The Memorial Sloan Kettering Cancer Center‘s new Josie Robertson Surgery Center (JRSC) is using a real-time location system (RTLS) to improve the flow of patient care as individuals move through surgery, post-op and recovery. The solution, provided by Versus Technology and installed by Ronco Specialized Systems, tracks where patients are located, how long they spend at any given spot and which staff members are with them. The system tracks not only when patients enter or leave a specific room or area, but also their activity level during post-op and recovery, and can determine if they have remained stationary for too long and thus might require assistance.
JRSC, a 179,000-square-foot outpatient facility located on Manhattan’s Upper East Side, first opened its doors in December 2015. The site, which serves up to 60 patient cases daily, has 12 operating rooms and more than 40 perioperative beds. Its 16 floors include areas for specialty procedures, operating rooms, waiting areas and a café. The center is designed to provide patients and families with a relaxed, comfortable environment, says Daniel Stein, the director of perioperative informatics and innovation in Memorial Sloan Kettering’s Division of Health Informatics. By implementing an RTLS solution, he explains, the center hopes to increase the efficiency of its workflow and enhance its patient care coordination.
JRSC aims not only to provide its patients with high-quality clinical care and a personalized experience, Stein says, but to do so efficiently so that patients can get back to the comforts of home and their daily routines quickly and safely. “This is not an easy mission,” he states, “given the complexity of cancer surgeries and the coordination required among the multidisciplinary teams involved.” Therefore, the clinic hopes that RTLS-based data will provide sufficient visibility to help it achieve its efficiency goals.
When a patient arrives at the center, he or she is issued a clip-on Versus Clearview badge, according to Tina Soyring, Versus Technology’s clinical solutions consultant. The badge transmits a unique ID number via an infrared (IR) signal, as well as a 433 MHz RFID signal using a proprietary air-interface protocol. IR sensors receive the badge’s infrared signal to identify its location, while RFID readers provide redundancy data. The IR sensors then forward the badge ID to a concentrator (or gateway), which uses a wired connection to send that data to the server on which the RTLS software resides. At the same time, the RFID readers receive the badge’s RF signal and forward that information to the concentrator as well. Altogether, 528 infrared sensors and RFID readers were installed on all 16 of JRSC’s floors—approximately 10 sensors for every reader.
As the individual travels from one room to another, the system is updated to indicate his or her new location. Because employees also wear badges, the software not only knows where that patient is and has been, but also when he or she has been visited by a health-care provider, and how long that visit lasted.
Once the patient enters the operating room, a staff member takes the badge, which is later returned to that patient when he or she leaves the OR following surgery.
The patient’s family members or other caregivers are also each provided with badges, thereby allowing those individuals to move freely around the facility—to visit the café, for example—and still remain accessible in case a physician or nurse needs to speak with them. Staff members can simply access the software, input a particular patient’s name and look up the location of that individual’s family members on the premises.
A total of 39 “Glance-and-Go” electronic status boards were installed in staff areas, where health-care providers can view real-time status updates based on specific patients’ locations. Those status boards display surgery schedules, as well as how long a patient has waited or remained alone. They also indicate when an operating room or bed has become available and is ready for cleaning and reuse.
The Versus software forwards RTLS-based data to the facility’s Epic OpTime software, which eliminates the need for personnel to manually enter the time at which surgery and other procedures begin and end. With the data from the Epic software and RTLS deployment displayed on a single centralized screen, employees can identify how quickly a post-operative patient is meeting recovery goals. The system tracks more than just which department a patient is in following an operation—it can also identify when that individual has gotten back on her feet and how much she has moved on her own, thereby indicating her recovery status.
Before opening its doors in December, Stein says, JRSC planned and tested the Versus system exhaustively. To simulate the workflow, the clinic physically practiced the movement of patients through their surgical experience, from when they arrive at the facility and receive their RTLS badges through the entire process, until when they are discharged and return the badges. “Along the way,” he states, “we made sure that the views configured within the RTLS system would meaningfully portray these various stages of the process.”
JRSC encountered a few challenges, Stein reports, including training its staff to wear the RTLS badge and make it part of their daily habit. The center is still finding ways to make best use of the copious amount of data provided by the system, he adds.
“We have not had adequate time, at this point, to formally evaluate the impact this has had on our workflow or outcomes,” Stein says, “but we are optimistic, based on anecdotal evidence, that the system has played a role in enhancing care and team coordination at the facility.”