use of rtls to support a model of patient centered care...1 use of rtls to support a model of...

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Use of RTLS to Support a Model of Patient Centered Care

Session 268, March 8, 2018

Kevin B. Hoover, MD, PhD

Medical Director, VCU Health Neuroscience, Orthopedic and Wellness Center

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Kevin B. Hoover MD, PhD

Has no real or apparent conflicts of interest to report.

Conflict of Interest

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Agenda

• Neuroscience, Orthopaedic and Wellness Center (N.O.W.) patient-centered care model

• Identifying the tools

• Mapping the patient journey

• Piloting and implementing RTLS (Real-time Locating System)

• Data and future goals

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Learning Objectives• Compare the function of patient self-rooming to the standard waiting

room model in an ambulatory care facility

• Compare the implementation of a RTLS in a preexisting clinic and a newly constructed ambulatory clinic

• Describe how RTLS can be used by staff at the point of care

• Recognize standard measures acquired with RTLS

• Appraise RTLS data to target processes in need of quality improvement

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Agenda

• N.O.W. patient-centered care model





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Our patient-centered care model

To measurably improve the quality of neurological and musculoskeletal health

by leveraging teamwork, information technology and innovation.

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William Jiranek, MD

Orthopaedics

Kevin Hoover, MD, PhD

Radiology

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John Duval (Former CEO)

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• Patient-friendly experience

• Multidisciplinary care based on symptoms and diagnosis

• Standardized care validated by patient outcome metrics

• Proximity and shared resources

Wellness

Radiology

PT/OT

Gait Lab

Diagnostic Lab

Arthritis

Sports

Spine

Neurological

Optimization

Pain Management

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Mary Anne Rutledge: Nurse

Manager

Sherry (Savitri) Gopaul: Clinical

Coordinator

Victoria Sulanke: Clinical

Coordinator

Michael Vasell,

Administration

Bruce Mathern, MD

Neurosurgery

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Agenda






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Tools

• Self-rooming and on stage/off stage

• Real-Time Locating System (RTLS)

• Outcome assessment (Promis)

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Standard Ambulatory Clinic

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Self-Rooming Ambulatory Clinic

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Self-Rooming Ambulatory Clinic

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Interactive True or False Question

Are patients reluctant to wear the RTLS badge?

A. Yes

B. No

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Self-rooming

Virginia Mason/Swedish Hospital/Sanford Health

Fewer waiting rooms

More exam rooms

More privacy

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On stage Off stage

Courtesy of

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88,000 ft2 clinical and support space

Third Floor

12 Belle Isle12 Brown’s Island1 Belle Isle Sub Waiting Area1 Brown’s Island Sub Waiting Area3 Staff Lounge

5 Trestle Trail Exam Rooms5 Chapel Island Exam Rooms5 Great Shiplock Park Exam Rooms2 Trestle Trail Sub Waiting Area2 Pony Pasture Sub Waiting Area

4 Tuckahoe Island

39 Exam 3 Staff Lounge 25 Corridor Fourth Floor

12 Kanawha Canal Exam Rooms12 Robious Landing Exam Rooms4 Riverview Rookery EEG Exam Rooms1 Kanawha Canal Sub Waiting Area4 Robious Landing Sub Waiting Area3 Staff Lounge

3 Elevator Lobby

7 Louise Burke Exam Rooms7 Williams Island Exam Rooms2 Louise Burke Sub Waiting Area2 Williams Island Sub Waiting Area

43 Exam 28 Corridor 3 Staff Lounge 9 Sub Waiting & Lobby

3rd

4th

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RTLS

• Infrared: requires visual path (e.g. television remote and TV); expensive

• Wi-Fi: large and expensive badges; expensive

• Ultra-Wide Band: most precise to cm (e.g. Amazon warehouses)

• Passive RFID: readers required ~ every 15 feet (e.g. library)

• Bluetooth: false positives

21IR RFID

►Infrared (IR) emitted from diodes on badge: every three seconds when moving

every two minutes when stationary

►Radiofrequency ID (RFID) emitted every two minutes

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RTLS

• Use RTLS (Versus)

• Live – supporting operations in real-time

• Periodic – KPI (e.g. wait times)

• Ad hoc – PI projects

• Room allocation tool – distribution of rooms by

physician need

• http://www.himssconference.org/event.aspx?It

emNumber=36302

Dana Farber Cancer Center

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Agenda






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https://drdollah.com/

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Action Definition

Patient Arrival

Message recevied via

HL7

Patient has room

reserved for them by

registration / PAR

Patient Enters the

Sub-Waiting Room

Location Filter and

is in the location for

10 seconds

Patient enters an

Exam room and is

in room for 30

seconds

Staff enters the

exam room and is

in room for 30

seconds - staff

types included in

Flow Manager

role. LPN, MA and

RN badge type.

RN enters the

exam room and is

in room for 30

seconds

NP (BT 36) or PA (37)

enters the exam room

for 30 seconds. (APP

stands for Advanced

Practice Professional -

there is no distinct badge

types for this role, it is

incorporating both PA

and NP badge types)

NP (BT 36) or PA (37)

exits the exam room and

is out of room for 30

seconds (APP stands for

Advanced Practice

Professional - there is no

distinct badge types for

this role, it is

incorporating both PA

and NP badge types)

Staff exits the

exam room and

is in room for 30

seconds

Physician enters the

exam room and is

present for 30

seconds

Physician exits

the exam room

and is out of

room for 30

seconds

Staff enters the

exam room

and is in room

for 30 seconds -

staff types

included in

Flow Manager

role. LPN, MA

and RN badge

type.

Staff changes

color of room

to Purple to

HOLD room

while patient

tranists to

others areas

and back

Staff exits the

exam room and

is in room for

30 seconds

Patient enters lab

waiting and is seen in

the area for 30 seconds

(discharge from MSK

upon entrance in

Primary Care Waiting)

Patient Enters Lab

and is seen for 30

seconds

Patient exits lab

and is seen

outside the

area or 30

seconds

Patient enters

Imaging Waiting

Patient Enters

Imaging and is

seen for 30

seconds

Patient exits

Imaging and is

seen outside the

area or 30

seconds

Patient Enters

Rehab Waiting and

is seen in the area

for 30 seconds

Patient enters

Rehab Services

and is seen in the

area for 30

seconds

Patient Exits

Rehab Services

and seen out of

the area for 30

seconds

Patient Enters

Diagnostic

Waiting and is

seen in the area

for 30 seconds

Patient Enters

Diagnostic Area

and is seen in

the area for 30

seconds

Patient Enters

Neuro Opthalmic

Exam and is seen in

the area for 30

seconds

Patient Exits Neuro-

Opthalmic Exam and

is seen out of the

area for 30 seconds.

Patient Enters

Bone Dilatometry

and is seen in the

area for 30 seconds

Patient Exits Bone

Dilatometry and is

seen out of the

area for 30

seconds.

Patient Enters

EMG and is seen

in the area for 30

seconds

Patient Exits EMG

and is seen out of

the area for 30

seconds.

Patient Enters

EEG and is seen

in the area for

30 seconds

Patient Exits

EEG and is seen

out of the area

for 30 seconds.

Patient Enters Neuro

Psychology and is seen

in the area for 30

seconds

Patient Exits Neuro

Psychology and is

seen out of the area

for 30 seconds.

Patient Exits

Diagnostic Area and

is seen out of the

area for 30 seconds.

Patient Enters

Infusion and is seen in

the area for 30

seconds

Patient Exits

Infusion and is seen

out of the area for

30 seconds.

Patient Enters Clinical

Research and is seen

in the area for 30

seconds

Patient Exits Clinical

Research and is seen

out of the area for 30

seconds.

Patient returns to room

from other areas (if

necessary)

Patient exits the

exam room and is

out of room for 30

seconds.

Patient 's Badge

is deposited in

Drop Box

MA is in the room for

15 seconds, presses

Remote Station button

on to signify the room

is clean.

Processes

Arrival To Exam Room

Appt to Exam

Exam Prep Exam Prep

Staff Exam

Arrival to RN

APP Exam APP Exam

Arrival to Provider

Appt to Provider

Exam to Provider

Provider Exam Provider Exam

Exam Follow-up

Patient Room Time

Arrival to Lab

Lab Lab

Arrival to Radiology

Radiology Img Proc

Arrival to Rehab

Rehab Rehab Serv

Arrival to Diagnostics

Diagnostics

Arrival to Neuro Opth

Neuro-Opthalmic Neuro-Opthalmic

Arrival to Bone Dilatometry

Bone Dilatometry

Bone

Dilatometry

Duration

Arrival to EMG

EMG Duration EMG Duration

Arrival to EEG

EEG EEG

Arrival to Neuro Psychology

Neuro-Psychology

Neuro Psychology

Duration

Arrival to Infusion

Infusion Infusion Duration

Arrival to Clinical Research

Clinical Research Clinical Research

Room Length of Stay Room Length of Stay

Overall Length of Stay

Visit Length Of Stay

Arrival to Imaging

Arrival to Rehab Services

Room Length of Stay

Overall Length of Stay

Arrival to Diagnostic Services

Arrival to Infusion

Arrival to Clinical Research

Diagnostic Services

Arrival to Neuro Opth

Arrival to Bone Dilatomery

Room Length of Stay (if exam room was held thorugh any of these additional care services)

Arrival to Lab

Patient is registered

in Versus (Badge

Utility or Interface)

and patient badge is

seen by sensory

network.

Arrival to Exam Room

Appt. to Exam

Exam Follow-up

Arrival to Provider

Appt to Provider

Exam Door to Provider

Patient Room Time

Staff Exam

Arrival to RN

Arrival to EMG

Arrival to EEG

Arrival to Neuro Psychology

Visit Length Of Stay

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Agenda






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Stony Point

Multidisciplinary Clinic

Orthopaedics

Radiology

*

*X-ray

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N.O.W. CenterStony Point Pilot (no

HIS interfaces)

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► “Plug and play” wireless

► Sensors mapped in existing clinic

► No HIS interfaces

► Helped define basic workflow

How to wear the badge

Store in badge cabinet

Clean with isopropyl alcohol

► Language

Stony Point RTLS Pilot

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Interactive Multiple Choice Question

What is the most common question asked about RTLS?

A. Does this improve my visit?

B. Who sees the data?

C. Do you see in the bathroom?

D. Why wear a badge?

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X-rayX-ray

N.O.W. RTLS Integrated with Construction

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Shared registration

Radiology

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Floor plan view

List view

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Please use blank slide if more space is required for charts, graphs, etc.

To remove background graphics, right click on selected slide,

choose “Format Background” and check “Hide background graphics”.

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Please use blank slide if more space is required for charts, graphs, etc.

To remove background graphics, right click on selected slide,

choose “Format Background” and check “Hide background graphics”.

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Look at those belly timers!

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Interactive Multiple Choice Question

Which statement about RTLS is false?

A. Displays LAST name

B. Badge detected by sensors

C. Patients can decline badge

D. Badge triggers visual cues

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Agenda






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Periodic and ad hoc

Initial KPI focus on patient satisfaction:

• Overall length of stay (OLOS): badge assigned to deposited

• Wait time: sub-wait or prior to time in exam room with clinical staff

• Time alone: time alone once in room

Focus on Orthopaedics and Radiology

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Stony Point (SP) Versus NOW

N Mean Std. Deviation Std. Error Mean

NOW 634 70.369 32.954 1.309

SP 441 79.092 40.062 1.908

Group Statistics

Location

OLOS Minutes

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NOW 633 15.596 18.106 0.720

SP 397 18.652 18.431 0.925

Group Statistics

Location

WaitMinutes

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NOW 602 18.85797 15.242188 0.621225

SP 345 20.79333 15.793077 0.850271

Group Statistics

Location

AloneMin

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Combined post-op x-ray visit scheduling

Combined

appt


OLOS min Yes 9 41 13.8 4.6

No 8 42.5 16.3 5.8

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Time spent in Radiology

N Mean

Std.

Deviation

Std. Error

Mean

NOW 266 8.213 5.720 0.351

SP 135 12.767 6.857 0.590

Group Statistics

Location

Duration

Minutes

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Challenges• “Off the shelf” reporting practical only for drilling down on individual

patients.

• Process analysis requires visualizing ALL of the data

• Current process:

– Daily (12 AM) data transfer to SQL server

– Tableau used to manipulate based on:

• Actions

• Processes

• Intervals

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Courtesy Vimal

Mishra, MD

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Learning Objectives• Compare the function of patient self-rooming to the standard waiting

room model in an ambulatory care facility

• Compare the implementation of a RTLS in a preexisting clinic and a newly constructed ambulatory clinic

• Describe how RTLS can be used by staff at the point of care

• Recognize standard measures acquired with RTLS

• Appraise RTLS data to target processes in need of quality improvement

50

Our patient-centered care model

To measurably improve the quality of neurological and musculoskeletal health

by leveraging teamwork, information technology and innovation.

51

The Neuroscience, Orthopaedic and Wellness (N.O.W.) Center

• Patient-friendly experience

• Multidisciplinary care based on symptoms and diagnosis

• Standardize care validated by patient outcome metrics

• Proximity and shared resources

52

Questions

• [email protected]

• https://www.linkedin.com/in/kevin-hoover-74772a3b/

• https://vcuhealthnowcenter.org/

• Please complete online session evaluation!

https://www.linkedin.com/in/kevin-hoover-74772a3b/

https://vcuhealthnowcenter.org/

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