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Where the IV Pumps Roam

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In an earlier era, wheelchair No. 36 might have given Jeff Falwell fits. Falwell, a senior project manager in the information technology department at Seton Family of Hospitals, needed to locate the chair—which can be easier said than done amid a hospital’s maze of hallways and rooms. But this wheelchair sported a small tag that emitted an ultrasound signal, part of Seton’s newly deployed asset-tracking system aimed at reining in its inventory. “It had been tucked in behind an ice machine in a pre-op floor,” recalls Falwell. He was led precisely to the chair by the wireless system, which the five-hospital health system is deploying on its main campus in Austin, TX. “It was not where it was supposed to be.”

The same could probably be said for countless other wheelchairs and devices throughout the industry. Trying to pinpoint the location of wheelchairs, pumps and other equipment can be an exercise in geographic frustration. That’s why hospitals like Seton are turning to wireless systems to keep tabs on mobile equipment—or even patients. After taking the plunge into largely uncharted waters, a few early adopters have touted the benefits of wireless tracking systems, citing both improved patient flow and better inventory control. But other experts advise against jumping headlong into wireless tracking, noting that the technology remains in its infancy.

Help for the ED

One early adopter of wireless tracking is Christiana Care Health System in Wilmington, DE. Beginning in fall 2004, the two-hospital system deployed a patient and asset tracking system at Christiana Hospital’s emergency department in Newark, DE, and then installed the system at Wilmington Hospital’s ED in April 2006. Serving a total of nearly 150,000 patients annually, the two EDs were chaotic environments, acknowledges Linda Laskowski-Jones, RN, vice president of emergency, trauma and aeromedical services. “We felt that knowing when rooms were open would help us organize services,” she says.

To date, Christiana has invested just under $1.1 million in a wireless system from Patient Care Technology Systems. It raised more than half of the capital through federal and state grants; the grant money came, Laskowski-Jones explains, because the system would enable Christiana to help identify patients during a post-disaster surge. “We can look instantly at the state of our ED and know how many more people we can accept,” she says.

Christiana Care’s system runs on infrared technology. Patients are given small badges that emit an infrared beam detected by a ceiling sensor—there are more than 400 of them in Christiana’s main ED. Mobile equipment, such as procedure carts, sport tags as well. Using the accompanying tracking system software, staff can call up a graphic display of the department and tell where a patient is. In addition, the system includes an interface to other hospital information systems, which allows clinical staff to use the tracking system to review a patient’s lab results.

Laskowski-Jones credits the tracking system with improved patient flow. “We’ve had a 36-minute reduction in ED length of stay for patients treated and admitted, and a 14-minute reduction for patients treated and released despite a 7 percent increase in ED volumes,” she says. Much of the system’s value, Laskowski-Jones adds, lies in its connectivity to other systems. “We are able to keep patients better informed about their lab values without rifling through the charts.”

The technology is not foolproof, however. If the patient’s badge is flipped over or under a cover, the signal will not transmit. To cope with this limitation, Christiana has affixed the patient tags to a large plastic circle with the hospital logo. The plastic backing helps stabilize tags.

To overcome the limitations of infrared, Christiana is looking to convert to a radio frequency identification system in its EDs. First, the health system is piloting RFID in its operating rooms to track equipment. RFID is similar to the infrared system in that badges emit signals, but the radio signals are less likely to be blocked, Laskowski-Jones says.

Sorting through wireless tracking options like these is one of the biggest hurdles of adopting the technology, users say. There are multiple varieties of RFID systems, for example; tags can be either active—constantly emitting a signal—or passive, reacting only when a signal hits it. According to Falwell, the Seton project manager, radio-based tracking systems are inferior to ultrasound, which he says can pinpoint the precise location of an object.

Wireless upgrade

At Hennepin County (Minnesota) Medical Center, Phillip Gill is weighing the multitude of wireless tracking options. For the past 20 years, the 420-staffed-bed Minneapolis hospital has been using barcode technology to keep tabs on equipment. It used a proprietary system for 18 years, switching in 2004 to more sophisticated technology from St. Croix Systems that enables both inventory management and location tracking, says Gill, IT manager. The county hospital uses the system to track the location of more than 2,000 mobile devices. Clinicians swipe a barcode on a device when it enters a patient room, and the system links the usage to a patient account. Later, if a patient has a problem related to a pump, for example, the medical center can use the software to identify exactly which equipment was used during the hospitalization.

But Hennepin wants to expand its use of wireless tracking technology. For example, the hospital may overlay an electronic medication administration application on its recently installed clinical information system—technology that could work well with barcoded medications. The hospital is also considering using RFID technology to keep track of equipment. Using RFID tags would pre-empt the need for staff to manually scan equipment every time it changes rooms. RFID could be used to tag patients, as well. Currently, the hospital has no tagging technology in place when it comes to patients. “We are trying to figure out how to marry these needs without having 10 different systems,” Gill sighs.

Long Beach (CA) Memorial Medical Center is gravitating toward RFID technology for its asset tracking needs. The facility is upgrading infrared technology from Patient Care Technology Systems that it put in its ED about four years ago, explains John Stewart, executive director of information services. “With infrared you don’t know the precise location,” he says. “With RFID the granularity is about a foot.” Beginning this summer, Long Beach is conducting a pilot in its 23-room operating room department to track equipment using RFID technology, and later will attempt to tag patients. “It is easier to manage the workflows around equipment than with patients,” Stewart explains. “But we can help avoid delays in the OR if we can find the equipment quickly. Having people going around searching for it is a major delay.” Eventually, Stewart says, Long Beach would like to deploy equipment tracking technology throughout the entire hospital.

That’s the route Seton is going. However, equipment tracking hospitalwide requires prioritization, cautions Falwell. After spending $400,000 to enable one building with the ultrasound tracking technology from Sonitor Technologies (including $40,000 for tags alone), Seton has to be judicious about which devices it will tag. To determine which items will be tracked, Falwell compiled a master list of equipment type, then ranked the equipment by cost and probability of being lost. After doing the analysis, Seton is tagging some 2,400 pieces of equipment, including IV pumps, wheelchairs and leg compression cuffs, Falwell says.

Knowing where the equipment is should help the hospital avoid oversupplying various items, he says. “Triple channel IV pumps cost nearly $10,000 each, and you don’t want to have more than you need.” Ironically, not all expensive equipment is being tagged. A cardiac c-arm, for example, costs nearly $300,000, but it is so large it doesn’t move around very often, Falwell says. “We assumed we would tag it when we began, but we didn’t.”

Gary Baldwin is technology editor of HealthLeaders magazine. He can be reached at