10 Steps to Consider When Implementing RTLS in Healthcare

17 April 2020

For hospitals and other healthcare facilities around the world, keeping track of both assets and people is fundamental to their operations. An inability to do so reliably inevitably results in diminished standards of patient care and staff efficiency, along with higher equipment and operating costs.

But a real-time location system (RTLS) can significantly improve a healthcare facility's capabilities in this area.

With RTLS, assets such as medical equipment, available hospital beds, and pharmaceutical supplies can be tracked in real time to ensure they are available for use when and where needed. The same system can also track people—both patients and staff—to enhance security and boost productivity.

That's why RTLS systems are steadily increasing their penetration into the healthcare community, and are now used in about 25% of U.S. hospitals.

But what exactly is RTLS, what benefits it offer, and what are the ten steps to consider when implementing RTLS in your healthcare facility?


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What is RTLS?

A real-time location system identifies the locations of targeted assets or individuals within a defined area. That area may include, for example, an entire hospital, or various subsections of a facility. Items of interest are given ID tags or badges, each of which transmits a wireless signal with its own unique ID. Sensors at various locations within or adjacent to the target area receive those signals, and use them to identify where the tagged item or person is located.

Location information for each individual asset or person is typically consolidated within a centralized RTLS software. Staff members needing to know the whereabouts of a particular patient or piece of equipment e.g. and IV Pump can log into the system and access that information on a continuing, near real-time basis.

How RTLS systems work

RTLS systems may use any of several different technologies, depending on the particular use case.

Passive & Active RFID

Passive RFID systems are similar to those used in stores to prevent theft. A strategically placed reader sends out a signal that is received by the tag attached to an item. That tag responds with its own signal sent back to the reader. These systems can be quite inexpensive, with tags costing as little as a dime. Active RFID, on the other hand, employs battery-powered tags that, while somewhat more costly, provide greater capabilities and flexibility. For example, while passive RFID requires that tags be fairly close to the reader for it to work, an active RFID tag emits its own signal that can be read much farther away.

Bluetooth Low Energy (BLE)

Bluetooth is often considered one of the best technologies for asset tracking. It offers low-cost tags with extremely long battery life, making them ideal for reusable assets. The tradeoff is the short-range, which requires a fairly tight grid to track assets. Bluetooth is also readable with many devices, including ordinary smartphones. As an RTLS solution, however, Bluetooth is extremely popular, and with reason. There will be more about Bluetooth later in this article. BLE asset tracking is cheap, easy to manage, and the solution for most non-edge cases.

WiFi

WiFi used to be the go-to technology but has not been used as much recently. There are still some use cases in which WiFi asset tracking may be useful. Most particularly, WiFi tracking uses existing WLAN infrastructure, meaning that the company does not need to invest heavily in beacons, etc. However, WiFi is generally not as efficient as newer technologies and is mentioned here primarily because of its long history. There are still some use cases in which Wi-Fi tracking may be useful, but most companies should be considering moving on, especially as WiFi bandwidth is used for so many other means of communication.

Infrared

These systems use tags that emit line-of-sight infrared signals. The sensors are typically located on the ceiling. As long as the visual path between the tag and the sensor is not obstructed, an infrared RTLS can provide highly accurate location information.

Infrared RTLS tags can be very inexpensive. However, the fact that a reader must be installed within sight of each tag can raise the overall system cost significantly.  Because of the line-of-sight requirement, infrared is better suited for use with fixed assets rather than for tracking mobile assets or personnel.

Ultra Wide-Band (UWB)

UWB is a lot more expensive than Bluetooth but offers a really high level of precision. For most use cases, it is more precise than is technically needed. This less familiar technology uses a large frequency signal with at least a 500MHz bandwidth, and special readers. The broadcast is kept very low-powered so as not to interfere with other uses (some WiFi solutions now go into this frequency-range, because it allows for higher bandwidth). Ultra-wideband can detect assets to within a couple of meters, which is better than other solutions. However, it seems likely that ultra-wideband will eventually take over a lot of WiFi functionality, which might result in interference and bandwidth issues if it is also being used for asset tracking.

What are the benefits of introducing an RTLS to your healthcare system?

"Next-generation RTLS technology is as transformative to hospital operations as Uber is to personal transportation... Just as Uber eliminates the waiting and uncertainty associated with personal transportation, RTLS eliminates hours of searching, repetitive calling and paging to locate people and equipment, all the while automatically tracking key metrics to analyze workflows." - Ari Naim, Contributor, Becker Hospital Review
Before diving into the measures you can take to implement an RTLS, it is helpful to review a few of the key reasons why healthcare executives would want to invest in an RTLS. From time savings to a more streamlined workflow, here are some benefits of introducing RTLS in healthcare.

  • Enhanced department workflows as patients move more efficiently from the waiting room to the exam room to a patient room
  • An improved patient experience that unfolds when clinical staff can locate necessary equipment faster to proceed with treatment
  • Superior equipment management and preventive maintenance
  • Improved room utilization as staff have access to real-time movement of patients and equipment
Learn more about RTLS in Healthcare

In everyday operations, and particularly in emergency situations, the ability to locate such assets quickly and reliably within a short period of time, and without having to devote staff time and attention to doing so manually, can be critical. That's why hospitals often purchase 10% to 20% more portable equipment than they actually need simply because staff often can't locate a device when it's urgently needed. But RTLS can turn that situation around.

RTLS benefits for providers and patients

RTLS systems can provide hospitals with advanced capabilities that are highly beneficial to the facility, its staff, and its patients. Let's take a quick look at some of these.

Increasing Bed Availability

When things get busy, or a hospital is nearing capacity, managing the availability of beds is vitally important. It is, unfortunately, not unusual for patients to have to wait to get a bed when, in reality, there are unused beds on the premises.

RTLS can help to alleviate that problem by providing a notification when a patient is discharged and that bed becomes available. In fact, RTLS has been demonstrated to help hospitals achieve up to 50% faster bed turnover times.

Keeping track of medical equipment

Keeping track of portable medical devices, such as ICU ventilators, IV pumps and defibrillators, to ensure their availability when and where needed, can be difficult. In many cases, such items sit idle in one part of a facility while there's a dire need for them elsewhere, without staff being aware of that fact.

In addition, according to one study, an average of 20% of a hospital's equipment drops out of the inventory entirely every year due to items being misplaced or lost.

When staff members have difficulty finding critical pieces of equipment in emergency situations, they often resort to "hoarding" such items to ensure they're immediately available when needed. The result is that hospitals have to purchase more equipment than they really require to ensure devices are available when and where needed.

RTLS makes finding such items quicker and easier, with substantially less use of staff time. Instead of having to search manually throughout a facility for the equipment they need, staff members can bring up location information on a display to find the items they're looking for. In an emergency, when time is of the essence, that ability can literally be the difference between life and death. And because RTLS alleviates the fear of medical personnel that they won't be able to locate needed equipment in a timely fashion, the problem of hoarding is substantially reduced.

Lowering HAI (Hospital Acquired Infection) risks

The COVID-19 pandemic has highlighted the critical necessity of being able to identify people who come into close proximity to patients who have communicable infections. RTLS makes such contact tracing far easier than it's been in the past.

In addition to helping hospitals control the spread of infections between patients, RTLS also helps lower the chance of transmission from staff members to patients. Perhaps the most fundamental practice for minimizing the spread of HAIs is handwashing discipline. RTLS systems can track when staff members come into the vicinity of hand hygiene stations, and whether they make use of them. When the University of Fukui Hospital began using location technology to monitor hand hygiene practices, the rate at which medical staff engaged in hand hygiene while caring for patients increased by more than 300%.

Increasing security

RTLS enables healthcare facilities to be alerted when patients or staff members enter areas where they shouldn't be. For example, patients who are under the influence of alcohol or drugs, or who are in some type of mental distress, must normally be closely watched to ensure they don't wander away from their treatment area or into parts of the facility where they may pose a danger to others. By issuing an alert whenever such patients cross a virtual boundary into an area where they are not authorized to be, RTLS can maintain a high level of security while reducing the amount of time staff members must devote to directly monitoring these patients.

What are ten steps to help you successfully introduce an RTLS?

Clearly, there are many reasons to implement an RTLS. And while the nation's top hospital asset tracking systems are designed to be easy to roll out, the key to a streamlined implementation is to have a well-organized plan in place. Below is your step-by-step guide to introducing an RTLS.

Step One: Secure buy-in from stakeholders and your leadership team

The path to a successful RTLS launch begins with the support of your owners, executives, and department managers. Some leaders may bristle at the idea of change, worrying about the initial expense and potential disruptions to productivity. But if hospital leaders receive your RTLS with open arms, your frontline staff will typically follow suit. Here are some ways to generate enthusiasm and secure the support of your leadership team:

  • Outline the specific benefits. Make sure department heads know exactly how the RTLS will benefit their departments.
  • Highlight estimated financial gains. Providing an exact dollar amount is nearly impossible. However, you can provide projected financial gains.
  • Emphasize the ease of use. Reassure stakeholders that introducing an RTLS will not interfere with hospital productivity or patient care.
  • Reference specific success stories. Cite the financial success other hospitals are enjoying by using an RTLS. Here is an example:
    "In the first year of redeploying its RTLS, Texas Health saved $412,000. This is hard savings, minus cost of RTLS, employee salaries and benefits." - Bill Siwicki, Healthcare IT News

Step Two: Outline the goals you wish to achieve with your RTLS

Now that your leadership team has embraced the idea of implementing an RTLS, your leadership group needs to be on the same page with respect to your ultimate goals for introducing the system. Outlining your goals will also help you select the type of RTLS to implement at your medical facility. Here are some of the most common goals hospitals hope to achieve through RTLS implementation:

  • Decrease asset search time
  • Reduce the number of stolen medical devices
  • Minimize emergency incident time
  • Decrease the amount of money spent on equipment repairs
  • Reduce the need for costly spur of the moment equipment rentals

Step Three: Make a list of your existing software systems

Every hospital or medical facility has existing technology platforms, many of which will need to be integrated with your RTLS. The integration process should begin by creating a comprehensive list of the software systems being used in each department. Common examples include general hospital management software, accounting software, and operating room management systems.

Step Four: Obtain baseline measurements prior to implementation

Measuring the impact of your RTLS is essential to justifying future usage. This measurement process begins with a baseline measurement of the key performance indicators you outlined when you set your goals in Step Two. With baseline figures in place you can then calculate any differences that occur and determine whether they are statistically significant. Here are a couple of examples using the hypothetical goals referenced in Step Two:

  • Total number of medical equipment rentals in 2019: 450.
  • Total amount of capital spent on rentals: $390,000.
  • Average time spent searching for medical devices in 2019: 32.5 minutes.
  • Total amount of money spent on equipment repairs in 2019: $360,000.

Step Five: Determine the degree of location accuracy you require

RTLS solutions vary in terms of the degree of specificity they offer. For example, some systems provide an estimated location of a device by indicating the hospital unit where the device is located. Other solutions offer a much greater degree of specificity or certainty, identifying the exact patient room and space where the device is located. Before selecting a solution, review your workflow applications and budget to determine what type of system best meets your needs.

Step Six: Seek a speedy solution

"Equipment tracking with the use of RTLS also saves time for facility staff. Being able to know the exact location of a tagged piece of equipment provides staff clear direction for retrieval — and ultimately allows them to spend more time with patients." - Josh Kelly and Nikki Tuft, Health Facilities Management

Ideally the RTLS solution you select will be responsive and able to detect activity between devices, staff, and patients immediately. Slow systems interfere with accuracy, preventing you from capturing real-time data on equipment. With a speedy system, on the other hand, you can capture mileposts right away, thereby improving efficiency.

Step Seven: Use care when selecting device tags

The efficiency of your RTLS hinges on the reliability of the tags you select. Tags should be constructed with high quality materials and feature long-life batteries. Many hospitals use infrared tags, as they are relatively simple to use. However, the type of tag you use should reflect your goals for introducing an RTLS in the first place. Tag selection should also reflect the value of the assets you are tagging. Here are some tips to consider with tag selection:

  • Battery life: Look for tags with a minimum battery life of 18 months and offer notification that replacement batteries are needed.
  • Cost: A $60 high-tech tag makes sense if you are tracking a $250,000 C-arm or $50,000 anesthesia machine. But not if you are tracking $100 stools.
  • False positives: Tags for radio-based systems are relatively inexpensive but tend to produce more false positives, which can waste time. 

Step Eight: Consider your facility's future when selecting a system

Scalability is a key factor to think about as you plan to launch your RTLS. Specific points to consider include any upcoming plans for expansion, acquisition, or merger with other healthcare centers. Selecting a system that can easily be introduced to new wings and new sister hospitals will help your healthcare organization operate smoothly and with minimal disruption as growth occurs. 

Step Nine: Schedule comprehensive training sessions for your staff

Transparency and communication with frontline staff is vital to a smooth roll-out of your RTLS. Employees need to understand how the system will impact their duties and how it will make their jobs easier. They also need an opportunity to ask questions and express any thoughts or concerns about the system.
The most effective way to achieve these objectives is to schedule a comprehensive training initiative that involves initial education, multi-step training, and refresher courses. Additionally, FAQ sheets should be prepared and posted in highly visible locations for employees to easily access. 

Step Ten: Periodically review and update your RTLS

Successful RTLS implementation does not occur in a vacuum. Progress should be reviewed on a regular basis, especially in the formative months following rollout. Through regular reviews and analysis of outcomes, you can identify opportunities for improvement and make any necessary changes. Here are some tips to ensure that you conduct an efficient review:

  • Consider forming a small committee of leaders who can review your RTLS and summarize performance results.
  • Create a quarterly review schedule for committee leaders. Meetings should occur more regularly immediately following rollout.
  • Quantify financial outcomes. For example, you can describe how your hospital saved $225,000 by lowering the rate of missing equipment.

What is the single most important step to take when implementing Real Time Location System in Healthcare?

RTLS implementation is not a fast or simple process. By following the ten steps above, you can ensure that the process unfolds as smoothly and quickly as possible. But even more important than these measures is choosing a trusted software provider with a proven track record of success in healthcare. By selecting a proven industry expert, you can help ensure that you achieve your RTLS goals and continue to improve your hospital's efficiency. 
The single best step to take when considering RTLS implementation is to schedule a discovery call with a Kontakt.io specialist. During this discovery call, you can learn how Kontakt.io can help you achieve the following:

  • Straightforward and efficient system setup
  • True cloud adoption
  • Time and cost savings
  • Improved patient safety
  • Compatibility with your existing hardware
  • Enhanced patient satisfaction

Reach out to the Kontakt.io team today! We look forward to helping your hospital become a model of efficiency and high quality care. 
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Aneta Ciurkot

Director, Product Marketing

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    [Updated for 2020]
    [Updated for 2020]