VA Ann Arbor Healthcare System
RTLS Benefit Realization
Real Time Location System (RTLS) Benefit Realization
VA VISN 11 and Hewlett Packard Enterprise
“At Ann Arbor, we embrace innovation and technology to meet our mission: Honor America’s Veterans by providing exceptional healthcare that improves their health and well-being. With RTLS, we can improve efficiencies and reduce errors—and with 1.1 million square feet of hospital, RTLS helps us locate the right medical equipment and inventories in real time. That is critical for Veteran safety and care.” -Chris Cauley, Executive Assistant to the Associate Director, VAAAHS.
What is VA Real Time Location System?
Critical for enhanced patient safety is ensuring the U.S. Department of Veterans Affairs (VA) has real-time visibility of its medical assets, and medical staff has optimal equipment and supplies to treat Veterans. To accomplish this, VA and Hewlett Packard Enterprise are rolling out a powerful solution called the Real Time Location System (RTLS). RTLS uses radio frequency (RF) ID tags to give medical facility staff end-to-end visibility across VA facilities via an integrated, easy-to-use portal. Simple, inexpensive tags on objects transmit signals wirelessly to transmitters and receivers throughout the facilities sending information to a computerized tracking system. Data collected from the tags is fed into a unified dashboard and is then used to optimize decision-making, equipment utilization, clinical efficiency, staff productivity and satisfaction, and most importantly patient safety.
RTLS applications used in VISN 11 include the following:
· Active Asset Tracking: improves efficiency by providing real-time locations of equipment moving around the medical facility, such as infusion pumps, patient beds and defibrillators.
· Passive Asset Tracking: improves efficiency of inventory management with the use of technology that reduces asset scanning time from hours to seconds.
· Sterile Processing Instrument Tracking and Workflow: improves patient safety by reducing the possibility of human error in disinfecting scopes and preparing instrument trays for surgery, moving technicians from a paper checklist to an application with automated count sheets, photos and detailed instructions.
· Cardiac Catheterization Lab Supply Management: improves patient safety and optimizes resources by maintaining a continuous inventory with ‘smart’ cabinets. These cabinets automatically update inventory, notify staff in advance of supply expiration dates and continuously monitor par levels, alerting staff when it is time to re-order supplies. This application also tracks recalled products directly to the affected patient or stock supplies within seconds.
· Hewlett Packard Enterprise is supporting VA with RTLS, providing program management, operations planning, implementation, testing and training services as well as ensuring site readiness prior to solution roll out. With RTLS, Hewlett Packard Enterprise is integrating various technologies to actively track assets, medical supplies and surgical instruments in real time.
“Bottom line, with RTLS I know we will never implant a recalled or expired product in a patient, ever. The quality checks and controls RTLS puts in place are critical for patient safety. Would I go back to the way we did it before? No way!” -Barbara Clarke, Cardiology Nurse Manager, VA Ann Arbor Healthcare System.
RTLS at the VA Ann Arbor Healthcare System
Cardiac Catheterization Lab experiences better patient safety and cost savings with RTLS
Ensuring cardiologists have the critical medical devices needed to treat Veterans undergoing heart procedures, the Ann Arbor Cardiac Catheterization (Cath) Lab turned to the VA RTLS solution. The Cath Lab uses imaging equipment to visualize and treat the arteries and chambers of the heart. With RTLS, initial studies have found improvements in routine inventory management, replenishment activities and proactive management of outdating on-hand supplies.
These studies have found that RTLS:
· Eliminated the need to physically scan and count 84 percent of the inventory kept within the Cath Lab primary supply inventory, reducing the time spent identifying stock in need of replenishment on a semi-weekly basis. Because the new replenish process is in real time, the staff does not have to wait for the physical count. RTLS shows which items have reached their restock par levels, decreasing the risk of running out.
· Used the capability of remotely monitoring expiration dates on 84 percent of the product kept within the Cath Lab primary disposable supply inventory. This automated a manual effort where staff previously spent significant amounts of time physically removing all supplies from the cabinet, visually verifying the expiration date on the product and then physically ensuring the supplies were organized in a first-in, first-out inventory rotation. This rotation ensured items with the earliest expiration date were used first.
“The biggest cost savings is being able to anticipate expiration dates. We found that by just by turning RTLS on, it was already saving us $13,156 a month, which is $158,000 annually. We haven’t even calculated total cost avoidance yet, but it could be in the hundreds of thousands.” -Jordan Miller, Supply Management Specialist and RTLS site lead, VAAAHS.
Supply tracking and inventory management with ‘smart’ shelving
With thousands of items in the Cath Lab, keeping track of inventory levels, expiration dates and item locations is difficult, expensive and time-consuming. Examples of such assets include stents, catheters, guide wires and artificial heart valves costing as much as $30,000.
“When we got RTLS, it helped right off the bat having everything we needed. With the ‘smart’ cabinets, we know everything we have and exactly where it is. When there are 50 to 60 different types of catheters alone, this makes a huge difference in finding things faster during patient procedures,” said Tom Lewandowski, Lead Cardiovascular Technologist.
Each asset is tagged with RTLS/radio-frequency identification (RFID) tags that communicate with sensors in the smart cabinets and the point of care stations. Those sensors then feed data in real-time back to the central RTLS application. Each time an item is added or removed from the ‘smart’ shelves, the inventory is automatically updated and technicians can instantly locate what they need. RTLS also alerts staff when an item is nearing expiration and notifies vendors when inventory gets too low.
“And by notifying our vendors directly, it saves us time from having to contact them, ensures they provide exactly what we need and has also minimized vendor traffic in our Cath Lab,” added Barbara Clarke. “That means less of a chance for cross contamination and better Veteran safety measures.”
With RTLS and interfaces to legacy VA systems, the accuracy of what is ordered is significantly improved. The orders reflect what is actually needed instead of what vendors think the lab needs. The automatic notification also saves the clinical staff time in having to communicate orders with vendors. As an item is removed from the shelf and scanned, it automatically adjusts inventory and reporting. This automation saves errors from manual typing, especially when entering in lengthy lot and serial numbers and allows clinical staff to be more efficient in assisting patient procedures. Additionally, all items are associated with an identification number to protect patient privacy.
“By alerting us of expired products, it eliminates the risk of using expired product on a patient—and serves as another built-in patient safety check,” said Tom Lewandowski.
Efficient and effective product recalls
When product recalls are issued by a manufacturer, the speed and accuracy of pulling those items from clinical operations has a direct patient safety implication. With RTLS, the item is entered into the system and the location of each affected product is made visible with the click of a button. Logistics staff can then immediately target those locations and pull the affected product. Most importantly, facilities can effectively track implants directly to the Veteran in whom the implant was placed. Prior to RTLS, the tracking of these critical patient care items was very labor-intensive and often impossible, but now all implantables as well as any supplies used are scanned directly to the individual patient record.
If at any time there is a manufacturer recall on products in these areas, RTLS can accurately track each recall within seconds. As a result, staff using RTLS can confidently know if any of the recalled products were used during a patient procedure and take appropriate actions.
The RTLS system also has controls that lock an item so that it cannot be ordered until the recall is cleared. “If there is ever a recall of a medical device, it is easy and fast for us to find out exactly which patients may have been affected, or better yet, pull the device before it is ever used,“ said Chris Cauley.
“We conducted many mock recalls so the staff could demonstrate their abilities. We were able to trace to the granularity of specific manufacturer lot numbers. Finding the exact items went from being nearly impossible to locating these items in seconds with RTLS.” -Karla Sandell, Network Chief Logistics Officer/Senior RTLS Contracting Officer’s Representative.
Cost and time savings
Within the first six months of having RTLS in operation, the Ann Arbor Cath Lab was able to save significantly in expired supply returns alone. This means that the RTLS application would alert staff of impending expirations. Instead of throwing the items away after expiration, the staff is able to alert the vendors with return policies and receive newer replacement products at no extra cost.
“Before RTLS it was cost prohibitive to follow the replacement policies because everything was manual on excel spreadsheets. Now the computer alerts us, and we’re able to take advantage of this significant cost saving benefit,” said Angela Hernandez, Inventory Manager for Cardiology. Additionally, the Cath Lab staff has programmed the system to automatically send emails to vendors of the expiring supplies so they are able to send replacement product. This also saves the staff time they would spend making phone calls to vendors. “Those savings can go right back to patient care,” explained Chris Cauley.
The Cath Lab staff has also been able to better determine item utilization: implantable and non-implantable supplies that are critical to have versus those that are sitting unused on the shelves too long. “We did get things off our shelves that were taking valuable shelf space and costing us money that we knew we should offload. Some physicians and clinical staff were not convinced. Using the concrete data we were getting from RTLS, we could show the surgeons how often or little these items were being used,” continued Barb Clarke. “For example, we were able to remove 36 underutilized balloons off the shelf.”
RTLS also provides a view into supply inventory levels across medical centers, helping to share VA resources without having to make new purchases where possible. For example, if the Indianapolis VA Medical Center needs additional heart valves and Ann Arbor has extra inventory, it can be shared with no additional cost to VA resources.
“If an item expires, you have to throw it away…it’s wasted. With RTLS we can prevent that waste.” - Eric Hobbs, Total Supply Support and Inventory Management Supervisor, VAAAHS.
From manual to automated
“An inventory process that previously took me three hours now takes seconds with RTLS.” - Angela Hernandez, Inventory Manager for Cardiology, VAAAHS.
Before the RTLS solution, counting inventories including expiration dates, was a very manual process. An inventory manager would have to spend hours looking for each individual item which could be hidden in any room, shelf or drawer—sometimes as many as 2,000 line items.
Using the RFID technology that automatically reads inventory levels, this also reduces the human error element of mistakenly miscounting or misreporting assets.
“You not only need stock ready for par levels but you also need to be a good steward of federal government dollars and to not be wasteful. Now with RTLS, if we have excess product on the shelf, we can be more accurate with what we really need and use the data generated with RTLS to make better purchasing decisions,” said Eric Hobbs.
Read the full RTLS report here: VA_RTLS_Achievement_Report_softcopy.pdf