Geisinger Danville—Improving Visibility & Efficiency with RTLS (Part 1)

Interviewer:

Welcome to Patient Flow podcast today. We're very pleased to have two guests, Seth Hostetler, Lead Process Engineer Supply Chain Services at Geisinger, and TeleTracking’s Robert Teachout, Enabling Technologies, Workflow Services, Project Manager. Welcome.

The past few years have demonstrated the importance of being able to access equipment quickly and easily in order to keep a patient flow moving effectively. You both have an extensive background in process improvement and quality. Could you share an overview of RTLS, real-time locating software, how that works as a process improvement tactic, and then, how it can positively impact capital overspend, equipment rental and life cycle management?

Seth Hostetler:

One of the great benefits of the RTLS is truly that real-time locating. And so, you can open the application and search for say an IV pump and find the nearest one to you when you're in need if you're a clinician on a nursing unit. And so that in itself is a great benefit. But one of the things we realized early on is that the flow that we thought some of our assets were taking, for example, IV pumps, was not actually occurring.

We thought the process would be when a patient's discharged, the pump is put in a soil room that goes from the soil room down to the basement to get cleaned and then put back into the central distribution to reallocate. After we were able to do review the historical data, we were able to see that probably about 90% of our pumps were being cleaned in place. And so, we were able to better support that process and ensure that cleaning process was done appropriately by educating staff and re-looking at the overall support. But also, that helped us understand why maybe central distribution doesn't always have as many pumps as they would like to redistribute, and that we may need to search the supply rooms of nursing units to retake these pumps once they've been clean so that they can use elsewhere within the facility.

And similarly with capital overspend, we were working on something similar to this over the last year with IV pumps, we thought we might need more. And we were able to use the RTLS to show that we do have plenty of pumps in the system at one of our specific hospitals, we just needed to review that process and again, improve on that circulation of those pumps and make sure that we work with our clinical partners on the nursing units to make sure that those pumps aren't hidden away on the units.

And I'll just end this question with the equipment rental that RTLS is great for. We’re able to be notified that a rental asset that a patient has is no longer needed, we're able to look in the RTLS immediately, find it, reclaim it, and get it sent back. So, we're not paying for any extra days of service.

Robert Teachout:

When we go in front of a client, we try to educate them on that exact distribution cycle of on volume equipment, which means we're going to start with a collection of inventory in a clean and ready state. And the critical next step for those is where folks need equipment at their fingertips to do their daily work, or it's going to go straight to a usage situation where it's deployed to a patient at the point of care.

An important piece of this is the removal from the room. And one of the education points that we've typically spent a lot of time on is that the device doesn't necessarily need to wait until a patient discharged for removal from the room. As Seth mentioned, and then eventually it might go to a clinical engineering group or biomedic group for repair or preventative maintenance based on its condition or it's a due date.

And then you repeat that cycle. And in terms of a process improvement, you can imagine what happens if you don't have good visibility, for any of those steps. Teams can look at their potential infusion purchases and to either reduce or eliminate the need for that.

Think about your own fleet being distributed to places where it's not necessarily an immediate need, and what happens is supplemental rental kicks in.  You end up renting devices that you don't really need.

Seth Hostetler:

The initial win is absolutely just being able to find assets when you need them. Especially training our frontline staff to be able to look at and find the assets and possibly not even needing to involve a central distribution group for request. One of the bigger initial challenges is having 15 pumps sitting in a nursing unit, even though they may never be used, it makes the staff feel safe that if they ever need one, they're going to be there. And so, one of those biggest challenges is building trust so that when a team member requests something, they know they’re going to get it quickly now because we can see where things are versus when we had no visibility.

Before when team members requested something, if we didn't have it in the central distribution area, we had to just go out and look to find one. And when we found it, we had to convince a unit to let us borrow it. So, that certainly it's a benefit, but it’s one of those change management pieces that an organization needs to be aware of.

Robert Teachout:

I like that. It takes six months to a year for equipment to be delivered on time, every single time for nurses to feel confident.

Interviewer:

So, a lot of power in the visibility that it gives and the ability to analyze the data to see where the needs are. Seth, what challenges was Geisinger facing that led them to decide to implement the asset tracking solution.

Seth Hostetler:

IV pumps are what we made our ROI decision on. Nine years ago, we were actually in the process of doing a full pump replacement. Our prior pumps had gotten to the end of the life. And we were bringing in a whole new batch for our two largest hospitals and we wanted to make sure we had the right number. Well, our audits as we were doing this planning showed that we couldn't account for over 30% of our pumps. We probably would have purchased an additional 600 pumps and those aren't cheap.

The costs can add up very quickly. And so that was really our one of our biggest challenges. We've certainly improved on a lot of other challenges as well. I reference IV pumps frequently because it's far and away our biggest asset class. Feeding pumps was another very big win for us. With our feeding pumps, we were almost daily having incident reports being submitted that the nursing units couldn’t get those in a timely manner.

It was posing a patient safety risk. And so, through the implementation of the RTLS we were able to essentially, I believe go three full years without another report. Because we now had visibility to where these feeding pumps were. When the report came in, we're able to look at the data and prove, I think we had 48 in circulation, 45 or in use and three had just been removed from patient use and were in the cleaning process. So, we're able to prove we were nearly a 100% utilized and that was a very easy purchasing decision for the hospital to understand that we were at the limits of what we could do with what we had.

Interviewer:

What distinguished the asset tracking out of other solutions you may have been looking at the time?

Seth Hostetler:

I think it's the precision with which we could locate. So, at that at the time, and I think really still to a large degree today, many competing solutions use triangulation methods either through ultrasound or Bluetooth or Wi-Fi. And that requires very high density of those beacons to emit those signals. And then that triangulation is not necessarily as accurate. It's much more difficult to account for walls. What I think was one of the biggest advantages to us that we saw with the asset tracking solution that we've deployed is that it uses the dual technology, the infrared light, and the RFID.

And so, using that infrared light, we're able to not only distinguish exactly specific rooms, but we've been able to split rooms where we still have semi-private beds and distinguish bed space, say, in the PACU, or even our smallest spaces such as our hallway beds and then the emergency departments are all specific locations as well. And so, I think that the ability to scale from a unit level coverage, all the way down to that specific bed, depending on what are our business cases are in those different departments or different areas of the hospital was certainly one of the things that attracted us to asset tracking and ultimately led to was choosing that solution.