Using a real-time location system (RTLS) has proven to be exceptionally beneficial to cost containment at Christiana Care Health System, a not-for-profit teaching health system in Wilmington, Delaware, that includes two hospitals with more than 1,100 beds. One of the most significant benefits has been that the RTLS helps us understand how to manage our equipment fleet. The technology’s asset utilization data provides us with insights to avoid purchasing or renting equipment unnecessarily. The RTLS also helped us achieve our primary goals of improved nurse satisfaction and operational efficiency. When nurses can expect equipment to be available and in its proper location, their trust in the equipment distribution system increases, their frustration with “hunting and gathering” equipment is reduced and hoarding behaviors are eliminated or greatly reduced.
Prior to the RTLS implementation, locating equipment was sometimes a challenge, particularly in our surgical and procedural units. In 2006, we began to explore RTLS technology, but the hardware didn’t meet our needs and the project was postponed. We revisited the project and signed a contract in 2008 to implement the technology in 2009.
We began the RTLS asset management initiative with our infusion pumps since historically this resource proved the biggest challenge to our nurses who were looking for available, clean and ready-to-use pumps when they needed them. At that same time, we were also considering buying additional infusion pumps and talked with clinical leaders to determine needs. The estimates were much larger than we expected, so we conducted an investigation to determine the reasons.
For nurses, the process for obtaining pumps was laborious and time-consuming. When an IV pump was needed, the clinician had to log in to a computer and complete an online request that was sent to the equipment room. The request sat in queue with all the other requests throughout the hospital until the equipment staff could locate an available pump, clean it and redeploy the item. Our goal was to deliver an IV pump within 20 minutes of the request, but our response time was often 60 minutes — or as long as four hours. With the RTLS, we avoided a major capital expenditure of additional equipment, and we were also able to significantly improve our nurses’ equipment procurement process.
By Scott Pentecost
Using a real-time location system (RTLS) has proven to be exceptionally beneficial to cost containment at Christiana Care Health System, a not-for-profit teaching health system in Wilmington, Delaware, that includes two hospitals with more than 1,100 beds. One of the most significant benefits has been that the RTLS helps us understand how to manage our equipment fleet. The technology’s asset utilization data provides us with insights to avoid purchasing or renting equipment unnecessarily. The RTLS also helped us achieve our primary goals of improved nurse satisfaction and operational efficiency. When nurses can expect equipment to be available and in its proper location, their trust in the equipment distribution system increases, their frustration with “hunting and gathering” equipment is reduced and hoarding behaviors are eliminated or greatly reduced.
Prior to the RTLS implementation, locating equipment was sometimes a challenge, particularly in our surgical and procedural units. In 2006, we began to explore RTLS technology, but the hardware didn’t meet our needs and the project was postponed. We revisited the project and signed a contract in 2008 to implement the technology in 2009.
We began the RTLS asset management initiative with our infusion pumps since historically this resource proved the biggest challenge to our nurses who were looking for available, clean and ready-to-use pumps when they needed them. At that same time, we were also considering buying additional infusion pumps and talked with clinical leaders to determine needs. The estimates were much larger than we expected, so we conducted an investigation to determine the reasons.
For nurses, the process for obtaining pumps was laborious and time-consuming. When an IV pump was needed, the clinician had to log in to a computer and complete an online request that was sent to the equipment room. The request sat in queue with all the other requests throughout the hospital until the equipment staff could locate an available pump, clean it and redeploy the item. Our goal was to deliver an IV pump within 20 minutes of the request, but our response time was often 60 minutes — or as long as four hours. With the RTLS, we avoided a major capital expenditure of additional equipment, and we were also able to significantly improve our nurses’ equipment procurement process.
Proactive changes
It became clear that our nurses had lost confidence in the existing pump distribution process, and therefore they retained idle pumps in patient rooms for use with future admissions. For example, a procedural area may have 30 to 40 beds, but the patient volume for a day may only be 23. With little confidence in the process, sometimes nurses retained pumps in all 30 to 40 rooms, believing that they needed one pump per bed. ED nurses would remove IV pumps when transferring patients to inpatient units, believing that they needed to keep the pumps in the ED to maintain a ready supply. This caused the inpatient nurses to search for additional pumps for the same patients. This behavior is completely understandable in light of the built in challenges of the previous distribution system, but was a practice we hoped to impact with the new system.
We needed to regain the confidence of our clinicians and free them from worrying about equipment availability and cleaning retained equipment, so they could instead put their focus back where it should be — on patient care. We also hoped to ensure compliance with the organization’s sterilization processes by improving compliance with our centralized cleaning protocols.
Our goal was to proactively anticipate the needs of our clinicians by employing a lean management approach, ensuring availability while optimizing utilization of our fleet of IV pumps. This necessitated reconstruction of the flow of IV pumps throughout our hospitals. The previous process relied on procuring equipment as the need arose. The new process allows for the equipment to be placed where it is needed, and available in advance of the need.
This was only possible, though, because we understood our nurses’ needs by observing their actual workflows and building our asset utilization process around them. We wanted to take advantage of automated business rules within our RTLS solution to improve the efficiency of our Materiel Operations staff while meeting these availability goals.
Another initiative that helped us achieve our streamlined inventory was the implementation of IV pump integration, which involves the receipt of HL7-standard messages from IV pumps indicating whether or not they are infusing. By combining RTLS-based location information with infusion status, we achieved a new level of understanding of the true utilization of our equipment.
While developing a strategy for managing idle pumps, a review of nursing practice demonstrated that the maximum interval for intermittent IV therapy was every 12 hours — this is the maximum delay time between infusions. With that in mind, we employed the business logic of the RTLS to flag pumps that may be targeted for collection and instituted departmental procedures for communicating with nursing about their retrieval. The equipment team can then clean and redeploy the pump for the next patient. Additionally, rooms are typically prepared in advance for planned admissions, so another process was established that if a pump was located in a patient care area and was non-operational for more than 24 hours, then its status would change as well.
These rules and other asset utilization features in the RTLS helped us determine the periodic automatic replacement (PAR) levels we needed so that we could become proactive in anticipating and meeting clinician’s needs for IV pumps. For example, when clinical team members remove enough pumps from a clean PAR area to reach the minimum threshold, the equipment team is notified and replenishes the fleet. Therefore, nurses can always count on a clean IV pump being located in the clean PAR area.
We also created “feeder areas”; feeder areas are departments through which most of our admissions originate. Patients are provided a pump from the feeder departments, and the pump follows the patient throughout the system until they no longer need the device. We’ve ensured that feeder area PAR levels are high enough to match typical demands and prioritize timely replenishment for these areas, whereas non-feeder PAR areas are kept at a minimum level such as 2 or 3 pumps. Materiel Operations staff can quickly and easily identify inventory by department and pump location by reviewing the RTLS dashboards and geospatial maps.
Managing fleet size
We first started using the RTLS with an IV pump fleet replacement, and we conducted a needs assessment experiment by reducing the pump inventory to a much lower level than the expected requirement; we actually purchased 637 fewer pumps than requested by our clinical staff. Based on the experiment, as well as the utilization data and insight derived from our automated rules, we discovered we needed to add 191 additional pumps to our fleet — which is still 446 less than requested. We bought those 191 pumps in 2009 and we haven’t needed to purchase or rent any additional pumps in the past five years, despite a rapidly growing patient volume. Additionally, we currently operate at an IV pump-to-bed ratio of 1.3:1, which is far below the industry average of 4:1.
Another benefit is that maintaining the proper amount of equipment helps keep our hallways less cluttered. Additionally, the RTLS allows us see how many pumps are in operation at any time, regardless of the department.
Fewer calls, greater satisfaction
The Materiel Operations’ call volume has declined dramatically. Prior to the RTLS, the equipment team received an average of 700 calls per week for IV pump requests, among others. In the first two weeks of using the RTLS, that volume decreased to 100 calls per week. We now answer about 11 calls per week, and that’s typically because a provider is looking for a unique device, such as a double-channel pump. We no longer receive calls about lack of equipment availability.
These results were only possible because we learned about our nurses’ and other clinicians’ asset utilization experience, their workflows and their needs, before our RTLS implementation. I can’t overstress how important that decision was to our outcomes. Too often in hospitals, a project is launched requiring people to adopt or change their processes without their input, which is a recipe for failure.
As we plan for our next major asset management initiative, for sequential compression devices, we plan to meet with clinicians to review their workflows and use advanced business logic to manage equipment fleets in a manner that addresses their needs. As our first RTLS implementation has proven to us, it is better to err on the side of too much inclusion than not enough.
Scott Pentecost is the Manager of Materiel Operations at Christiana Care Health System.
