Like a growing number of hospitals, the Albert Einstein Medical Center is leveraging a real-time location system (RTLS) to locate patients, employees and medical devices. But the Philadelphia teaching hospital has taken its RTLS beyond simple tracking—it’s utilizing the system to monitor the training of residents and interns, and to track the work and efficiency of its doctors and nurses.
The RTLS combines Sonitor‘s ultrasound-based indoor positioning system (IPS) with Amelior EDTracker software from Patient Care Technology Systems (PCTS). Amelior EDTracker is designed to help a hospital’s emergency departments monitor and analyze patients’ physical locations, as well as the status of their care, then display that information in charts and graphs via computers located throughout the department. Most of the computers are at three pods throughout the department, but the application can also be accessed via computers located on carts that can be wheeled from room to room.
Sonitor’s IPS utilizes battery-powered tags that transmit 20 kHz to 40 kHz acoustic signals to receivers. Through frequency modulation, each tag communicates a unique ID number to the receivers, which employ Sonitor’s patented Digital Signal Processing (DSP) algorithms to calculate the signals’ locations and convert them to data. The receivers then transmit the location and tag data to a central computer via an existing LAN, and that information is then used to populate the Amelior EDTracker software.
The hospital first began seeking an automated way to monitor patient flow back when it embarked on a $10 million expansion and renovation of the emergency department, according to Dr. Albert Villarin Jr., the hospital’s chief medical information officer. Around that time, Villarin witnessed a demonstration of PCTS’ Amelior EDTracker, and the hospital decided to try it out.
Back then, however, PCTS’ software mainly worked with infrared tags, so Albert Einstein Medical Center initially began utilizing that tracking technology. Infrared signals, however, generally require an unobstructed line of sight between the tag and the sensor. That posed challenges when attempting to track patients, as the infrared tags would sometimes inadvertently end up under the patients, blocking the required line of sight between a tag and the reader.
In September 2008, therefore, the hospital switched from an infrared system to Sonitor’s ultrasound technology, after PCTS had worked with Sonitor to build links between the company’s products and PCTS’ software, which PCTS announced in May 2007.
Today, Albert Einstein Medical Center provides every patient that comes into the emergency department with a Sonitor tag. “We have 350 tags available to us for patients,” Villarin says, “and on Mondays and Tuesdays, we usually max out.”
During admissions, a clerk picks up a Sonitor tag, enters its ID number into the computer—along with the patient’s name and other information—then prints out an adhesive label displaying the tag number and that person’s name. The label is adhered to the Sonitor tag, which is then clipped to a brightly colored plastic card that travels with the patient at all times (much like a chart would). When a patient is taken into the triage area, for instance, the plastic card with attached Sonitor tag is hung on a pegboard. When the patient is moved to a room, the card and tag are taken to that room as well. When a patient is discharged, the label is taken off the card, the software system is updated and the Sonitor tag is cleaned and readied for reuse.
The hospital created the card-and-tag process when it had the infrared system, Villarin says, in order to avoid the possibility that a sensor’s signaling might be blocked. It kept that process largely because the staff had become used to it, and because it was working. “Today,” he states, “everyone thinks about a patient and tag together.”
Doctors, residents, interns and nurses also wear Sonitor tags as part of their employee badges (the hospital has issued approximately 300 such tagged badges to date). About 30 medical devices, such as mobile X-ray machines, have also been tagged.
Additionally, the facility has approximately 75 receivers installed in its ceilings—at least one receiver in each patient room, as well as others positioned throughout the emergency department, captures the tags’ signals, and the information is continually used to update Amelior EDTracker. The data offers the hospital a real-time view of where patients—as well as any caregivers who treat them—are located at any point in time.
Suppose a patient in respiratory distress comes in via ambulance, for example, and is admitted to the emergency department. As that individual is wheeled into a room, his whereabouts are tracked. “When the attending [physician] goes into the room, that’s tracked,” Villarin explains. “If a resident goes in, same thing. If a nurse goes in, that’s tracked too.”
Amelior EDTracker has been integrated with the hospital’s other back-end systems, such as those used by radiology and labs. Any treatment ordered for a patient is documented manually in Amelior EDTracker by a nurse. Once that order is inputted, it is sent automatically. “So the patient’s whereabouts, which doctors and nurses treated him, and what was ordered (and when) is all documented,” Villarin says. The time and date a lab specimen is received, and that lab work is completed, are also entered and updated in the software, so doctors and nurses treating the patient are aware of the lab work’s status.
Since the expansion, renovation and implementation of its RTLS, Albert Einstein Medical Center has seen a $4.5 million increase in hospital revenue and a 24 percent increase in the number of patients in its emergency department and hospital admissions. The facility has decreased payment denials for emergency department services from 3.4 percent to 2.1 percent, reduced the percentage of people who come into the emergency department but leave before treatment is completed from more than 5 percent to between 1 and 2 percent, and shortened the length of hospital stays.
Equally important to tracking patient flow and improving the emergency department’s ability to treat patients efficiently and effectively is the hospital’s use of its RTLS to monitor the training of residents and interns. Since staff members wear tagged badges, the system can capture which residents visit which patients, as well as which doctors work with which residents.
“We can track the interacting between attending physicians and residents,” Villarin says. “We can track how many sick patients residents see, versus patients that aren’t very sick. We have a million data elements we can capture, and it helps us know how efficient our residents are—what’s lacking. We can improve their throughput and efficiency by monitoring.” While tracking residents’ and interns’ training doesn’t directly affect the emergency department, he notes, “it does affect our emergency department’s efficiencies and throughput.”
The RTLS also enables the hospital to evaluate its doctors’ performance. At monthly faculty meetings, each doctor receives a report, generated by an EDTracker program designed for data analysis from PCTS, that quantifies the number of patients treated by that physician, as well as the time it took to treat those patients, how often each person was visited, the length of time before each was discharged or moved out of the emergency department, and more.
The Albert Einstein Medical Center is now working with PCTS to integrate Amelior EDTracker with a new system it is implementing for electronic medical records. Once that is complete, the hospital will have a single portal for all patient data, including real-time location data, patient charting and other information, such as diagnoses, treatment plans, age and weight-based medication dosing and medication alerts.