Effects of a WLAN-based real time location system on outpatient contentment in a Level I trauma center

Contact tracing using real-time location system (RTLS): a simulation exercise in a tertiary hospital in Singapore

OBJECTIVE

We aim to assess the effectiveness of contact tracing using real-time location system (RTLS) compared with the conventional (electronic medical records (EMRs)) method via an emerging infectious disease (EID) outbreak simulation exercise. The aims of the study are: (1) to compare the time taken to perform contact tracing and list of contacts identified for RTLS versus EMR; (2) to compare manpower and manpower-hours required to perform contact tracing for RTLS versus EMR; and (3) to extrapolate the cost incurred by RTLS versus EMR.

DESIGN

Prospective case study.

SETTING

Sengkang General Hospital, a 1000-bedded public tertiary hospital in Singapore.

PARTICIPANTS

1000 out of 4000 staff wore staff tags in this study.

INTERVENTIONS

A simulation exercise to determine and compare the list of contacts, time taken, manpower and manpower-hours required between RTLS and conventional methods of contact tracing. Cost of both methods were compared.

PRIMARY AND SECONDARY OUTCOME MEASURES

List of contacts, time taken, manpower required, manpower-hours required and cost incurred.

RESULTS

RTLS identified almost three times the number of contacts compared with conventional methods, while achieving that with a 96.2% reduction in time taken, 97.6% reduction in manpower required and 97.5% reduction in manpower-hours required. However, RTLS incurred significant equipment cost and might take many contact tracing episodes before providing economic benefit.

CONCLUSION

Although costly, RTLS is effective in contact tracing. RLTS might not be ready at present time to replace conventional methods, but with further refinement, RTLS has the potential to be the gold standard in contact tracing methods of the future, particularly in the current pandemic.

Process mining based on patient waiting time: an application in health processes

Purpose

Similar to many business processes, waiting times are also essential for health care processes, especially in obstetrics and gynecology outpatient department (GOD), because pregnant women may be affected by long waiting times. Since creating process models manually presents subjective and nonrealistic flows, this study aims to meet the need of an objective and realistic method.

Design/methodology/approach

In this study, the authors investigate time-related bottlenecks in both departments for different doctors by process mining. Process mining is a pragmatic analysis to obtain meaningful insights through event logs. It applies data mining techniques to business process management with more comprehensive perspectives. Process mining in this study enables to automatically create patient flows to compare considering each department and doctor.

Findings

The study concludes that average waiting times in the GOD are higher than obstetrics outpatient department. However, waiting times in departments can change inversely for different doctors.

Research limitations/implications

The event log was created by expert opinions because activities in the processes had just starting timestamp. The ending time of activity was computed by considering the average duration of the corresponding activity under a normal distribution.

Originality/value

This study focuses on administrative (nonclinical) health processes in obstetrics and GOD. It uses a parallel activity log inference algorithm (PALIA) to produce process trees by handling duplicate activities. Infrequent information in health processes can have critical information about the patient. PALIA considers infrequent activities in the event log to extract meaningful information, in contrast to many discovery algorithms.

A Survey About Real-Time Location Systems in Healthcare Environments

Every year healthcare organizations suffer from several issues, such as unapropriated workflow, thousands of deaths caused by medical errors, counterfeit drugs, and increasing costs. To offer better patient care and increase profit, hospitals could adopt solutions that help remedy these problems. Real-Time Location Systems have the potential to deal with many of these issues, as well as offering means for developing new and intelligent solutions. This kind of system enables tracking assets and people, allowing several improvements. Even though the benefits of such solutions are well known and desired by healthcare providers, their large scale adoption is still distant. In this article, we surveyed Real-Time Location Systems usage in hospitals. While developing this survey, we observed a need for organizing important aspects of healthcare-oriented Real-Time Location Systems. Therefore, we analyzed challenges regarding this topic and a taxonomy proposed. This survey offers researchers and developers ways to comprehend the challenges surrounding this area while proposing a classification of aspects that a Real-Time Location System for healthcare environments must assess for it to be successful.

A Novel Step Length Estimator Based on Foot-Mounted MEMS Sensors

Pedestrian Dead Reckoning (PDR)-based pedestrian navigation technology is an important part of indoor and outdoor seamless positioning services. To improve the performance of PDR, we have conducted research on a step length estimator. Firstly, based on the basic theory of inertial navigation, we analyze in detail the errors in traditional Strapdown Inertial Navigation Systems (SINSs) caused by the unique motion state of pedestrians. Then, according to the fact that the inertial data from the foot can directly reflect the gait characteristics, we conduct a step length estimator that does not rely on SINS. The experimental results show that accuracy of the proposed method is between 0.6% and 1.4% with a standard deviation of 0.25%.

Real-time location system-based asset tracking in the healthcare field: lessons learned from a feasibility study

Background

Numerous hospitals and organizations have recently endeavored to study the effects of real-time location systems. However, their experiences of system adoption or pilot testing via implementation were not shared with others or evaluated in a real environment. Therefore, we aimed to share our experiences and insight regarding a real-time location system, obtained via the implementation and operation of a real-time asset tracking system based on Bluetooth Low Energy/WiFi in a tertiary care hospital, which can be used to improve hospital efficiency and nursing workflow.

Methods

We developed tags that were attached to relevant assets paired with Bluetooth Low Energy sensor beacons, which served as the basis of the asset tracking system. Problems with the system were identified during implementation and operation, and the feasibility of introducing the system was evaluated via a satisfaction survey completed by end users after 3 months of use.

Results

The results showed that 117 nurses who had used the asset tracking system for 3 months were moderately satisfied (2.7 to 3.4 out of 5) with the system, rated it as helpful, and were willing to continue using it. In addition, we identified 4 factors (end users, target assets, tracking area, and type of sensor) that should be considered in the development of asset tracking systems, and 4 issues pertaining to usability (the active tag design, technical limitations, solution functions, and operational support).

Conclusions

The successful introduction of asset tracking systems based on real-time location in hospitals requires the selection of clear targets (e.g., users and assets) via analysis of the user environment and implementation of appropriate technical improvements in the system as required (e.g., miniaturization of the tag size and improvement of the sensing accuracy).

We do not know what we do not know: innovative approaches to value measurement

PURPOSE OF REVIEW

Over the past several years, there has been an increasing focus on improving the 'value' of healthcare delivered, defined as the ratio of clinical outcomes to the costs incurred to achieve them. The former U.S. Secretary of Health and Human Services Sylvia Burwell announced in 2015 that the majority of healthcare payments in the Medicare and Medicaid programmes will align with value by 2018. Although this has yet to fully mature, numerous health systems have restructured with a goal of improving the value of care delivered to their populations. Nevertheless, there remain important unanswered questions regarding how we measure value in the current U.S. healthcare system. The purpose of this review is to highlight innovations that are not only making it easier to measure value but also to improve care from the patient, provider and healthcare system perspectives.

RECENT FINDINGS

Behavioural start-ups and the introduction of relatively inexpensive health coaches are starting to permeate the healthcare landscape. These coaches are the consumers' advocate, acting as the quarterback of an extended care team in order to optimize health. Furthermore, time-driven activity-based costing has allowed us to understand costs on a more granular level, and novel tracking software may further automate these costing algorithms in order to better facilitate their dissemination.

SUMMARY

We must all work to enable new models of care that improve value by incentivizing individuals, payers and providers to improve health, rather than treat the disease after it manifests. We must also continue to improve the efficiency of healthcare delivery largely through improvements in value measurement.

Effects of Different Communication Tools on the Efficiency of Anesthesiologists in the Perioperative Setting

Objective

To assess if Real Time Locating Systems (RTLS) technology has an effect on the perioperative efficiency of anesthesiologists at our institution.

Methods

A retrospective chart review was performed for all outpatient and short-stay patients who received general anesthesia and monitored anesthesia care between January and June of 2016. Patients over 18 years with an ASA classification of 1, 2, and 3 were included. Time was used as a measure of efficiency between two groups of anesthesiologists.

These two comparison groups were as follows:

Group 1: Anesthesiologists at the academic center’s main campus who do not have access to RTLS

Group 2: Anesthesiologists at Josie Robertson Ambulatory Surgical Center where RTLS is available and use of RTLS is compulsory

Two outcome measures were collected from patient electronic records:

DUR1: Duration between when patient is admitted to a presurgical bed and preoperative evaluation by the attending anesthesiologist

DUR2: Duration between when patient is admitted to the operating room and initiation of induction by the attending anesthesiologist.

Results

Anesthesiologists who had access to RTLS technology were found to be more efficient in completing their preoperative anesthesia evaluation and initiating intraoperative induction. They took less time to complete these tasks and the difference was statistically significant to p<0.0001

Conclusion

Anesthesiologists at our institution, who have access to RTLS as an additional communication tool, were found to be consistently more efficient in their perioperative workflow. There are confounding factors that can account for the shorter times and more efficient perioperative workflow of anesthesiologists. With continued application and investigation over time, the utility of RTLS on workflow efficiency of healthcare providers will become more apparent.

mHealth: Mobile Technologies to Virtually Bring the Patient Into an Oncology Practice

Accompanied by the change in the traditional medical landscape, advances in wireless technology have led to the development of telehealth or mobile health (mHealth), which offers an unparalleled opportunity for health care providers to continually deliver high-quality care. This revolutionary shift makes the patient the consumer of health care and empowers patients to be the driving force of management of their own health through mobile devices and wearable technology. This article presents an overview of technology as it pertains to clinical practice considerations. Telemedicine is changing the way clinical care is delivered without regard for proximity to the patient, whereas nonclinical telehealth applications affect distance education for consumers or clinicians, meetings, research, continuing medical education, and health care management. Technology has the potential to reduce administrative burdens and improve both efficiency and quality of care delivery in the clinic. Finally, the potential for telehealth approaches as cost-effective ways to improve adherence to treatment is explored. As telehealth advances, health care providers must understand the fundamental framework for applying telehealth strategies to incorporate into successful clinical practice.

Process Mining Methodology for Health Process Tracking Using Real-Time Indoor Location Systems

The definition of efficient and accurate health processes in hospitals is crucial for ensuring an adequate quality of service. Knowing and improving the behavior of the surgical processes in a hospital can improve the number of patients that can be operated on using the same resources. However, the measure of this process is usually made in an obtrusive way, forcing nurses to get information and time data, affecting the proper process and generating inaccurate data due to human errors during the stressful journey of health staff in the operating theater. The use of indoor location systems can take time information about the process in an unobtrusive way, freeing nurses, allowing them to engage in purely welfare work. However, it is necessary to present these data in a understandable way for health professionals, who cannot deal with large amounts of historical localization log data. The use of process mining techniques can deal with this problem, offering an easily understandable view of the process. In this paper, we present a tool and a process mining-based methodology that, using indoor location systems, enables health staff not only to represent the process, but to know precise information about the deployment of the process in an unobtrusive and transparent way. We have successfully tested this tool in a real surgical area with 3613 patients during February, March and April of 2015.