Accuracy of patient's turnover time prediction using RFID technology in an academic ambulatory surgery center

Real-time locating systems to improve healthcare delivery: A systematic review

OBJECTIVE

Modern health care requires patients, staff, and equipment to navigate complex environments to deliver quality care efficiently. Real-time locating systems (RTLS) are local tracking systems that identify the physical locations of personnel and equipment in real time. Applications and analytic strategies to utilize RTLS-produced data are still under development. The objectives of this systematic review were to describe and analyze the key features of RTLS applications and demonstrate their potential to improve care delivery.

MATERIALS AND METHODS

We searched MEDLINE, SCOPUS, and IEEE following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Inclusion criteria were articles that utilize RTLS to evaluate or influence workflow in a healthcare setting. We summarized aspects of relevant articles, identified key themes in the challenges of applying RTLS to workflow improvement, and thematically reviewed the state of quantitative analytic methodologies.

RESULTS

We included 42 articles in the final qualitative synthesis. The most frequent study design was observational (n = 24), followed by descriptive (n = 12) and experimental (n = 6). The most common clinical environment for study was the emergency department (n = 12), followed by entire hospital (n = 7) and surgical ward (n = 6).

DISCUSSION

The focus of studies changed over time from early experience to optimization to evaluation of an established system. Common narrative themes highlighted lessons learned regarding evaluation, implementation, and information visibility. Few studies have developed quantitative techniques to effectively analyze RTLS data.

CONCLUSIONS

RTLS is a useful and effective adjunct methodology in process and quality improvement, workflow analysis, and patient safety. Future directions should focus on developing enhanced analysis to meaningfully interpret RTLS data.

Analysis of Managers' Perception Regarding the Use of Traceability Tools in the Context of Brazilian Health

Our society has advanced in terms of technology, and health could not be different. Despite the benefits and advantages that such improvements entail, it is unknown what contributions have been added to the hospital environment and whether such technological engineering has managed to generate value and adapt to different factors within such institutions' professional culture to establish relevance to the base of utilitarian nature. The use of tools can be conditioned to the view that the managerial sectors have such instruments. The work aims to identify and understand the perception that health managers have traceability tools such and their view on their efficiency and effectiveness in the hospital environment. The results direct us that the traceability tools have a significant expression in the hospital context, collaborating for efficiency and efficacy. Traceability tools can help the entire health system to be more uniform in service, in accountability, and in inspection processes.

Clinical Interest and Economic Impact of Preoperative SMS Reminders before Ambulatory Surgery: A Propensity Score Analysis

Patient contact by telephone the day before ambulatory surgery is considered as a best practice. The Short Message Service (SMS) could be a suitable alternative. The objective of this prospective study was to evaluate the interest of preoperative instruction (PI) reminders by SMS compared to telephone calls. This was a prospective single center before-and-after study. Patients scheduled in ambulatory surgery were included during 2 consecutive periods of 10 weeks. The "Call" group received a telephone call for preoperative instructions (PI) and the "SMS" group received an automated protocol SMS reminder. The primary endpoint was patient compliance with PI and time of convocation. The two populations were compared with a non-inferiority hypothesis and the impact of the contact modality on compliance with the PI was assessed using a propensity score. The analysis concerned 301 patients in the Call group and 298 in the SMS group. The absence of dysfunction was observed in 75% of patients in the SMS group compared with 61% in the Call group (Risk difference: 14% [95%CI: 7-21]). The use of SMS was associated with a significant improvement in compliance with the PI (Odds ratio: 1.90 [1.48-2.42]; p < 0.0001). Patient satisfaction was similar regardless of the method of PI reminders. The automation of preoperative SMS reminders is associated with a better respect of the PI compared to the conventional calling method. This PI reminder method satisfies the majority of patients and may have a favorable financial impact.

The Impact of Overestimations of Surgical Control Times Across Multiple Specialties on Medical Systems

Optimization of operating room (OR) resources and costs require accurate estimations of procedure times. In some institutions, surgeons are asked to predict their surgical control time (SCT), which typically constitutes the majority of the total procedure time. Here, we examine differences in predicted versus actual SCT and variations by specialty. Data included all scheduled surgical procedures at one academic institution from October 2008 - September 2014. Exclusion criteria consisted of missing values for SCT as well as estimated SCTs that fell outside of 5 standard deviations of any given procedure's mean. Differences in estimation were calculated by subtracting estimated SCT from actual SCT and compared against a null hypothesis of 0 with a two-tailed t-test. Differences between specialties were examined using analysis of variance and Games-Howell tests. Between 2008 and 2014, 119,410 scheduled procedures were performed. After exclusion, 116,599 cases were analyzed. On average, SCT was overestimated by 12.9 min (p < 0.0001). Overestimations persisted when divided by specialty (p < 0.0001). With thoracic surgery as a control, all other specialties except for cardiac surgery had overestimations of SCT. The greatest time differences were seen in dental (37.6 min, p < 0.0001), cardiology (33.0 min, p < 0.0001), and neurosurgery (29.7 min, p < 0.0001). Overall, SCTs are overestimated at this institution across many specialties. Depending on the methodology by which a hospital chooses to allocate OR time, SCT estimations could potentially be reduced in certain specialties to allow for better allocation of OR resources.

RFID analytics for hospital ward management

In this paper, we present an RFID-enabled platform for hospital ward management. Active RFID tags are attached to individuals and assets in the wards. Active RFID readers communicate with the tags continuously and automatically to keep track of the real-time information about the locations of the tagged objects. The data regarding the locations and other transmitted information are stored in the ward management system. This platform enables capabilities of real-time monitoring and tracking of individuals and assets, reporting of ward statistics, and providing intelligence and analytics for hospital ward management. All of these capabilities benefit hospital ward management by enhanced patient safety, increased operational efficiency and throughput, and mitigation of risk of infectious disease widespread. A prototype developed based on our proposed architecture of the platform was tested in a pilot study, which was conducted in two medical wards of the intensive care unit of one of the largest public general hospitals in Hong Kong. This pilot study demonstrates the feasibility of the implementation of this RFID-enabled platform for practical use in hospital wards. Furthermore, the data collected from the pilot study are used to provide data analytics for hospital ward management.

Combining the ASA Physical Classification System and Continuous Intraoperative Surgical Apgar Score Measurement in Predicting Postoperative Risk

The surgical Apgar score predicts major 30-day postoperative complications using data assessed at the end of surgery. We hypothesized that evaluating the surgical Apgar score continuously during surgery may identify patients at high risk for postoperative complications. We retrospectively identified general, vascular, and general oncology patients at Vanderbilt University Medical Center. Logistic regression methods were used to construct a series of predictive models in order to continuously estimate the risk of major postoperative complications, and to alert care providers during surgery should the risk exceed a given threshold. Area under the receiver operating characteristic curve (AUROC) was used to evaluate the discriminative ability of a model utilizing a continuously measured surgical Apgar score relative to models that use only preoperative clinical factors or continuously monitored individual constituents of the surgical Apgar score (i.e. heart rate, blood pressure, and blood loss). AUROC estimates were validated internally using a bootstrap method. 4,728 patients were included. Combining the ASA PS classification with continuously measured surgical Apgar score demonstrated improved discriminative ability (AUROC 0.80) in the pooled cohort compared to ASA (0.73) and the surgical Apgar score alone (0.74). To optimize the tradeoff between inadequate and excessive alerting with future real-time notifications, we recommend a threshold probability of 0.24. Continuous assessment of the surgical Apgar score is predictive for major postoperative complications. In the future, real-time notifications might allow for detection and mitigation of changes in a patient's accumulating risk of complications during a surgical procedure.