When Randy Saad first started as director of perioperative services at Los Angeles-based Adventist Health White Memorial, way back in 2005, he faced multiple challenges.
The primary challenge was case progression. If the first surgery of the day at the 353-bed, not-for-profit teaching hospital was delayed, it disrupted the entire schedule for the rest of the day.
This was primarily due to difficulty in communicating efficiently and in a timely manner with the various surgery teams and support staff to let them know about delays, schedule changes and other factors in the multiple phases of the patient’s care.
“It was also due to the fact that our patients could be on any one of our three floors, either having their blood drawn or having imaging or testing done, so we were not always certain of their location,” Saad explained.
“Inefficiencies and miscommunication resulted in delays and slower turnaround times in our eight operating rooms, which negatively affected the experience of patients and families, surgeons and staff, as well as increasing our costs,” he said.
The goal was to improve the patient experience and turnaround times. The hospital needed the ability to locate patients in real time, regardless of where they were in the facility. Staff also sought to improve communication between units and between support staff to improve coordination of resources, both physical (supplies and equipment) and human (staff and surgeons).
So Saad and the IT and caregivers teams turned to the Zebra Technologies Android-based TC51-HC mobile computer. It enabled them to improve because it is integrated with an OR workflow solution from vendor Tagnos.
“Perhaps the most valuable aspect of the workflow solution is our new reporting ability, which enables us to track and analyze time-savings performance in every phase of the patient journey.”
Randy Saad, Adventist Health White Memorial
“The platform incorporates radio-frequency identification tags on the patient’s wristband to track and display their precise location and amount of time spent in every phase of the journey, from registration to OR discharge,” Saad explained. “The RFID tags also allow us to track equipment needed for the surgery.”
Tagnos then aggregates and analyzes data from the tags, as well as information from a variety of hospital systems, to provide real-time alerts to the surgical and support teams of every phase, so the OR does not sit empty and providers are not waiting to deliver services.
“Through the Tagnos app on the Zebra mobile devices, care and support teams can more effectively coordinate scheduled surgery times and collaborate workflows for faster care delivery and improved patient/family experience,” he said. “For example, when the patient enters and departs the OR, their family is notified through a waiting room monitor, allowing them to follow the progress.”
There is a variety of RFID technology vendors on the market today. Some of these vendors include AB&R, Alien Technology, Avery Dennison, Checkpoint Systems, Impinj, Nedap and Smartrac.
MEETING THE CHALLENGE
The technologies are used by the surgery and support teams, primarily the charge nurse, surgical registered nurse, anesthesia technicians and environmental services personnel. The Tagnos OR workflow system is integrated with the Cerner EHR so that once the patient is tagged at registration, that data flows into the Tagnos platform.
“We are currently working with the vendor so that the timestamps captured through the platform are automatically exported to our EHR, and the process to manually export the data is fairly simple,” Saad noted. “Our goal is always to capture the most accurate time – the Tagnos system captures data every three seconds – not only to improve the productivity and efficiency of our ORs, but also because billing is based on OR time.”
To further improve efficiency, nurses are quickly able to receive accurate and automated real-time alerts through the Tagnos app on the Zebra mobile computers. This alleviates them from having to log into a computer or use a landline phone to communicate with environmental services, anesthesia techs or pre-op or PACU nurses to notify them that a patient’s procedure is completed.
“We are working on an advanced solution that would enable a surgical nurse to receive alerts that a patient in pre-op is prepared for surgery, or that the pre-op is delayed,” Saad reported. “Thanks to the RFID tags, the messaging on Tagnos is automatic when a patient exits or enters a room, and OR nurses can send custom messages manually. Outside the OR, clinicians and staff can track the patient’s progress on a dashboard available on the Tagnos app.”
The notifications are especially crucial in Adventist Health White Memorial because the floor that houses its OR suites is shaped like a rectangle, so team members on one side of the floor cannot see the hallway traffic on the other side. The Tagnos automated status alerts offer real-time awareness to staff, regardless of their location.
“Perhaps the most valuable aspect of the workflow solution is our new reporting ability, which enables us to track and analyze time-savings performance in every phase of the patient journey, including his or her total length of stay in our perioperative departments,” Saad explained. “Tracking, trending, and generating reports and graphs used to be a tedious and complicated process; now it is quick and comprehensive.”
The reporting may also contribute to improved scheduling accuracy, thanks to the analytics capabilities that allow staff to better predict how much time each case would need based on previous experience with similar cases and patient characteristics, he added.
The precise overview of patient location and care journey status, as well as automated communication, has enabled Adventist Health White Memorial to reduce OR turnaround time by nearly 10%, or approximately 3 minutes, while increasing environmental services response time by 61%.
Anesthesia tech response time improved by 20 percentage points because they are notified about their next patient’s status through the Tagnos app instead of having to log-in to the EHR or return a call from the charge nurse, which they may not have time to do.
“While at first look, three minutes may not seem like a significant time-savings improvement, it is yielding significant financial benefits,” Saad said. “At five turnarounds per day multiplied by six operating rooms, that three-minute improvement saves 90 minutes per day. Multiplying 90 minutes a day by the $ 41 per-minute cost of each OR, we are saving an estimated $ 974,160 per year, just through that small improvement.”
ADVICE FOR OTHERS
“I would recommend that other hospitals or facilities with ORs take a hard look at their turnaround time data and outcomes,” Saad advised. “They should ask themselves if they trust the accuracy of those measurements and whether the reports are producing valuable information to determine improvement opportunities.”
Second, clinicians may inaccurately describe how much time the patient spends in pre-op, waiting room or the OR, given all the distractions clinicians are faced with in any given case, he explained.
“Real-time location system capabilities offer a precise, time-stamped chronology of each phase of the surgery,” he concluded. “With this extremely accurate, objective and verifiable data, leadership is more effective in understanding processes, managing process improvements, and promoting clinician and staff behaviors that support our mission and goals.”