The purpose of the project was to use the technology to measure the direct patient care work by shift and patient type in order to develop process improvements for safe, effective and efficient care. Technology has the potential to create a better work environment for inpatient nurses by improving efficiency, safety, and quality of care. Technology solutions such as RFID and RTLS can have a dramatic impact on patient safety, quality of care, patient and nurse satisfaction contributing to overall enhanced hospital operations. (California HealthCare Foundation, 2008). RFID and RTLS have mainly been used to help track equipment. A study conducted by Indiana University-Purdue University Indianapolis documented nursing time spent locating equipment was 60 minutes per shift. Implementing the technology resulted in process improvements to save $750,000 in-direct costs and give the nurses back the hour to spend with their patients (Wicklund, 2009). Nurses are the hub in a complex web of care delivery as well as an expensive resource in the acute care setting. Validating the work of nurses can identify opportunities for improvement.
Staff members were assigned RFID tags to allow tracking of movement and time on the Innovation Unit. Data was collected for three months and converted into spaghetti maps and graphs to demonstrate traffic flow and time spent in patient care by shift, day of the week, and month. The data was analyzed and validated by leaders and members of the team to identify opportunities for process improvement in the specific areas of staffing by shift, by patient type, and time of day that impacts care delivery and expense for the unit.
RFID and RTLS technology data identified minutes by shift workload (direct care) day shift and night shift as similar, supporting that the nurse to patient ratio for both shifts should be the same. Day shift spent 129,452 minutes versus 90,207 minutes during night shift. The differences between the shifts were 39,245 minutes which converted to .5 FTE annually. The technology validated care delivery patterns by total minutes spent per hour in patient’s room specifically related to hand off communication and assessments. Data, sorted by patient type, documented the time spent by specialty service patient type. This information supported adjusting assignments to allow for patients with complex care needs to be balanced with those requiring less time. Individual nurse data was used to improve individual efficiencies. Data was also used to support redesign of work spaces based on actual flow of nursing staff to minimize steps and inefficiencies.
RFID and RTLS on the Innovation unit have validated process improvements related to nursing ratios, patterns of care delivery, nursing assignments, and work flow efficiencies. These changes created a better work environment for nurses through improved efficiency, safety and quality of care delivered. Celebration Health embraces, supports, and experiments with technology to understand the work of nursing and to fulfill one of our core purposes to be a living laboratory. Technology is rapidly growing in healthcare but for it to be successful it is extremely important to understand the current workflow and explain the “why” behind the implementation. Michael Fraai director of biomedical engineering at Brigham and Women’s hospital quoted “There is a huge cultural component to the implementation of technology. You can install a lot of technologies, but if a technology doesn’t fit into the existing workflow, it won’t be adopted”.
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