Real time locating system leads to improvements in emergency department

As Rouge Valley Ajax and Pickering (RVAP) prepared to open its new 20,000 square-foot emergency department (ED) in 2009, we were faced with a new dilemma: How would we track the flow of patients in multiple areas of the ED without the use of an emergency department information system (EDIS), a real-time electronic tracking system?

Most EDIS’ come with a $1 million price tag, far beyond the hospital’s  budget at the time. It was around this time that I recalled having tested out a (RTLS) that works for patients, staff and equipment in an ED of any size and configuration.

Years later, that state-of-the-art RTLS currently being used in the RVAP ED is helping to significantly improve patient wait times, patient safety and efficiency in the ED. It tracks our patients as well as key performance indicators, such as patient wait times, in real-time. RVAP’s ED is the first Canadian acute care facility to use this particular system, by Versus Technologies. The RTLS can track a patient’s entire visit to the ED, from the point of triage, right through to discharge or admission.

Since first going live in February 2010, the RTLS has helped the RVAP ED to surpass targets in all provincial metrics. In 2010-2011, physician initial assessment time (PIA) dropped from 3.6 hours down to 2.7 hours, and to below 2.4 hours in 2011 – 2012. Our PIA is currently averaging at 1.4 hours. Much of this reduction can be directly linked to the real-time tracking system. And as overall length of stay (OLOS) targets have been set even lower, RVAP has managed to keep within targets virtually every day.

The system consists of infrared sensors that are installed in the ceiling throughout the ED. The sensors receive a signal from badges worn by patients and staff. After triage, patients register and are assigned a badge that allows the system to track each milestone along the ED visit, their OLOS in the ED, including the length of time they spend in the waiting room; how long they wait for a nurse and a physician after being assigned to a treatment space; and the OLOS from triage up to discharge or admission to hospital.

Once a patient is seen by a nurse or physician, that caregiver is automatically assigned to them, eliminating the extra step of documentation for staff. Staff in the ED, including physicians, nurses and personal support representatives (PSR), also wear badges that track their whereabouts in the ED. This makes it much easier to locate them when they are needed. Such improvements can help to lessen the time it takes for patients to be seen by ED staff. In the end, both patients and staff benefit.

Each badge has assigned rules based on badge type. A button on each badge will result in pre-defined actions when pressed, also depending on the type of badge. For example, a button press on the badge worn by the mental health team will send an alarm to each workstation, alerting that the crisis worker is in a threatened situation.

In the past, it would have taken months to receive statistics on wait times. Receiving this information quickly and in real-time not only efficiently supplies the data needed to improve patient wait times, but it can also help improve the quality of care patients receive in the ED. We can recognize and correct issues as they occur, helping to maintain our metrics within target each day.
Almost immediately, we were able to see the benefits and power of this system.

The system allows us to easily see the availability of beds in the ED; whether or not a room is cleaned or occupied; waiting room lists (including triage code, complaint and OLOS in real time); and is able to generate reports on trending, both short and long term. Assets within our ED, including EKG machines, ultrasounds, Dopplers, GlideScope and intravenous pumps can be easily located in urgent situations by doing a quick search in the program’s “Enterprise” view.

Another benefit was realized quite early in our experience with the RTLS when we needed to track down everyone within the ED who had been in contact with a meningitis patient within the department, for the purpose of getting prophylaxis to each one. The system was able to generate a report in moments, identifying each staff member that had come in close contact with that patient, allowing us to promptly administer prophylaxis to each.

In 2008, the Ministry of Health and Long-Term Care (MOHLTC) selected (RVHS) to be among 23 emergency departments that would focus on reducing wait times in the ED. The system has helped to support those wait time goals, and has helped with the increasing ED visits experienced in the RVAP ED since the newly-expanded department opened to the public in 2009.

More recently, we have worked with the RTLS to make modifications to the system to allow tracking of established Ministry of Health performance metrics and give us immediate visual management of each patient as to their OLOS, PIA, ambulance off-load times and more. As a patient’s length of stay approaches pre-defined times, the user sees a visual colour warning in the physician assignment and OLOS boxes. These visual warnings prompt our physicians and nurses to intervene, helping us to meet our PIA and triage code-linked OLOS metrics within our provincial target times. Ambulance off-load time tracking has been automated using an “off-load nurse” badge assignment. When the EMS patient is “seen” by the off-load nurse in the off-load area, the off-load time is automatically recorded.

RVHS is now in the final stages of acquiring an EDIS. However, EDIS is only as good as the data that is supplied. In a busy ED, staff can often get behind in updating a patient’s status in the EDIS. The RTLS will automatically capture and update the EDIS on all patient milestones.

Our tracking system has given RVAP a huge return on investment and continues to pay big dividends as we continue to identify new ways to use this versatile technology. What was initially seen as a stop-gap measure has become in integral part of our daily ED management. We could not imagine working without it.

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