Since opening last month, the new Stanford Children’s Health Specialty Services—Sunnyvale clinic has received the best patient satisfaction survey results of any of Stanford Children’s Health 60-some facilities. The health-care company attributes the high patient satisfaction levels, in large part, to a real-time location system (RTLS) that enables the staff to find patients, personnel and assets efficiently, says Lee Kwiatkowski, Stanford Children’s Health’s director of ambulatory transformation.
Stanford Children’s Health Specialty Services—Sunnyvale offers 20 clinical subspecialties, ranging from endocrinology and urology to pediatric development and adolescent medicine. The 77,000-square-foot, two-story facility also includes a phototherapy room and radiology suite, as well as a 6,000-square-foot high-tech laboratory for diagnosing and treating children’s sports injuries. In addition to providing pediatric services, Stanford Children’s Health has a department for fertility and reproductive health.
To manage the movements of patients and health-care workers throughout appointments within these departments, the clinic installed Versus Technology‘s Advantages Clinic RTLS, with the aim of minimizing wait times and making check-ins more efficient. The adoption of an RTLS solution was important to the new clinic, Kwiatkowski says, so it could avoid some of the shortcomings that can otherwise plague a large facility offering such a complex array of services.
“The first problem is the ability to see how long patients are waiting and what happens along the way, during their appointment,” Kwiatkowski says. The clinic wanted to be sure that it could locate patients and their family members in real time when an appointment was ready, or when they were otherwise needed. In some cases, a patient may have multiple appointments in several departments within the clinic, potentially making it difficult to identify where they are located and whom they’ve seen at any given time. The clinic also wanted to ensure that patients did not spend a great deal of time waiting in an examination room alone, or that an exam room cleaning was not delayed or missed due to staff members not knowing that a patient had left it.
In addition, Kwiatkowski notes, the clinic didn’t want to be the kind of place at which patients sat in a crowded waiting room until a staff member walked through a doorway and called out a name. Instead, Specialty Services—Sunnyvale was intended to be a more personal facility, at which a patient would know that his or her turn was coming, would not have to wait for long, and would receive a more discreet notification when that turn arrived.
By using RTLS technology, the clinic departments could accept and treat patients efficiently, and ensure that they remained on time for other appointments at the same facility. The system that the clinic installed employs a Versus Clearview battery-powered active 433 MHz RFID and infrared (IR) tag in form of a badge (RFID provides redundancy for the IR transmissions). Each badge transmits a unique identifier to a nearby receiver, either a V-Direct (with a cabled data and power connection) or the wireless, battery-powered V-Link. Specialty Services—Sunnyvale has approximately 400 such badges onsite for patients and personnel. A badge can be clipped onto an individual’s clothing, typically near that person’s chest or shoulders, so that sensors mounted on the ceilings can receive the unique ID that the badge transmits. The Clearview badge contains a button that a patient or staff member can press to summon assistance. The clinic is also attaching Versus Asset tags, measuring 1.5 inches square, to wheeled tablets for language interpreting, blood pressure machines and other equipment.
When a patient arrives, personnel explain the RTLS solution to that individual, who then receives a badge. Teenagers and family members tend to each get their own badge, while an infant or toddler and family members typically only require a single badge for the entire group, since they won’t be separated during their stay. The ID number transmitted by the badge is stored in the RTLS software, where it is linked to the patient’s information, and is also integrated with the electronic medical record (EMR) system so that not only a patient’s name, but also his or her physician and appointment time are linked to that tag ID.
The waiting rooms are intended to be comfortable and not overcrowded, Kwiatkowski says. In fact, there are several for each area—typically, one with a television, one without and one in which an activity is taking place to keep children occupied. The rooms are divided into zones, based on the locations of receivers throughout each room, so that the system knows not only in which room a particular badge or tag is located, but also in what part of that room.
Two 55-inch video screens are installed in the staff area of each department throughout the facility. Using data collected from the RTLS software, the screens show where individuals and assets are located, and also display a list of which patients are waiting. When a patient arrives for an appointment, his or her physician can see that the individual is present.
Once the exam room is ready, a staff member accesses the RTLS software to determine the patient’s location, proceeds to the patient in that room and zone, and escorts her to the exam room. The software then tracks how long the patient remains alone, when the nurse visits that patient and when she is ready to see the physician. This data is also displayed on the 55-inch screens for physicians and other staff members.
When a patient’s visit is completed, the technology identifies when that individual leaves, based on the badge reads, and can update the room’s status as ready for cleaning. The patient is then reminded to return the badge by placing it in a box that reads the badge’s ID number and updates that visit as completed. After the badge is cleaned, it can then be reused by another patient. Additional return boxes are installed at the building’s doorway, with signage reminding those who have not already turned in their badges to place them within the box. Staff members make phone calls to patients who appear to have inadvertently taken theirs home despite these reminders.
Some employees are full-timers who have Clearview badges dedicated to them, while others—such as the many physicians who are onsite periodically—have badges assigned to them every time they arrive for work. Staff members can use the system to locate each other, and to find equipment they need without having to physically search for it.
A total of about 500 sensors are installed throughout the facility. Some sensors are used to identify the specific exam room in which a given individual is located, while others provide bed-level granularity—in the procedure recovery area, for instance.
The clinic has been serving 100 to 200 patients daily, Kwiatkowski reports, though that number is ramping up. The facility expects 40,000 patient visits during its first year. Since its opening about six weeks ago, Kwiatkowski says, he has been pleasantly surprised by the results in terms of customer satisfaction. The satisfaction scores, he explains, tend to reflect wait times and the information available to patients about their wait (the cause of the delay, for example, or what services are coming next), and the scores from patients at the clinic have been the highest that the health-care company has ever seen. According to Kwiatkowski, several physicians have already determined that, based on the technology, they can accomplish more visits per day than they did at the previous facility on the Stanford University campus. This has boosted the satisfaction levels of doctors and other employees as well.
Kwiatkowski says he and his team are now examining the analytics to determine what they can learn about the clinic’s efficiency, where bottlenecks occur, and how well patient scheduling matches the abilities of employees and the facility to serve patients in a timely manner. “If there’s a problem, we can see where things broke down,” Kwiatkowski states, adding that it will still take time to sort through those details.
Stanford Children’s Health is currently in the process of expanding its Lucile Packard Children’s Hospital Stanford facility. The company plans to install the same Versus technology at that hospital, primarily for asset tracking, once the expansion opens in approximately a year.