Education Real Time Location System
Real-time locating systems (RTLS, also known as real-time location systems) have become an important component of many existing ubiquitous location aware systems. While GPS (global positioning system) has been quite successful as an outdoor real-time locating solution, it fails to repeat this success indoors. A number of RTLS technologies have been used to solve indoor tracking problems.
The ability to accurately track the location of assets and individuals indoors has many applications in healthcare. This paper provides a condensed primer of RTLS in healthcare, briefly covering the many options and technologies that are involved, as well as the various possible applications of RTLS in healthcare facilities and their potential benefits, including capital expenditure reduction and workflow and patient throughput improvements. The key to a successful RTLS deployment lies in picking the right RTLS option(s) and solution(s) for the application(s) or problem(s) at hand. Where this application-technology match has not been carefully thought of, any technology will be doomed to failure or to achieving less than optimal results. State-of-the-art reviewReal-time locating systems (RTLS, also known as real-time location systems) are local systems for the identification and tracking of the location of assets and/or persons in real or near-real-time. An RTLS consists of specialised fixed receivers or readers (location sensors) receiving wireless signals from small ID badges or tags attached to objects of interest and/or persons, to determine where the tagged entities are located within a building or some other confined indoor or outdoor space (Figure ). Each tag transmits its own unique ID.
The tag ID is logged against the asset or person to which/whom it is attached. The tags periodically transmit their ID, and depending on the technology chosen, the system locates the tags (and therefore the tagged entities) within a few rooms on one of several floors or to a specific room or part of a room on a specific floor.
When staff members require portable assets, they log onto the system at a workstation (or using a mobile device), identify where the closest available item is located, and go and get it. Basic components of an RTLS (modified from ).RTLS location information typically does not include complete or continuous navigation details such as speed, direction, or spatial orientation of tracked assets and persons.
Standards governing RTLS include ISO/IEC 24730 standards series, which describes a form of RTLS used by a subset of vendors, but does not cover the full range of RTLS technologies.Emergency first response, healthcare and hospitals -, care homes and even everyday home life (as an assistive technology, where applicable) can all potentially benefit by using an appropriate RTLS solution. RTLS components and technologiesIn an RTLS, the location engine software communicates with tags and location sensors to determine the location of tagged entities. The location engine relays this information to specialised middleware and applications.
The middleware in an RTLS acts as the “plumbing” between the core RTLS components (tags, location sensors and location engine software) and a range of software applications capable of displaying and exploiting the real-time location and status information of tracked entities. RTLS applications in healthcareRTLS can be used to quickly locate healthcare staff in large facilities when a patient or other member of staff summons assistance during a medical emergency. RTLS can also be deployed to track the physical movement of patients to help ensure their safety, particularly in the case of Alzheimer’s and dementia patients. An RTLS can alert staff and pinpoint the location of a resident who wanders away from a pre-defined area or tries to leave the building, e.g., when a patient passes too close to an entrance or an exit.
Automatic door locking may also be triggered in such cases, as appropriate. (A related outdoor tracking application for Alzheimer’s patients using GPS is described in.)Because locating by associating can provide detailed data on who is near whom, it can be used to detect how long a nurse has attended to a patient. A similar low-cost system for care homes can record each time care assistants attend to residents in their rooms ,. Estimates indicate that hospitals will purchase 10% to 20% more portable equipment than actually required for operational needs, so that staff may find it when needed. Let us assume the example of a hospital originally planning to procure 600 IV pumps at GBP £3,250.00 each (total: GBP £1,950,000.00). With the deployment of a suitable RTLS, these figures can be reduced to 530 IV pumps for a total cost of GBP £1,722,500.00.
This is a saving of GBP £227,500.00. Now, if the investment in the RTLS has cost GBP £97,000.00, the final savings after investment will be GBP £130,500.00, a 134.5% ROI (return on investment) with immediate payback time. For more expensive equipment such as ICU ventilators, the ROI can be much greater, even when assuming a 50% depreciation value of purchased equipment (which cuts RTLS savings to half).Lower capital expenditure will also result in a reduction in the cost of depreciation (where applicable), and fewer assets (530 instead of 600 IV pumps in the above example) will translate into a proportionate reduction in storage and maintenance needs and costs. Furthermore, with an RTLS, medical personnel spend less time looking for equipment, thus increasing efficiency and productivity, as well as staff (and patients’) satisfaction.By deploying RTLS to locate IVF pumps, one can also track whether members of staff are complying with regulations regarding proper disinfection between uses by different patients. To quantify the benefits of deploying such an application, one can consider the industry average costs spent and negative effects on reputation in case a violation citation is received.Compliance with hand hygiene protocol in hospitals can significantly minimise the risk of nosocomial infections. RTLS can be used as a low cost method for recording when members of staff use hand sanitation stations before and after they enter and leave rooms and wards.
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When a member of staff uses a hand washing station, a nearby electromagnetic field emitter (exciter) triggers the personal badge tag (active RFID) worn by the caregiver to transmit a ‘hand washing event’ message that identifies the caregiver and the time that the specific dispenser was used. The system is not used to micromanage individual members of staff, but is rather used as a hospital infection control measure to identify individuals and groups who may need additional training or education.RTLS has the potential of improving the productivity of nurses and caregivers and hence their job satisfaction levels by reducing many mundane and repetitive tasks that staff encounters on a daily basis. For example, a nurse or a caregiver typically has to manually cancel a call (register that it has been answered), but an RTLS can perform the same task automatically by recognising the nurse’s presence in the room. RTLS can also cut the time staff has to spend to check the status of rooms and beds and also improve a patient’s family/visitors’ satisfaction by increasing their awareness of patient location.An RTLS can be deployed as an important component of a comprehensive hospital security solution. Instances of physical and verbal abuses of nurses and other members of staff (by abusive patients, visitors and other staff) in healthcare facilities, especially psychiatric hospitals, are not uncommon. RTLS can improve the safety of staff and nurses by giving them a means to request emergency assistance during crisis situations.
Moreover, tracking personnel also alleviates security concerns by monitoring unauthorised access in restricted areas. However, RTLS can be perceived as ‘big brother’. It is therefore important to promote its operational benefits to stakeholders prior to implementation and include appropriate checks to ensure their privacy is not infringed.In 2001, the second author was involved in an RTLS deployment at a major London hospital which failed. The project was to install a nurse call/nurse tracking system within a new wing in the hospital. The scope of the project in the beginning was to improve safety procedures for nurses within the hospital.
It had been noted that physical attacks and verbal abuse of nurses was occurring almost daily. In order to address this, hospital management decided to implement a system that enabled the nurses to raise an alarm and alert security personnel to nurse’s precise location when an incident occurred. The hardware was installed in the new wing and the nurses were issued each with an ID badge; the badges were fitted with a distress button and transmitted the ID and therefore the nurses’ locations as they moved around the wards. In addition to the nurse tracking system, a nurse call system was also required for the new wards, and it was decided that the nurse call system and the RTLS systems should be integrated. This function would allow management to identify where nurses were located when a nurse call event was activated, what type of event they were dealing with at the time, and how long they took to respond to nurse calls. But the nurses refused to comply with the system (they did not wear the ID badges) and therefore could not be tracked. As a result of this, the system was never used, hence the importance of educating users and addressing any privacy or other concerns they might have.
Discussion, practical recommendations and conclusionsIn healthcare facilities, RTLS can be used to locate portable assets and equipment, locate staff quickly and efficiently, and improve workflow. Hospital throughput of patients can be improved by ensuring the correct medical staff and equipment are in the correct place at the right time.It is important to keep in mind that when vendors are more knowledgeable than the people procuring anything complex, the potential for dissatisfaction is likely to be present. Healthcare procurement teams should not simply take vendors’ marketing information and glossy brochures at face value. Moreover, the impact of the lack financial stability of many of the RTLS players within the industry in today’s (2012) gloomy global economic climate (particularly among the smaller vendors/system integrators) means that vendors are often desperate for revenue; under the circumstances, they may be compelled to offer and sell their products or “solutions” for any healthcare-related project, even when they do not have the correct solution for the client. This could be summarised as ‘ to a hammer, every problem looks like a nail’.Many of the companies providing products are several years from profitability, they are investing in building a sales and customer support infrastructure, and it is unlikely that all of them will survive to maturity.
The problem for the clients of such companies will be how to support legacy (closed, proprietary) systems if the vendors are no longer trading. To reduce such risks, clients should insist on procuring standards-based technologies that support open APIs.Prospective clients should also ask vendors bidding for an RTLS installation to provide references from existing customers covering previously delivered work, particularly work of similar nature and requirements as the current job. They should then carefully check all references received (the second author knows of at least one company who has no installations, but nevertheless advertises several “references”).Many IT (information technology) projects fail, particularly large ones; they are either abandoned prior to implementation (due to cost overruns), or they do not achieve the required functional or business benefits. There have been several well documented IT project failures (either partial or complete) in the healthcare sector, including the well-known case of the NHS (National Health Service) National Programme for IT in England.
RTLS installations bring in additional factors that may lead to project failure.The IT sector has an inbuilt expertise in protecting themselves from the consequences of project failure. Indeed, the techniques are taught in many universities; they are called ‘functional specifications’. The deliverables and system functionality of a proposed system are detailed in its functional specifications. This is the case for all major IT deployments, including RTLS installations. The outcome is defined in such a way that allows the project to be declared a success if it can be shown to have met its functional specifications, regardless of whether or not it has also met the requirements as sold and anticipated by the client.
One problem here is that vendors are experts in the sciences of the hardware and marketing; they hard promote their hardware because they consider that to be their differentiator in the marketplace. Clients, on the other hand, are usually purchasing a solution to an operational problem (rather than a mere hardware installation), and misunderstandings can arise in the (fine, but often critical) details.RTLS systems are high involvement products, and typically the evaluation, selection and procurement team will consist of a of a stakeholder panel drawn from only the procuring organisation. The panel will examine and evaluate the offers received in detail; often they quickly adopt the domain and terminology of the vendors. Vendors usually provide information about radio type and frequency of transmission, received signal strength (RSSI), triangulation, multiple paths, etc. Depending on the makeup of the selection panel, this may or may not be relevant information, because they may not be cognisant of the differences in the capabilities of products offered, due to minutiae. Unfortunately, although the product details supplied by the vendors may be accurate, buyers responsible for the procurement of RTLS for the first time may not be aware of the consequences of decisions based on minutiae provided by vendors.The choice of RTLS technology must be very carefully made. A given technology or hardware may not work well despite all its merits, if not properly matched to the intended application or the care facility’s (physical) environment, budget and future expansion plans (the latter will require an adequately scalable RTLS solution).
For example, radio signals are susceptible to interference via signal propagation, metals, water, people, and radio signal collisions. Not every environment is suited for RF (radio frequency) systems.Procurement teams should ideally include as many stakeholder groups as is possible in the whole process, from its beginning till final delivery.
This is also needed to avoid cultural and organisational resistance to new procedures and working practices introduced by a new system and to successfully manage the associated organisational change and stakeholders’ adaptation to the new workflows. It should not just be assumed that everyone will willingly agree to all changes, because they seem like a good idea to senior management.It is also advised (whenever possible) to invite a member of the vendor’s team to serve on the project panel from an early stage (once a suitable vendor has been picked). This enables the vendor to give advice on on-going system changes and enhancements at the ideas stage, rather than the vendor being presented with evolving requirements that are proposed by the client and then either attempting to “shoe horn” them into the system or negotiate changes after the fact.Healthcare institutions should aim at improvements which are well within the capabilities of the technology and require modest procedural changes on behalf of users. They should make incremental changes and keep them simple.Finally, selection and procurement teams should focus on achievable and demonstrable real-world benefits such as cost savings, improved efficiency, improved staff and patients’ satisfaction, etc.
Rather than on mere system specifications, making sure that any chosen vendor is committed to achieving these benefits. Bandi also suggests partnership with vendors in a shared risk acquisition model. Vendor selection should always include a ‘Plan B’: what happens if the vendor fails; is there a contingency to source replacement hardware and obtain software support in this event? RTLS For Dummies.
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Education Real Time Location System Reviews
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