Kaiser Permanente San Jose Medical Center has begun employing a ZigBee-based real-time locating system (RTLS) to help its staff more easily locate items for equipment maintenance or clinical use, as well as to track the temperatures of its cooling and warming units.
The 242-bed facility handles 35,000 outpatient visits and delivers 2,225 babies annually. A study entitled “A 36-Hospital Time and Motion Study: How Do Medical-Surgical Nurses Spend Their Time?” analyzed staff efficiency and found that nurses traveled 1 to 5 five miles per 10-hour shift—with a median of 3 miles—and that three-quarters of their time was devoted to their nursing practice. The article, published in The Permanente Journal, further found that 6.6 percent of the nurses’ time was spent engaging in activities categorized as waste, such as wandering around the hospital searching for needed equipment. The statistics in the report were based on data collected at 36 hospital medical-surgical units within 17 health-care systems and 15 states. However, Kaiser Permanente San Jose conducted its own study, according to Terri Simpson-Tucker, the medical center’s assistant administrator, and determined that in 2007, it wrote off 251 assets, with a total value of $212,500, simply because they could not be located.
To resolve such problems, the hospital considered several technological options. “We started looking [at RFID] about four and a half years ago,” Simpson-Tucker says. The medical center’s research included reading about the technology in articles published by RFID Journal, speaking with vendors, and studying options related to passive and active systems, as well as plug-and-play solutions (such as a ZigBee-based system) versus those that are hardwired.
“We knew a hardwired system would be a problem,” Simpson-Tucker says, due to the facility’s age, and because California’s construction requirements made installing wires in the walls or ceilings problematic. “We needed room-location accuracy, non-disruptive installation and tags that were sterilizable,” she states, since some would have to go through the sterilization process with the equipment to which they were attached. The hospital determined it required a holistic approach, with a solution that would benefit its patients, health-care professionals and management by providing both managers and caregivers with better data concerning equipment availability, location and usage. The hospital invested $500,000 in the project.
Kaiser Permanente San Jose Medical Center selected Awarepoint‘s ZigBee-based system, with access points (that Awarepoint calls sensors) that plug directly into power outlets. In December 2009, the hospital launched the system in 10 buildings in which assets and nurses are located, with a total of 660,000 square feet and 35 floors of coverage area. The medical facility is tracking 4,200 items, including more than 100 food and medication refrigerators and warmers.
Battery-powered RFID tags on assets transmit 2.4 GHz signals encoded with a unique ID number. The tag data is then sent over the IEEE 802.15.4 (ZigBee) communications protocol, and forwarded via mesh network consisting of other tags, as well as access points, until that information is received by a bridge unit. From the bridge, all data is forwarded via an Ethernet connection to the application software running on a vendor-hosted server. The software pinpoints each tag’s location via patented signal-strength algorithms.
By logging onto any networked computer, staff members can search for an item by inputting that object’s name or asset number, or by using a pull-down list of tagged assets. A map of the facility is then displayed, with icons indicating where that item can be found, including in which room. One challenge related to implementing the system involved determining the proper naming convention for the assets being tracked. An IV pump in one department might be known as an infusion pump in another, for example, and by a brand name in a third department. This required working cooperatively with the various departments to assign names to items that all employees could use when seeking a particular asset in the software.
The medical center tagged items of value that are often misplaced, such as wheelchairs, EKG machines, ventilators, aspirators and dialysis equipment. In addition, Simpson-Tucker—who has a background in nursing—was able to identify other objects that should be tracked as well. She also attached tags to keys, phones and other items that nurses might misplace, but that were of high value and significance to the tasks they perform. Thanks to the ZigBee-based RTLS, nurses spend less time searching for missing assets or their own tools, and can thus use that time to care for patients.
With the new system, Simpson-Tucker indicates, the hospital hopes to realize an annual savings of approximately $257,000, from reduced theft and increased utilization of existing equipment (and, therefore, fewer rentals). In this way, Kaiser Permanente San Jose Medical Center projects that it will recoup its investment after two years and seven months. Recovery of just a few high-value assets, she says, has the potential to substantially increase its investment, and the hospital has yet to determine whether increased utilization of its assets will reduce its equipment-purchasing budget.
When it comes to temperature monitoring, Simpson-Tucker began with pharmaceutical refrigerators, placing temperature probes, wired to active RFID tags, inside the refrigerators. The probes measure the temperature, and the tag transmits that information, along with its ID number. If the temperature fluctuates out of the acceptable range for a predetermined span of time, the server also issues an alert to hospital management, advising them to have the unit checked. That data can also be stored and provided to the Joint Commission, in order to display the temperatures of all coolers on a daily basis. This, she notes, makes Joint Commission reporting easier and more accurate. Prior to installing the temperature-monitoring solution, workers recorded temperatures manually, requiring that clinical staff members take time away from their other tasks to record those temperatures.
The hospital then began applying temperature monitors to other items, such as fluid and blanket warmers. “We started with an eye for asset management,” Simpson-Tucker says. “Then, with an initiative from the pharmacy for automatic temperature reading—because the infrastructure was in place—we said, ‘Let’s take a look at what else we can do with this.'” Refrigerators filled with patient food will be the next target, she adds, with about 125 of those units scheduled to be tagged during the next few months.
Since the system has been installed, Kaiser Permanente San Jose Medical Center has formed a steering committee to review the system’s reports “so we can get a look at the ROI,” Simpson-Tucker says. To date, the committee has found that there is a significant reduction of complaints from clinicians regarding missing equipment. “We have increased staff efficiencies. It was taking [on average] 30 minutes to find a piece of equipment; now it’s an average of 5 minutes.” The hospital’s biomedical staff previously spent 30 percent of their time locating equipment to perform preventative maintenance, she says, adding that they now spend 5 percent of their time—and that time, she notes, is spent looking for items that have yet to be tagged.
“We’ve been able to stop some requested rentals,” Simpson-Tucker says, due to equipment being located that previously might not have been found.