Tracking RTLS-enabled automatic tracking and workflow orchestration technology promises to improve the care and overall hospital experience of elderly patients.
As I was scanning the UK news this morning, a headline from The Telegraph grabbed my attention: “Elderly suffer poor care in half of NHS hospitals.” I’ve learned that you have to view headlines in British newspapers with a healthy dose of skepticism. However, in this case, the contents of the article from The Telegraphlargely supported the headline. Here’s an excerpt:
The Care Quality Commission says that too often staff pay more attention to paperwork than those they are looking after.
Unacceptable care has become standard in some trusts, with doctors and nurses talking down to patients, ignoring their calls for assistance and failing to help them eat, drink or wash.
I’m proud to say that my team and I are currently collaborating with a progressive NHS facility on a pilot project to help prevent exactly these kinds of problems. Deployed on a 20-bed dementia ward, the solution uses RTLS-enabled automatic tracking and workflow orchestration technology to improve communication between caregivers, enhance coordination of care, and maximize the visibility of patients’ statuses and current needs. Our ultimate goal is to dramatically improve the patient experience by ensuring that patients are never overlooked and that they receive special attention based on their individual needs.
9 Ways RTLS Improves Quality of Care
Let’s look at a few specific examples of how this new system improves patients’ quality of care.
When a patient with an elevated risk of falling arrives on the ward, her nurse notes the concern electronically. If that patient then leaves her bed space without a caregiver present, the system raises an audio and visual alert at the nurses’ station.
If a patient spends too long alone in an “isolated” location (e.g., the toilet), the system prompts staff to check on him. He might just be catching up on the football scores in the newspaper. Or he might have fallen and is in serious danger. It’s good to know which it is.
If a patient attempts to leave the ward without a staff escort, the system immediately raises an audio and visual alert at the nurses’ station. Caregivers can then retrieve the patient before she even reaches the corridor outside the ward.
The system tracks how much time has elapsed since any caregiver—or a caregiver of a certain role—has last seen the patient. The elapsed time is always displayed on the ward’s electronic tracking board, and the value becomes more prominent as time passes. For example, at 45 minutes, the backlighting changes to yellow; at 60 minutes it changes to red. The system can also issue reminders (via e-mail, pager, SMS, instant message) to nurses and supervisors at different thresholds.
The data about caregivers’ interactions with patients provides insight into how much time caregivers in various roles (nurses, healthcare assistants, therapists, junior doctors, consultants) spend with different types of patients with specific conditions at different times of the day. Supervisors and process-improvement specialists can also use this information to more effectively manage staffing and streamline process flow.
Ensuring “protected mealtimes” is a major initiative in UK hospitals. The goal is to avoid interruptions to both patients and nurses during mealtimes to ensure that patients get ample opportunity to eat—and that caregivers have the opportunity to help them do so. The system automatically records when staff other than nurses and healthcare assistants (e.g., physicians, physiotherapists, pharmacy technicians, etc.) visit patients during mealtimes. Supervisors then receive reports summarizing which off-ward caregivers make a habit of violating protected mealtimes.
When a patient with an elevated risk of malnutrition arrives on the ward, his nurse records his MUST (malnutrition universal scoring tool) score. Similarly, that nurse can note if the patient needs assistance eating. The system then monitors interactions between staff and these at-risk patients to ensure that they receive extra attention at mealtimes.
When a patient with an elevated risk of pressure sores arrives on the ward, her nurse records her Waterlow score. If the score is above a certain level, the system can automatically request a pressure-relieving mattress from Clinical Engineering. The system also records whether at-risk patients receive frequent visits for re-positioning—even at night.
The system continuously monitors whether caregivers comply with hand hygiene protocols. It then helps identify groups and individuals who might benefit from additional training. Perhaps as importantly, the system helps describe and analyze existing behaviors to determine how changes to processes or the physical environment might improve hand hygiene and reduce the incidence of healthcare acquired infections (HCAIs).
These are just a few of our initial efforts at using the real-time locating technologies and business rules to improve the patient experience for the elderly. We have many other ideas that we hope to implement over time.
Transforming the Patient Experience
The end result is a system that we hope will increase both the quantity and quality of time devoted to caring for patients. Moreover, as some of the earlier examples indicated, we also want to personalize care and ensure that patients receive special attention based on their individual needs (e.g., risk of falls, malnutrition, pressure sores, etc.).
No patient should ever go hours without being seen by a nurse. And it’s absolutely unconscionable that a patient would die of malnutrition or dehydration while in hospital.
Technology can never replace or instill the “kindness and compassion” the CQC report says that many caregivers lack when dealing with the elderly. However, it can give those same caregivers (and their supervisors) tools to ensure that they don’t simply forget what attention individual patients need.
We invite you to join us in this conversation as we explore how RTLS is evolving beyond "location" to Real Time Awareness Solutions that take into consideration all of the factors that matter to hospital administrators and patients alike.