Real-time Location System (RTLS) Asset Management at

University of California San Francisco Medical Center

A Case Study: Efficiently tracking the location, status and movement of the

hospital’s mobile medical equipment

Presented by Jim Barnes, Director of OR Support Staff

Facts & Figures •   In top 10 of nation's academic medical centers •   General acute care hospitals include Mount Zion, Moffitt-

Long Hospitals, UC Ambulatory Surgery Center, UCSF Children’s Hospital and The Orthopedic Institute

•   Campus occupies approximately 24 acres •   ~750 inpatient beds, 47 operating rooms,1.75 million sq. ft •   5,500 employees and an operating budget ~ $1.7 billion

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Why a Real-time Location System? •   UCSF Medical Center is dedicated to:

–   Highest-quality, patient-centered care –   Humanistic, cost-effective health services –   A supportive work environment to recruit and retain the

best people •   We believe RTLS helps support our values by

–   Supporting efficiency and cost control –   Increasing patient, surgeon and staff satisfaction –   Assuring right equipment, right place, right time

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RTLS Vendor Evaluation Process •   6 in-depth proposals presented representing

numerous technologies; narrowed to 2 •   On-site proof of concept demonstrating use cases

of 9 different scenarios, including: –   non-disruptive installation during normal daily activities –   tracking equipment at multiple locations across 1.5 miles –   locating assets placed deep in metal storage carts within

surrounding electronics –   proving the accuracy of the location –   proving the self-healing, self-calibrating network

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RTLS Contracted Awarded: 2007 •   Awarded to San Diego-based

Awarepoint –   ZigBee sensor network needs no

hardwiring –   Wireless sensors simply plug into

electrical outlets to form network –   Small, battery-powered tags are securely

attached to assets –   Assets tracked and managed using the

web-based software, alerting and reporting tools

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RTLS Project History •   Began in late 2007 •   1,000 high value OR assets tagged

including mobile PCs, transport monitors, GlideScopes

•   Network installation took only 4 days to complete

•   Within first weekend, 700 assets tagged, with remaining 300 tagged following weekend

Initial Value Drivers for RTLS •   Meet regulatory requirements

necessitating halls be kept clear of equipment

•   Equipment storage facility 2 miles from the main hospital –   Staff reluctant to send equipment to

storage without tracking system

•   Equipment (especially anesthesia) often travels between 15 floors and multiple buildings

Additional Operating Room Benefits •   Need for OR equipment to be reliably

retrievable within minutes including weekend and after hours shifts

•   Eliminate long delays looking for high-use items

•   Ability to rapidly find difficult intubation carts and other urgently needed items greatly enhanced

•   Clinical Engineering able to identify maintenance issues proactively

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The OR Need for Asset Management •   Multiple OR technicians used to go room to room at least

five times daily to find equipment needed for another room •   OR nurses lend equipment to other units, and equipment

gets left behind •   Surgeons walk off with equipment (e.g., headlights and the

light source) •   Even within the OR, equipment storage is decentralized

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0

1000

2000

3000

4000

5000

6000

Jan Feb Mar Apr May Jun

3526 3571

4636 5043

Search Trend - Last 4 Months

Reflects total searches throughout facility.

24% are specific to OR Staff

Our RTLS Search Trends: Last 4 Months

OR Staff Time Savings Total Searches

Q1 24% Specific to OR Staff

Minutes Saved per Search

Total Hours Saved Q1

Equivalent FTE Benefit

11,733 2,815 25 minutes 1,173 2.44

•   Main responsibility of operating room technicians is preparation of the OR suites

•   Starting cases on time is important from both an efficiency and patient safety perspective

•   Mobile devices such as GlideScopes, transport monitors and computers on wheels (COWs) are especially difficult to track as they travel with patients and are borrowed by other departments

•   RTLS provides search efficiency equating to staff time savings to better accomplish these tasks

Departmental Satisfaction •   Frustration with locating equipment in OR runs deep

–   Impacts surgeon and nurse dissatisfaction and ultimately rests with OR techs

–   Prior to RTLS, when equipment was missing, OR technicians were unable to gauge time it would take to locate (might be down the hall or on the 10th floor and could take hours to locate)

•   With RTLS, OR techs can see exact location and travel to equipment’s specific location, saving time and eliminating frustration

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Capital Redundancy: $ Savings •   Some pieces of OR equipment on preference cards

are “show stoppers” (without equipment case cannot start)

•   Finding what you need when you need it is imperative

•   Administrators typically purchase excess inventory to ensure a sufficient supply - these redundant inventory costs can be significant

•   Now have tools to track the OR equipment and observe usage

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Equipment Replacement Costs Avoided

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2008 Equipment Description

Average Cost Per Unit

Total Quantity Avoided

Avoided Replacement Cost

Transport Monitors $28,000 6 $168,000

GlideScope $20,000 4 $ 80,000 2008 Total Replacement Cost Avoided $248,000*

* Replacement cost savings repurposed to purchase latest equipment; e.g., upgraded Stryker Towers to HD video recording and monitors

Expanded Use: 2008 - 2010 •   Following success in OR, hospital-wide expansion

to 7,750 assets tagged and multiple campuses •   Steering committee now includes original OR and

Materials Management teams plus Clinical Engineering, Nursing, Food and Nutrition, Maintenance and Facilities Managers

•   Assets now include campus-wide high value items and temperature monitoring tags

Clinical Engineering Assets Requested

•  GE PDM Modules •  Transport Monitors •  Dialysis Machines •  Prisma Flex Dialysis •  Arctic Sun Hypo-hyperthermia •  Infant Incubators •  Infant Warmers •  Feeding Pumps

•  Medfusion Syringe Pumps •  Pulse Oximeters •  Pace Makers •  Defibrillators •  Sequential Compression Devices •  Blood Warmers •  Suction Pumps

Additional Campus-Wide Asset Categories

•  Anesthesia Carts & Machines •  Anspach Foot Pedals •  Beds / Cribs •  Bi Polar Systems •  Blanket Warmers •  CADD Legacy •  Electrosurgical : Force Fx •  Freezers / Refrigerators •  GlideScope and Towers •  Glucometers/HemoCues

•  Head Lights •  Hotline Warmers •  Instrument Tables •  Mobile PCs •  Specialty Carts / Video Carts •  Spectralink Phones •  Surgical Tables •  Ultrasounds •  Wheelchairs

Additional Opportunities to Maximize Savings

Next Steps •   Rentals

–   Review Rental Contract •   Utilization

–   Set Up Region Types on new maps for utilization and par levels

–   Idle alerts •   Shrinkage

–   Create Exit zones and alerts –   Missing alerts and workflow

•   Stationary Assets –   Several dozen items haven’t moved in over 30 days –   Should we take them out of service or reintroduce them?

Questions? Jim Barnes Manager, Operating Room Support Staff UCSF Medical Center James.Barnes@ucsfmedctr.org

James Barnes has 35 years’ experience working in hospitals and has been a Manager/Director for 25 of those. His vast hospital experience includes directing/managing multiple departments including SPD, Materials Management and the OR. Barnes was recruited by UCSF nearly 10 years ago for his current position of Manager, OR Support Staff. His responsibilities include the staff and budget for the Anesthesia Workroom, Equipment Technicians, and the patient care assistants. Previously, he spent 15 years working in several hospitals in San Diego. He has a Masters degree in Organizational Management from the University of Phoenix.