Advocate Good Samaritan Hospital Tracks Trays Packed With Surgical Instruments

The Illinois hospital, which serves approximately 9,000 patients per year, is using an active RFID-based real-time location system to track and find trays assembled for specific procedures.
Published: March 23, 2009

Advocate Good Samaritan Hospital (AGSH), a 340-bed acute-care facility located in Downers Grove, Ill., is installing a real-time location system (RTLS) that leverages active RFID and workflow software to help track surgical instruments that have been packaged onto trays in preparation for surgical operations.

The system includes real-time workflow automation and tracking software from Patient Care Technology Systems (PCTS), headquartered in Charlotte, N.C., and active RFID tags and readers from Awarepoint.

The RTLS implementation is part of a $45 million overhaul the hospital launched approximately four years ago to replace and refurbish its surgical department, which is now a 50,000-square-foot pavilion containing 15 operating suites, a number of private recovery bays and a centralized sterile processing department. “As part of this project,” says Peggy Guastella, AGSH’s director of surgical services, “we wanted to be sure that we looked at technology that would help us be more efficient, and instrument tracking is part of that journey.”

Awarepoint’s RTLS leverages reusable active RFID tags that can be sterilized—an important requirement for AGSH, since all devices and equipment moved into an operating suite must be sterile. “We looked at [RFID] technology several years ago, but it didn’t quite meet our needs at the time,” Guastella explains. “We need these tracing buttons, or tags, to be autoclavable—meaning they can be sterilized.”

Awarepoint’s tag, unveiled about one year ago, is designed to withstand steam autoclave cycles at temperatures of up to 135 degrees Celsius (275 degrees Fahrenheit), as well as common liquid sterilization methods, the company reports. The tag measures less than 1.5 inches in width and length, and can remain on assets as they undergo sterilization, thus enabling hospitals and health-care organizations to monitor the sterilization process.

According to Stephen Armstrong, PCTS’ VP of marketing, AGSH is expected to begin employing 150 of the tags this month, to track metal surgical trays of various sizes that are designated for appendectomies or other specific procedures. In addition, the hospital plans to utilize 40 tags to track various assets, including infusion pumps, surgical cameras and scope warmers (devices that heat endoscopes and laparoscopes to a person’s body temperature, in order to keep them from fogging up during surgical procedures).
The location data calculated by Awarepoint’s RFID system is shared with PCTS’ Amelior ORTracker software, designed to help hospitals track surgical assets (particularly movable equipment, such as surgical trays), patients and employees. The software also incorporates rules and algorithms to monitor workflow, patient flow, surgical schedules and processes.

PCTS has affixed the tags to the trays and assets using special clips. At the time a tag is attached, its unique ID number is associated with that asset or tray—and with related attributes, such as the type of surgery for which it will be used—via clicking on the tag number (which is also printed on the tag) in Amelior ORTracker’s drop-down menu. A select group of trays have also been associated with specific surgeons who have requirements for the particular instruments needed for the procedures they perform. As the hospital expands its use of the system, its staff will be able to affix the tags and make the associations in the software.

When a surgery is scheduled, staff members in the central sterile processing department will take the appropriate tagged tray and assemble the instruments required for that procedure (and, if applicable, for the attending surgeon), per instructions from the hospital’s existing surgical scheduling system. The tray and tag will then be sterilized and wrapped, placed onto a sterile case cart, and put into a sterile elevator to be moved into the correct OR in time for the surgery. The RTLS will be able to track that tag and tray as they move through this process. The tag and tray will also be tracked when the surgery is completed and the tray is moved back to the central sterile processing department, where it will then be stored until needed for another operation.

The tags operate at 2.48 GHz, transmitting their unique IDs over the 802.15.4 (ZigBee) communications protocol, to small readers (which Awarepoint refers to as sensors) that plug directly into standard 120-volt AC wall outlets. The tags and readers also function as transceivers, communicating with each other via the ZigBee mesh networking protocol. AGSH has 112 readers installed throughout the surgical department. A reader can transmit data to a main access point (known as a bridge—the hospital has seven of them in its implementation) or, if the access point is not in range, to another reader. That reader could then forward that information to a third reader, or to a main access point, if it is within range. Each reader employs the ZigBee protocol to forward a tag’s ID number and signal strength to a bridge, along with its own ID number, the time it read the tag and the ID of the transceiver that may have previously picked up the tag’s signal.

The bridges link, via an Ethernet cable, to a central server at AGSH that calculates the locations of all tagged assets. The server can identify each tagged asset’s location to an accuracy level of 1 to 3 meters (3 to 10 feet), using a proprietary algorithm to determine asset locations, based on the tags’ RF signal strength.
The ability to track the trays from assembly to surgery helps to ensure surgical instruments are ready when doctors need them, Guastella says. “We have a high volume of specialty surgeries here,” she explains, “and when surgeons come in to do their surgeries, if the tray isn’t already in the OR, we have to find the trays. I don’t want to have a surgeon waiting while we are looking and hunting for the tray.”

Now, a nurse can go to the nearest computer, access Amelior ORTracker, and search for a specific tray by entering the type of surgery, or the doctor’s name. “The software will show the nurse, within 8 feet, where that tray is,” Guastella states.

In the coming months, Armstrong says, several workflow features—such as watch lists for high-demand trays, and warnings triggered if dirty trays are taken into a clean area—will be incorporated into the hospital’s implementation. Additionally, PCTS will help the hospital integrate Amelior ORTracker with the surgical scheduling system so that trays can be associated with patients and their specific surgeries, thereby enabling nurses to search for and track particular trays via the appropriate patient names.

What’s more, Guastella says, the hospital plans to use the RTLS and Amelior ORTracker to monitor patients, and hopes to begin doing so in the next couple of months. “One of the things we’ve been looking for,” she states, “is a system that has a high degree of automation and can track the patient in a very passive way. We didn’t want the nurses to have to put more information into a patient chart; the nurses are very busy, as you can imagine. We want the technology to work for them.”

According to Guastella, a tag will be clipped onto the gown of each patient admitted for surgery. The tag’s ID number will be associated with a number assigned to that patient during admission, and only that individual’s ID number will be displayed on a screen in the patient waiting room. “The family will know that number,” she says, “and they will be able to see as the patient moves from pre-op to the OR to the recovery room. Patients’ families really love to have those kinds of updates.”