by Mary Jagim RN, MSN, CEN, FAEN | CNO at Infinite Leap
Traditionally, when discussing patient throughput in healthcare, length of stay (LOS) is defined as the time the staff completed registration to when the staff documented the patient’s discharge. What about the time the patient had to wait to check in and register? Is that time important, too?
Perhaps we should ask the acutely ill patient who waited 30 minutes to register, or the provider who is now behind schedule, whether these time delays are significant enough to consider. What about the time documented that the patient arrived in the exam or operating room? Does documentation always reflect reality? How about the time that an emergency physician “planned” to examine someone but was distracted by another critical patient? Suddenly, the patient door-to-doc time is no longer a valid data point.
It soon becomes clear that many components of patient throughput data are potentially missing — including some of the most valuable for defining the patient experience and identifying process delays. The data gap becomes even more apparent in ambulatory care settings, where patient check-in time is often the only data element that gets documented. The rest of the patient milestone steps are never or rarely recorded, resulting in a complete lack of transparency and clarity when it comes to patient wait times, patient-provider interactions or even the total visit time.
Generally speaking, patient visit data from electronic health records is retrospective, offering no opportunity to impact care that is still “in process.” How can we hope to change something that cannot be measured, or at best is measured inaccurately and after the fact?
Real-Time Location Systems (RTLS) can be a game changer by passively collecting throughput data in real time. Getting an RTLS badge on a patient when they enter and removing it when they leave is a bit of a process, yes — but it is the only way to collect real-time arrival to discharge data that is visible immediately and can be used by staff to modify the process as it’s happening. The secret to effective patient flow is balancing demand versus capacity, and that’s why being able to fine-tune processes with accurate real-time data is the optimal solution.
Let’s look at some examples to see how RTLS data can make a difference:
• In a multidisciplinary ambulatory practice, the arrival and registration process is crucial for keeping patient appointments on schedule. By using RTLS, a real-time queuing system can be implemented that not only creates an orderly, HIPAA-compliant registration and rooming process but also provides accurate arrival and registration wait time data. Registration staff can now see that one of the patients waiting in line to register is here to see the only specialty practice that is “on time” with their schedule. Staff can now pull that person ahead of the patients who arrived early for their appointments — keeping that practice on time. Simultaneously, you can support the other practices and help them get back on track by making other adjustments with patients waiting in line.
• Real-time information is also a valuable tool for staff throughout the entire patient visit. RTLS will automatically measure patient wait times, notify staff of extended waits, and let practitioners know when their patient has arrived in the exam room and is ready to be seen. This real-time awareness of patients waiting for services and of patient readiness is like “turning on the lights,” creating a more efficient experience for both patients and staff.
• Hospital imaging departments often provide services to both inpatients and outpatients. Offering real-time knowledge of outpatient arrivals as well as the location of inpatients needing imaging studies gives imaging staff valuable information — and allows them to balance the delivery of services while minimizing the wait time for all patients.
• In the OR, one of the most pivotal transitions for throughput is the room turnaround time (TAT). Staff documentation is unlikely to offer an accurate measurement of the actual time between wheels-in and wheels-out. Documentation also does not measure the time spent by each staff type involved in turning over the room. RTLS can measure this much more accurately while notifying turnover team members when the patient has left the surgical suite and it’s ready for cleaning. It can also alert the surgical team when the suite is ready for the next patient.
• In addition to providing valuable process information to the surgical team, RTLS can also give family members real-time updates regarding patient progress through the surgical experience. Communication to families can be automatically initiated by registering the movement of the patient from pre-op to surgery to recovery — and it’s no longer reliant on the timeliness of staff phone calls or documentation in the electronic health records system.
By giving us this crucial data for all aspects of the care process, Real-Time Location Systems offer a unique opportunity to create the optimal patient, family and staff experience — and it’s time to consider how RTLS can impact your own organization’s patient flow.