Redux: Using RTLS To Improve Patient Safety

In my September 7 blog in this space, I recounted some of the basic ways in which RTLS can play a role in making patient care safer. These included preventive maintenance of hospital equipment, facilitating equipment recalls, automated temperature monitoring, avoiding the use of dirty infusion pumps, and monitoring hand hygiene. However, there are even more RTLS patient safety improvement opportunities where the system is fully deployed through the broad utilization of equipment, patient and care-giver tags.


Here are some important examples:

• Prevent Patient Falls.  Patient falls and resulting injuries among the elderly remain one of the most nagging and serious patient safety problems in hospitals. One-third of these occurrences involve falls from a hospital bed, and occur most often while the patient is trying to go to the toilet unaided. The frequency of these falls is greatest on night and weekend shifts when staffing is lowest. The ability of RTLS patient tags to identify and alert care-givers to unexpected patient movement at the bed level offers important opportunities to prevent or mitigate patient fall injuries or at least facilitate immediate medical attention for the patient who has already fallen.

• Monitoring of “Time-Outs” Before Surgery.  One of the most perplexing patient safety issues today remains the unwillingness of some surgeons to participate in time-outs before the actual commencement of a surgical procedure. The principal purpose of the time-out to prevent wrong-site, wrong procedure, or wrong patient surgeries which, despite the long-standing efforts of The Joint Commission and the World Health Organization, continue to occur with significant frequency. The typical time-out involves confirmation of the identity of the patient, the procedure to be performed, the planned surgical site with particular attention to laterality (right versus left side of the body), the intended patient positioning on the operating table, and the expected use of implants or special equipment (if applicable). The RTLS operating room (OR) workflow software lends itself especially well to solving this professional behavioral problem by virtue of its ability not only to codify, monitor and drive existing workflow steps but also its potential to introduce new process steps (i.e., like those involved in a time-out) whose intent is to improve surgical safety.

• Prevent Pressure Ulcers.  More than 2.5 million hospitalized patients develop pressure ulcers each year, and almost 60,000 of them die because of pressure ulcer complications. Pressure ulcers develop in partially or totally immobilized patients when the blood supply to the skin and underlying tissue is cut off for extended periods of time. This problem is often created when the patient lies in bed in the same position for hours at a time. The single most important preventive measure is regularly repositioning the patient with limited mobility according to a schedule based on the patient’s needs and pressure ulcer risks. The RTLS software can help prevent pressure ulcers through the use of automated patient-specific alerts to responsible nursing staff, timed in accordance with the patient’s repositioning schedule.

• Create Audit Trails.  One of the understated RTLS advantages is the ability to create audit trails. Assuming that equipment, patient, and care-giver tags remain properly in place, it is possible to create trails of equipment, staff and patient movements and interactions. The epidemiological importance of this capability is often not appreciated. Let’s say that a patient admitted to the hospital is later found to have a serious contagious disease (e.g., tuberculosis). It would then become of great importance to identify all of the care-givers who came into contact with that patient prior to this discovery, as well as the patients with whom these care-givers were subsequently in contact. The automatic RTLS audit trail could turn a nightmarish scenario into a straight-forward problem-solving exercise.

As stated in my earlier blog, Real-Time Location Systems are not a sweeping patient safety panacea, but they can unquestionably be part of the solution. I have described some of the ways in which these promises are becoming realized. More opportunities will undoubtedly be identified as the RTLS technology becomes increasingly sophisticated.

~Dennis O'Leary, M.D.