Outpatient Clinic Tracking Systems

Having looked at Patient Tracking Systems in the OR and ED settings in previous postings, we now turn to systems for Outpatient (Ambulatory) Clinics. As increasing numbers of medical conditions are conducted in the outpatient setting, the importance of managing patient flow increases. A tracking system can help optimize patient flow through Outpatient Clinics reducing wait times and increasing revenue.

Wavelength Information Services produces such a system.

A set of events is assigned to each patient when they arrive. As they receive each service, the user clicks to indicate that the patient is ready for their next event. The system displays the clinic that each patient is going to visit, along with the time of arrival, time of registration, and time the patient enters the care area.

In a study conducted to demonstrate the need for tracking systems in Outpatient Clinics, hospitals were found to have very different patient arrival patterns.

Two Ambulatory Surgical Centers were compared on the study. Hospital 1 has a clear patient arrival peak that will stress resources, whereas Hospital 2 has a more uniform patient arrival pattern.

This graph shows the gap between mean and maximum bed occupancy in an Ambulatory Surgical Center.

This table shows the variability from one physician to another when performing the same procedure.

Taken together, the results of this study demonstrate that the resources of Outpatient Centers are not used evenly throughout the day or by different providers resulting in stresses on the resources of the center. The study makes a strong case for a patient tracking system like the one above, which besides helping move patients through the center more quickly would allow for a patient arrival pattern that is more spread out.

ED Tracking Systems

The Emergency Department (ED) is both a primary site of care for many and an important entry point into the hospital. As a result, many EDs are overcrowded. To increase capacity and improve quality, EDs have turned to patient tracking systems.

One such system is made by Logicare.

As well as tracking a patient’s location in the ED, i.e. whether the patient is in the waiting room or in an examination room, it shows the name, age, and sex of that patient, their complaint, the RN and MD that saw them, length of stay, and any lab or radiology tests that may have been ordered. In some systems, RFID bracelets are used for automated entry of the patient’s location.

A recent survey of California hospitals showed that 69% used an ED tracking system. The two major reasons cited for using these systems was to improve quality of care and patient satisfaction. Users expressed high satisfaction with most features of ED tracking systems, such as ability to pull real-time data, user-friendliness, and ability to enter orders in a single location. However, users were unsatisfied with the ability to interact with other IT systems and physiologic/vital signs equipment. This seems to be a recurring theme in healthcare IT systems, and solutions to integrate the different IT systems used by healthcare organizations will have to be developed if adoption of IT by hospitals is to be improved.

Advantages of using OR Tracking Systems over Manual Entry

In the last entry I introduced OR tracking systems. In this one, I would like to discuss the advantages offered by these systems over manual systems.

A major benefit of using tracking systems is that it helps with the predictability of patient flow. When downstream units can predict when patients are going to arrive, it is easier for them to ensure that a bed is available when the patient arrives. Units are also better able to match staff supply with demand.

A second advantage of using OR tracking systems is that less revenue is lost due to ORs that are unused. In manual systems, anesthesia prep units do not know that an OR is available as soon as it is turned over. With automated systems, said units can anticipate when an OR will become available and can send a patient to it before the OR is idle.

A third benefit of using patient tracking systems is that it allows for quick detection of “wrong patient-wrong procedure” events. An RFID system was tested to determine the speed of response to bringing the patient into a wrong OR. The process model and the information flow look like this:

 

 

When a patient is wheeled into the wrong OR, it takes 30 seconds on average for an alert to be displayed in that OR, and it takes about three and a half minutes on average for the system to send pager messages like the one below to the appropriate staff.

A fourth advantage of using OR tracking systems is that the precision of a patient’s whereabouts are significantly improved. In a study comparing the accuracy of an RFID system to manual recording, the average delay between an activity and its documentation was 80 seconds for the RFID system and 735 seconds for manual entry. The significantly improved precision offered by the RFID system no doubt would greatly improve the ability of downstream units to predict patient flow as well as save time wasted by healthcare professionals checking in on a patient that is no longer there.

Together, these advantages make a strong case for the use of patient tracking systems in OR suites.

OR Tracking Systems

Traditionally, healthcare professionals have not had access to real-time information regarding a patient’s perioperative whereabouts. As a result, the different units that a patient flows through cannot anticipate when a patient is about to arrive, or when he/she should move to the next one. For example, the anesthesia prep unit may not know when the OR that is scheduled to have the patient is ready, or an ICU doesn’t know when a patient is going to leave the OR. In addition to poor patient flow, this results in underutilization of resources and a loss of revenue.

To track a patient’s location live, electronic status boards can be placed in the units through which surgical patients pass, or where interested parties work, such as the surgeon’s office, the prep area, PACU, ICUs, and wards. The patient’s location and status is entered by healthcare professionals in the different units, usually by pressing one function key. The boards indicate each patient’s location as well as other relevant information such as the surgery, surgeon, and the patient’s biographical data. Color coding is used to indicate a patient’s location and the surgical stage that the patient is in. Flashing is used to indicate delays or complications.

One example of such a system is LiveData’s OR-Dashboard.

Besides displaying patient status and location, it provides reminders and real-time tools to improve quality such as Active Timeout.

LiveData also offers PACU Dashboard for the Post Anesthesia Care Unit and Patient-Aware OR to deliver relevant case information to the entire OR team.

Introduction to Patient Tracking Systems

Healthcare professionals have dreamed of a tool that tells them patient location live. An anesthesiologist may desire to know if a patient is already in the prep unit. A surgeon would like to be alerted when the patient is already in the operating room. An ICU nurse manager would like to be able to tell when a patient leaves the OR. Knowing the location of a patient allows healthcare providers to anticipate workload and better coordinate care.

The advent of bar code technology made possible the development of early tracking systems in 1989 (1, 2). Bracelets containing unique bar codes were fastened to patients, and the bracelets were scanned as the patient moved between different locations. In the following two decades, newer technologies were developed. Today, patients wear RFID (Radio-Frequency Identification) bracelets that are detected by sensors throughout a medical institution and automatically update the patient’s location in his/her record (3). Rather than simply transmitting location, RFID-based systems allow for enhanced care by performing functions such as auto-tracking clinical interventions at the bed side (4) and monitoring and reporting vital signs (5).

The purpose of this blog is to review patient tracking systems used by hospitals to monitor patients throughout their visit. I will attempt to cover some of the different platforms available and some of the settings in which they are used. I will also cover the operational, clinical, customer service, and financial benefits, if any, of tracking patients in a medical services institution.

Refs:

1.      Zerbe TR. Engineering methods in an ambulatory surgery clinic: a case study in computerized patient tracking. J Ambul Care Manage. 1989 Nov;12(4):48-60.

2.      Zerbe TR and Zerbe, SD. Analysis of Patient Service Time in Ambulatory Clinics: Patient Tracking. Proc Annu Symp Comput Appl Med Care. (1990) November 7: 840–844.

3.      Ting SL, Kwok SK, Tsang AH, Lee WB. Critical Elements and Lessons Learnt from the Implementation of an RFID-enabled Healthcare Management System in a Medical Organization. J Med Syst. 2009 Dec 2.

4.      Ohashi K, Ota S, Ohno-Machado L, Tanaka H. Smart medical environment at the point of care: auto-tracking clinical interventions at the bed side using RFID technology. Comput Biol Med. 2010 Jun;40(6):545-54.

5.      Ohashi K, Kurihara Y, Watanabe K, Tanaka H. Safe patient transfer system with monitoring of location and vital signs. J Med Dent Sci. 2008 Mar;55(1):33-41.