Use of RTLS to Support a Model of Patient Centered Care

Use of RTLS to Support a Model of Patient Centered Care Session 268, March 8, 2018 Kevin B. Hoover, MD, PhD Medical Director, VCU Health Neuroscience, Orthopedic and Wellness Center 1

Conflict of Interest Kevin B. Hoover MD, PhD Has no real or apparent conflicts of interest to report. 2

Agenda Neuroscience, Orthopaedic and Wellness Center (N.O.W.) patient-centered care model Identifying the tools Mapping the patient journey Piloting and implementing RTLS (Real-time Locating System) Data and future goals 3

Learning Objectives Compare the function of patient self-rooming to the standard waiting room model in an ambulatory care facility Compare the implementation of a RTLS in a preexisting clinic and a newly constructed ambulatory clinic Describe how RTLS can be used by staff at the point of care Recognize standard measures acquired with RTLS Appraise RTLS data to target processes in need of quality improvement 4

Agenda N.O.W. patient-centered care model Identifying the tools Mapping the patient journey Piloting and implementing RTLS (Real-time Locating System) Data and future goals 5

Our patient-centered care model To measurably improve the quality of neurological and musculoskeletal health by leveraging teamwork, information technology and innovation. 6

William Jiranek, MD Orthopaedics 7 Kevin Hoover, MD, PhD Radiology

John Duval (Former CEO) 8

Patient-friendly experience Arthritis Multidisciplinary care based on symptoms and diagnosis Standardized care validated by patient outcome metrics Pain Management Optimization Wellness Radiology PT/OT Gait Lab Diagnostic Lab Sports Spine Proximity and shared resources Neurological 9

Mary Anne Rutledge: Nurse Manager Sherry (Savitri) Gopaul: Clinical Coordinator Victoria Sulanke: Clinical Coordinator Bruce Mathern, MD Neurosurgery Michael Vasell, Administration 10

Agenda N.O.W. patient-centered care model Identifying the tools Mapping the patient journey Piloting and implementing RTLS (Real-time Locating System) Data and future goals 11

Tools Self-rooming and on stage/off stage Real-Time Locating System (RTLS) Outcome assessment (Promis) 12

Standard Ambulatory Clinic 13

Self-Rooming Ambulatory Clinic 14

Self-Rooming Ambulatory Clinic 15

Interactive True or False Question Are patients reluctant to wear the RTLS badge? A. Yes B. No 16

Self-rooming Fewer waiting rooms More exam rooms More privacy Virginia Mason/Swedish Hospital/Sanford Health 17

On stage Off stage Courtesy of 18

12 Belle Isle 12 Brown s Island 1 Belle Isle Sub Waiting Area 1 Brown s Island Sub Waiting Area 3 Staff Lounge 4 Tuckahoe Island Third Floor 5 Trestle Trail Exam Rooms 5 Chapel Island Exam Rooms 5 Great Shiplock Park Exam Rooms 2 Trestle Trail Sub Waiting Area 2 Pony Pasture Sub Waiting Area 3rd 12 Kanawha Canal Exam Rooms 12 Robious Landing Exam Rooms 4 Riverview Rookery EEG Exam Rooms 1 Kanawha Canal Sub Waiting Area 4 Robious Landing Sub Waiting Area 3 Staff Lounge 3 Elevator Lobby Fourth Floor 39 Exam 3 Staff Lounge 25 Corridor 7 Louise Burke Exam Rooms 7 Williams Island Exam Rooms 2 Louise Burke Sub Waiting Area 2 Williams Island Sub Waiting Area 4th 88,000 ft 2 clinical and support space 43 Exam 28 Corridor 3 Staff Lounge 9 Sub Waiting & Lobby 19

RTLS Infrared: requires visual path (e.g. television remote and TV); expensive Wi-Fi: large and expensive badges; expensive Ultra-Wide Band: most precise to cm (e.g. Amazon warehouses) Passive RFID: readers required ~ every 15 feet (e.g. library) Bluetooth: false positives 20

Infrared (IR) emitted from diodes on badge: every three seconds when moving every two minutes when stationary Radiofrequency ID (RFID) emitted every two minutes IR 21 RFID

RTLS Use RTLS (Versus) Live supporting operations in real-time Periodic KPI (e.g. wait times) Ad hoc PI projects Room allocation tool distribution of rooms by physician need http://www.himssconference.org/event.aspx?it emnumber=36302 Dana Farber Cancer Center 22

Agenda N.O.W. patient-centered care model Identifying the tools Mapping the patient journey Piloting and implementing RTLS (Real-time Locating System) Data and future goals 23

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25 https://drdollah.com/

Action Definition Patient Arrival Patient is registered Patient has room Patient Enters the Patient enters an Staff enters the RN enters the NP (BT 36) or PA (37) NP (BT 36) or PA (37) Staff exits the Physician enters the Physician exits Staff enters the Staff changes Staff exits the Patient enters lab Patient Enters Lab Patient exits lab Patient enters Patient Enters Patient exits Patient Enters Patient enters Patient Exits Patient Enters Patient Enters Patient Enters Patient Exits Neuro- Patient Enters Patient Exits Bone Patient Enters Patient Exits EMG Patient Enters Patient Exits Patient Enters Neuro Patient Exits Neuro Patient Exits Patient Enters Patient Exits Patient Enters Clinical Patient Exits Clinical Patient returns to room Patient exits the Patient 's Badge MA is in the room for Message recevied via in Versus (Badge reserved for them by Sub-Waiting Room Exam room and is exam room and is exam room and is enters the exam room exits the exam room and exam room and exam room and is the exam room exam room color of room exam room and waiting and is seen in and is seen for 30 and is seen Imaging Waiting Imaging and is Imaging and is Rehab Waiting and Rehab Services Rehab Services Diagnostic Diagnostic Area Neuro Opthalmic Opthalmic Exam and Bone Dilatometry Dilatometry and is EMG and is seen and is seen out of EEG and is seen EEG and is seen Psychology and is seen Psychology and is Diagnostic Area and Infusion and is seen in Infusion and is seen Research and is seen Research and is seen from other areas (if exam room and is is deposited in 15 seconds, presses HL7 Utility or Interface) registration / PAR Location Filter and in room for 30 in room for 30 in room for 30 for 30 seconds. (APP is out of room for 30 is in room for 30 present for 30 and is out of and is in room to Purple to is in room for the area for 30 seconds seconds outside the seen for 30 seen outside the is seen in the area and is seen in the and seen out of Waiting and is and is seen in Exam and is seen in is seen out of the and is seen in the seen out of the in the area for 30 the area for 30 in the area for out of the area in the area for 30 seen out of the area is seen out of the the area for 30 out of the area for in the area for 30 out of the area for 30 necessary) out of room for 30 Drop Box Remote Station button and patient badge is is in the location for seconds seconds - staff seconds stands for Advanced seconds (APP stands for seconds seconds room for 30 for 30 seconds -HOLD room 30 seconds (discharge from MSK area or 30 seconds area or 30 for 30 seconds area for 30 the area for 30 seen in the area the area for 30 the area for 30 area for 30 seconds. area for 30 seconds area for 30 seconds seconds. 30 seconds for 30 seconds. seconds for 30 seconds. area for 30 seconds. seconds 30 seconds. seconds seconds. seconds. on to signify the room seen by sensory 10 seconds types included in Practice Professional - Advanced Practice seconds staff types while patient upon entrance in seconds seconds seconds seconds for 30 seconds seconds seconds seconds. is clean. network. Flow Manager there is no distinct badge Professional - there is no included in tranists to Primary Care Waiting) role. LPN, MA and types for this role, it is distinct badge types for Flow Manager others areas RN badge type. incorporating both PA this role, it is role. LPN, MA and back and NP badge types) incorporating both PA and RN badge and NP badge types) type. Processes Arrival To Exam Room Arrival to Exam Room Appt to Exam Appt. to Exam Exam Prep Exam Prep Staff Exam Staff Exam Arrival to RN Arrival to RN APP Exam APP Exam Arrival to Provider Arrival to Provider Appt to Provider Appt to Provider Exam to Provider Exam Door to Provider Provider Exam Provider Exam Exam Follow-up Exam Follow-up Patient Room Time Patient Room Time Arrival to Lab Arrival to Lab Lab Lab Arrival to Radiology Arrival to Imaging Radiology Img Proc Arrival to Rehab Arrival to Rehab Services Rehab Rehab Serv Arrival to Diagnostics Arrival to Diagnostic Services Diagnostics Diagnostic Services Arrival to Neuro Opth Neuro-Opthalmic Arrival to Neuro Opth Neuro-Opthalmic Arrival to Bone Dilatometry Bone Dilatometry Arrival to EMG Arrival to Bone Dilatomery Arrival to EMG Bone Dilatometry Duration EMG Duration EMG Duration Arrival to EEG Arrival to EEG EEG EEG Arrival to Neuro Psychology Neuro-Psychology Arrival to Neuro Psychology Neuro Psychology Duration Arrival to Infusion Arrival to Infusion Infusion Infusion Duration Arrival to Clinical Research Arrival to Clinical Research Clinical Research Clinical Research Room Length of Stay Room Length of Stay Room Length of Stay (if exam room was held thorugh any of these additional care services) Room Length of Stay Overall Length of Stay Visit Length Of Stay Overall Length of Stay Visit Length Of Stay 26

Agenda N.O.W. patient-centered care model Identifying the tools Mapping the patient journey Piloting and implementing RTLS (Real-time Locating System) Data and future goals 27

Radiology X-ray * * Stony Point Multidisciplinary Clinic 28 Orthopaedics

N.O.W. Center Stony Point Pilot (no HIS interfaces) 29

Stony Point RTLS Pilot Plug and play wireless Sensors mapped in existing clinic No HIS interfaces Helped define basic workflow How to wear the badge Store in badge cabinet Clean with isopropyl alcohol Language 30

Interactive Multiple Choice Question What is the most common question asked about RTLS? A. Does this improve my visit? B. Who sees the data? C. Do you see in the bathroom? D. Why wear a badge? 31

N.O.W. RTLS Integrated with Construction X-ray X-ray 32

Radiology Shared registration 33

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Floor plan view List view 35

Please use blank slide if more space is required for charts, graphs, etc. To remove background graphics, right click on selected slide, choose Format Background and check Hide background graphics. 36

Please use blank slide if more space is required for charts, graphs, etc. To remove background graphics, right click on selected slide, choose Format Background and check Hide background graphics. 37

Look at those belly timers! 38

Interactive Multiple Choice Question Which statement about RTLS is false? A. Displays LAST name B. Badge detected by sensors C. Patients can decline badge D. Badge triggers visual cues 39

Agenda N.O.W. patient-centered care model Identifying the tools Mapping the patient journey Piloting and implementing RTLS (Real-time Locating System) Data and future goals 40

Periodic and ad hoc Initial KPI focus on patient satisfaction: Overall length of stay (OLOS): badge assigned to deposited Wait time: sub-wait or prior to time in exam room with clinical staff Time alone: time alone once in room Focus on Orthopaedics and Radiology 41

Stony Point (SP) Versus NOW Location OLOS Minutes Group Statistics N Mean Std. Deviation Std. Error Mean NOW 634 70.369 32.954 1.309 SP 441 79.092 40.062 1.908 42

Stony Point (SP) Versus NOW Location WaitMinutes Group Statistics N Mean Std. Deviation Std. Error Mean NOW 633 15.596 18.106 0.720 SP 397 18.652 18.431 0.925 43

Stony Point (SP) Versus NOW Location AloneMin Group Statistics N Mean Std. Deviation Std. Error Mean NOW 602 18.85797 15.242188 0.621225 SP 345 20.79333 15.793077 0.850271 44

Combined post-op x-ray visit scheduling Combined N Mean Std. Deviation Std. Error Mean appt OLOS min Yes 9 41 13.8 4.6 No 8 42.5 16.3 5.8 45

Time spent in Radiology Location Duration Minutes Group Statistics N 46 Mean Std. Deviation Std. Error Mean NOW 266 8.213 5.720 0.351 SP 135 12.767 6.857 0.590

Challenges Off the shelf reporting practical only for drilling down on individual patients. Process analysis requires visualizing ALL of the data Current process: Daily (12 AM) data transfer to SQL server Tableau used to manipulate based on: Actions Processes Intervals 47

48 Courtesy Vimal Mishra, MD

Learning Objectives Compare the function of patient self-rooming to the standard waiting room model in an ambulatory care facility Compare the implementation of a RTLS in a preexisting clinic and a newly constructed ambulatory clinic Describe how RTLS can be used by staff at the point of care Recognize standard measures acquired with RTLS Appraise RTLS data to target processes in need of quality improvement 49

Our patient-centered care model To measurably improve the quality of neurological and musculoskeletal health by leveraging teamwork, information technology and innovation. 50

The Neuroscience, Orthopaedic and Wellness (N.O.W.) Center Patient-friendly experience Multidisciplinary care based on symptoms and diagnosis Standardize care validated by patient outcome metrics Proximity and shared resources 51

Questions Kevin.Hoover@vcuhealth.org https://www.linkedin.com/in/kevin-hoover-74772a3b/ https://vcuhealthnowcenter.org/ Please complete online session evaluation! 52