involving real-time location system (RTLS) technology to track staff movements, hand-hygiene compliance and bed safety for patients.
The organization is carrying out the pilot at its 34-bed Innovation Unit, located at Mackenzie Richmond Hill Hospital. Mackenzie Health established this acute-care medical unit a year ago, and refers to it as "a living and breathing laboratory for innovations to be developed, evaluated and adopted by other patient care units at Mackenzie Richmond Hill Hospital, as well as the new Mackenzie Vaughan Hospital." The RTLS solution has been provided by medical technologies firm Hill-Rom, a company that historically makes smart beds for health-care environments, and more recently also provides RTLS technology. Hill-Rom's solutions incorporate CenTrak RTLS badges, infrared (IR) sensors and RFID readers, while Hill-Rom's software manages the collected RTLS data.
Mackenzie Health created the Innovation Unit because it was interested in the technology available for health care, but also wanted a way to test some of that technology rather than fully adopting something that would not prove beneficial. "It comes down to this: There is some truly awesome technology that we can invest in and bring to our staff, and then find out they really don't need it, or won't use it," says Aviv Gladman, Mackenzie Health's chief medical information officer. By setting up an Innovation Unit, the staff can work with the technology in the actual health-care environment, he explains, and management can evaluate how technology changes health-care delivery and impacts patient care.
Mackenzie Health had implemented an RTLS solution within its hospital prior to deploying the application currently being tested at the Innovation Unit. The hospital still uses RTLS technology to track assets and equipment—such as beds, wheelchairs, IV pumps and crash carts—as well as other items. Active RFID tags are also used to monitor temperature, humidity and other environmental conditions.
"We found that the best way to test and evaluate innovation was to do so where the care actually happens," says Richard Tam, Mackenzie Health's executive VP and chief administrative officer.
For the RTLS pilot, the health-care organization is working with Hill-Rom, which also provides the smart beds that it uses at its hospitals. The first RTLS installation involved a hand-hygiene solution to identify the movements of employees as they enter and leave patient rooms, and to identify when they sanitize their hands.
Each staff member was provided with a battery-powered CenTrak RTLS badge that transmits a unique ID number linked to that individual in the Hill-Rom RTLS software.
On the ceiling of each room, a CenTrak infrared beacon transmits a unique ID in such a way that its IR signal fills the room (thereby reducing the likelihood of the module's signal being blocked by a physical obstruction). Infrared is the most appropriate technology, explains Brian Lawrence, Hill-Rom's CTO and senior VP, because it requires a line of sight so that the software knows in which room the individual wearing the badge tag is located.
Each tag contains an IR sensor for receiving a beacon's ID number. The tag transmits the beacon's ID every one and a half seconds, along with its own unique identifier, via a 900 MHz signal to the nearest of the hospital's RFID CenTrak Star access points. The access points then forward that data to the RTLS software via a Wi-Fi connection.
When a staff member enters a patient room, the software receives the related location data, including whether that employee dwells in front of the hand sanitizer both before and after visiting the patient's bedside. E-mails are then automatically sent daily to each worker wearing a badge tag, indicating his or her compliance rate.
Hill-Rom's Smart Beds come with built-in sensors to detect such things as whether the side rail is locked in place, the head of the bed has been elevated and the weight on the bed has changed, thereby indicating if a patient has gotten up. The sensor data can then be transmitted back to the software, Lawrence explains, either through a wired or Wi-Fi connection. Mackenzie Health is leveraging the Wi-Fi network to capture that data wherever the bed is located, without requiring a wired connection.
An LED screen acts as a status board that lists each patient according to the bed ID number linked to that individual in the software, as well as the status of certain bed features (green if the head of the bed is down, the side rail is locked and weight is detected on the bed). If a patient raises the bed, for instance, that will trigger an alert and an audible alarm will sound in that person's room, and information will flash red on the Smart Board. Data can also be forwarded to nurses, each of whom carries a BlackBerry device.
If the weight on the bed suddenly decreases, the system could issue an alert indicating a patient is attempting to leave the bed without required assistance.
When a nurse or other health-care worker responds to an emergency, the presence of that individual's CenTrak badge in the same room as the bed where the alert originated prompts the software to turn off the alert. When the staff member then leaves the room, the bed's exit alarm is automatically reactivated. Therefore, if the side rail, for instance, were still down, an alert would sound as soon as the nurse left the room. This function, Lawrence says, spares hospital personnel from the task of remembering to reactivate alerts after responding.
Mackenzie Health is also testing an asset-management component of the smart beds, stretchers and lifts. A CenTrak battery-powered tag (similar to the staff badge) is attached to each bed, thereby enabling the hospital to identify a particular bed's location based on the room's IR beacon ID number received by the tag. For more granular data about the locations of beds or employees, more beacons are installed to create zones, such as around the hand-hygiene station or next to each of several beds within a room.
In the event of an emergency, staff members can press the button built into their badges to signal that they need help. The software identifies the location and identity of the individual in distress and forwards alerts to the appropriate workers' BlackBerry devices.
"Hand hygiene has been one of the biggest improvements," Gladman reports. Since the hospital first deployed the technology, it has achieved a 30 percent increase in hand-hygiene compliance. In addition, Tam says, the smart-bed functionality reduces the incidence of falls, since employees can instantly see when a patient is trying to get out of bed without assistance.
Tam says the Innovation Unit will continue to use the system deployed for phase one, and Mackenzie Health will deliberate how to go about implementing the technology in other areas of the Richmond Hill facility, as well as in a new hospital set to begin construction in 2016. Phase two will study how the data can best be interpreted and shared with the appropriate hospital personnel. In this phase, the Innovation Unit will utilize software from ThoughtWire to use location data culled from the RTLS software and BlackBerry mobile devices to build advanced workflow automation. The health-care organization hopes to refine its use of the data to identify which individuals should receive alerts, and when.
With the RTLS solution and ThoughtWire's Ambient software platform in place, the system will be able to determine, for instance, which staff members are in the vicinity of a patient who places an emergency call from a bedside calling device. The system can thus issue alerts only to those individuals.
"We are currently exploring options for phase three and a phase four," Tam says, though such plans have not yet been finalized.
In the future, Hill-Rom plans to offer an RFID-based system to automatically track which bed a particular patient is in. The solution may include a passive RFID wristband on each patient, and an RFID reader mounted on that person's bed. In that way, users will no longer need to input data regarding which patient is in which bed. According to Lawrence, the frequency of passive RFID tag to be used has not yet been decided. The company is currently testing different options to ensure 100 percent read rates. About one year from now, Hill-Rom hopes to have the platform fully developed and commercially available.
