Hospital Information Systems
Walking in the patientsí shoes
By HT Snowday, August 2010
PacMed adopts a real-time locating system to improve processes, safety and the bottom line.
The care needs and documentation required to meet today's healthcare standards compel caregivers to expect more time and information from patients and processes than ever before. While there are tools to help make documentation easier, healthcare has traditionally lacked a good system to allow caregivers to "right-size" time with patients.
Physicians and nurses often feel overwhelmed — that their time is "hijacked." Meanwhile, hospitals and clinics carry a heavy patient load. Though they both need and want to care for more patients, their patient throughput processes are inefficient, and patients ultimately wait too long to receive care. Along the way, patient care documentation suffers — as does the patient's perception of quality care.
A patient-centric approach
In late 2009, Pacific Medical Center (PacMed) set out to address these issues with very specific goals: maximize provider time with patients and reduce an average overall visit time from about 70 to 46 minutes. Staff realized that the clinic would benefit as a result of achieving this goal, because reducing wait times would allow the clinic to see more patients and improve retention by improving patient satisfaction scores.
PacMed was building its Canyon Park Clinic, a full-service clinic in Bothell, Wash., and wanted to manage work flows and minimize wait times. To begin, PacMed began to examine the visit experience from the patients' perspective. They talked to patients, and each evaluation team member visited each of PacMed's seven other sites — as a patient.
"We went through the whole patient experience, from top to bottom," says Linda Eremic, RN, director of operations. "It was a valuable experience, and everyone recognized the need to maximize the time a provider spends with a patient."
According to Dr. Brett Daniel, the medical director for Canyon Park and someone who also played the role of a patient at PacMed, "We quickly realized that to create the efficient work flows, optimal use of staffing and reduced wait times that we desired, we would have to have a solution to help us manage our patient flow and improve team communication." Staff began by investigating the options available to meet their needs. They explored using communication headsets, tools within an EMR solution and some of the older electronic flag systems. It wasn't long before they hit on the idea of using a real-time locating system (RTLS).
"There was some initial concern about switching to a model where patients room
themselves in this 30,000-square-foot clinic, but we have had very few issues."
"Versus was the great tool that we found," says Dr. Daniel, referring to Versus Technology, a provider of real-time location and automation solutions based in Traverse City, Mich. "A few other sites in our area had used Versus, so we went to see what they were doing with it."
Using infrared and radio frequency identification (RFID) technologies, the RTLS identifies current locations of patients and resources, patient status and room status throughout the 30,000-square-foot Canyon Park Clinic. This information is delivered to providers within the context of the patient visit, so providers like Dr. Daniel know exactly when to see which patient. "Having a tool like this is essential to our patient safety and satisfaction goals," explains Eremic. "From the time perspective, if the provider is able to spend more time with the patient, and less looking for supplies or completing paperwork, their quality of care is better with better outcomes."
Integrating savings and satisfaction
PacMed's RTLS includes patient and staff locating, mobile equipment tracking, customized clinical work flows (automated by Versus), real-time bed management and several integrations to key systems like the GE Centricity scheduling and registration system. The system also provides metric reporting of patient care milestones to help PacMed monitor patient flow, interactions and other key performance indicators (KPIs). Implementation, training and ongoing support were included.
PacMed staff was able to justify the expense in several ways. From a planning and space perspective, they were able to build more exam rooms by making smaller reception areas and narrower hallways. From a supply perspective, they order fewer supplies since they know where to find them. They also do not lose items, because each is equipped with a finder tag. From a staffing perspective, they were able to hire fewer RNs, while maintaining the highest patient satisfaction scores in the company: 85 percent of patients report an excellent visit overall.
"We were able to reduce a large number of phone calls," notes Dr. Daniel. "Our call center has access to Versus and can 'see' where we are and send the calls accordingly. By simply answering the phone when the call comes in, dealing with the issue in the moment, we have dramatically reduced the generation of phone messages, time spent on phone tag and the delay in patient care that could affect patient quality and safety."
Minimizing infection, maximizing safety
Because patients go directly to a clean exam room, medical assistants are able to spend more time managing the quality of care for patients instead of just rooming patients. "Cutting wait times and eliminating the waiting room has served to enhance patient satisfaction, but it also helps prevent contamination," says Eremic. "We have all sat in waiting rooms with other patients who were coughing and sneezing! With Versus, we know where patients are and how long they've been here — even when they're behind a closed door in an exam room — so they don't have to wait in a waiting room."
Eremic adds, "From a more direct safety aspect, Versus allows us to track potential exposed patients. If a patient comes into the clinic and is later diagnosed with an infectious illness, such as tuberculosis, mumps or chickenpox, we can run a simple report that shows us any patients or staff who were in close contact long enough to be potentially exposed. Doctors can then make informed treatment decisions for those individuals." In the past, PacMed had to test more individuals for a potential TB exposure. And if patients were potentially exposed to chickenpox or measles, staff had to notify a waiting room full of patients when, in fact, none were in close enough contact for exposure. This can cause patient anxiety.
Versus can also be used as a communication tool for immediate help. For example, if a patient has a contrast reaction in the imaging area, the team can notify the physician or response team through Versus by pressing the button on the badge. Or, if a patient needs assistance in the bathroom, they can press the badge button and staff will know immediately where the patient is.
"We were very satisfied with the implementation process," explains Dr. Daniel. "There was some initial concern about switching to a model where patients room themselves in this 30,000-square-foot clinic, but we have had very few issues. In fact, one of our physiatrists said, 'I had an 82-year-old man with dementia and ataxia who was able to find his room just fine. So, I guess we'll be OK!' Like any new system, there were some issues that came up, [such as] people wanting more sensors here or there or a few minor programming blips. That said, we've been very impressed with how Versus helps us work through these issues.
"When we added it all up, the RTLS made financial sense," says Dr. Daniel. "Most people seem to believe that an EMR will make their practice more efficient. We see Versus as more critical to helping our efficiency and improving our work-flow model. As we implement our new EMR system later this year, we feel we are set up to put it into our current work-flow model and move forward smoothly. At our clinics without Versus, it is going to be a much harder process."
HT Snowday is chief technology officer for Versus Technology.
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