Texas Health Presbyterian Dallas Hospital was renting and purchasing equipment frequently.
Equipment expenses continued to increase. Nurses at the bedside were constantly calling and needing basic types of equipment to take care of patients. The nurses began to hoard equipment because they never knew when it may or may not be available to them. Workflows and responses to nurses’ needs were slow.
Texas Health decided its real-time location system was the answer. It uses one with vendor CenTrak for hardware and vendor Intelligent InSites for software.
For years the provider organization had used the system for asset management only. In 2017, it expanded use to determine where equipment was located at any time. The idea was the system would help staff make decisions about if and when they needed to purchase equipment.
“We eventually established par levels so the RN did not have to call,” said Judy Travis, senior director operations of ambulatory, retail, rehab services, and food and nutrition services, at Texas Health Presbyterian Dallas Hospital. “Once RNs realized the equipment was in a clean area, they stopped hoarding. We used the system to meet this need, but also had to establish a trusting relationship. During the first year of operation, we did not rent or purchase a single piece of equipment.”
There are many vendors of real-time location system technology on the market today. These vendors include Awarepoint, GE Healthcare, Hewlett-Packard, Midmark, Mojix, Siemens, Skytron, Stanley Healthcare, Versus Technologies and Zebra Manufacturing Solutions.
MEETING THE CHALLENGE
The system was implemented for asset management purposes in 2009. The system was not maintained and it had to be redeployed. Staff had to carefully examine how to cut back IT expense but still use the system to their benefit. They were using about 8,000 equipment tags per year. Staff formed a committee to determine what should be tagged.
“Our primary focus was what value was brought to our facility by tagging the equipment,” Travis explained. “We now use about 4,000 tags per year. Facilities must keep the system updated. If the system is not accurate, staff will not use it.”
“During the first year of operation, we did not rent or purchase a single piece of equipment.”
Judy Travis, Texas Health Presbyterian Dallas Hospital
The RTLS system decreases time to locate equipment, helps maintain par levels on nursing units, decreases expense for new equipment and improves patient care, she added.
“Our pro forma was a $600,000 contribution margin,” she said. “This was a prediction for the next 12 months. We started in September of 2017. In the last four months of the year, we were already saving on rentals and purchases. Finance annualized these savings to obtain the $400,000 for a year’s time.”
In the first year of redeploying its RTLS, Texas Health saved $412,000. This is hard savings, minus cost of RTLS, employee salaries and benefits.
“We did not use data for cost avoidance,” Travis said. “This year we will see additional savings in rental equipment. We have seen an 80 percent decrease – yes, 80 percent – in biomed equipment repairs. The system tells us when equipment hits a dirty area and it is pulled from the area immediately. This prevents equipment from getting broken. We are now in the process of using the system to improve workflows and hand hygiene compliance.”
With the RTLS, Texas Health achieved a total $288,447 savings in either potential lost equipment or decrease in purchases/rentals.
“We owned a significant number of Alaris pumps,” Travis said. “We were renting an additional 20 pumps. The majority of patients in a hospital are on an IV. Prior to using an RTLS system, it was not unusual to read in safety reports that an RN could not locate a pump to start a patient’s IV.”
All pumps were tagged with an RTLS tag during the inventory process. Par levels for these pumps were established on the floors in clean rooms. Now the organization is able to use the RTLS to make sure par levels are maintained.
“The system indicates to us when the par level is too low and we replace before the nurse has to call requesting equipment,” Travis explained. “We also are able to identify when the pump is moved to the dirty room and needs to be cleaned. This allows us to clean and get back into circulation quicker.”
By removing the equipment from the dirty room immediately, Texas Health has been able to decrease equipment repairs by 80 percent in a year. The staff trusts that the equipment will be in a clean room and no longer hoards equipment. The organization was able to return all of the rental equipment and decrease costs by $13,000.
A lean six sigma project was completed using RTLS and tracking of wound care VACs. Texas Health was spending almost $33,000 per month in rent for these items. It lost several VACs.
“All VACs are tagged immediately when they arrive at our facility,” Travis said. “Vendors no longer take the equipment to the patient’s room. Each morning, an RTLS report is run to show the location of the device. We retrieve the device as soon as it comes off the patient. This allowed us to know exactly when the equipment is placed on the patient and when it comes off.”
The vendor allowed Texas Health to use its system to turn billing on and off for each patient. The provider’s usage decreased and it was able to renegotiate the rental for VACs. This resulted in a rental savings of more than $160,000 and the hospital has not lost a single VAC.
ADVICE FOR OTHERS
“Do your research,” Travis advised. “I would recommend you visit other facilities that are using the IT system. Engage your team and brainstorm what will work for you. The frontline staff needs to be included. They have great ideas and will provide solutions for you.”
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