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Using RTLS Data to Increase Ambulatory Care Capacity

Session 53, February 12, 2019

Rodney L. Haas, VP Operations Excellence

University of Minnesota Physicians

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Rodney Haas, BS Mechanical Engineering

Has no real or apparent conflicts of interest to report.

Conflict of Interest

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• Overview of M-Health

• Real-Time Location System (RTLS) System Overview

• RTLS Case Studies

Agenda

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• Learning Objective 1: Describe how RTLS technology can be leveraged to improve patient and care team experiences

• Learning Objective 2: Initiate organizational change by engaging care teams with data

• Learning Objective 3: Create an environment of continuous process improvement

Learning Objectives

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Vision:

• Innovative health care model implemented by interprofessional teams

• Patient experience extraordinary care and exceptional outcomes

• Education and research missions flourish

University of Minnesota Health Clinics and Surgery Center

The Facility:

• 342,000 square foot

• 37 Adult Specialties

• Masonic Cancer Clinic &

Advance Treatment Center

• Lab, Imaging & Diagnostic

Services

• Retail Pharmacy

• Ambulatory Surgery and

Procedure Center

• Full Service Café

• Three-Story Staff Lounge

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• Maximize space (from 300 exam rooms to 178)

• Providers do not own space: flexible usage based on volume

• Only one waiting room per floor

• Patients are greeted by name

• No one waits more that 15 minutes past their appointment

Redesign the Delivery of Care

• 2,500 Unique Patient Appointments per day

• 1,500 staff members practicing at any time

• 10+ percent (%) growth per year since opening in 2016

RTLS supported the

design of the building with:

• Exam Rooms: 122 less exam

rooms

• Clinic Growth: 2016 > 2018 =

19% increase

RTLS supported the

design of the building with:

• Exam Rooms: 122 less exam

rooms

• Clinic Growth: 2016 > 2018 =

19% increase

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Care Connect (RTLS)

xxx

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Active Practice Management

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Patient & Staff Experience

Connecting with the Patient• Patient concierge and rooming staff

locates the patient using the RTLS

display and photo in Epic Cadence

• Greets the patient by name, informs

them about their visit, and escorts the

patient to the exam room.

Wait Time Management• If a patient is in the Waiting Room 15 min past their appointment time or in an Exam Room alone

for longer than 10 minutes, a popup will display at the Concierge Tablet

• If a patient is in the exam room and an alone time pop up occurs, the pop up is cleared by proximity

of a staff or provider badge

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Patient & Staff ExperienceBackground

1. RTLS data identified check-out portion of visit as a major source of wait time for Primary Care and

Urology clinics.

2. Frustrated patients skipped the check-out process, resulting in many critical follow-up appointments

not scheduled in timely manner.Solution

1. Create a separate fast-track process (“Express Check-Out”) for patients with three or fewer follow-

up appointments.

2. Warm hand-off of patients between clinic staff and check-out staff

3. Patients who require complex check-out receive close monitoring on RTLS track board and

frequent update. Complex check-out patients do not become bottleneck points of the process.

% of pts who have all follow-up appointments scheduled prior to departure: 71% 93%

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Active Practice Management

Move from reactive problem

solving to anticipation of

issues

Manage Space & Flow• No assigned provider rooms

• “First Room Up”

• Patients taken to available rooms

(green)

Providers use the RTLS

status boards to:• Know exactly where to go

• Monitor how long patients visit and

experience

• Locate other care team members

and equipment

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Active Practice Management

Providers use the RTLS

status boards to:• Know exactly where to go

• Monitor how long patients visit and

experience

• Locate other care team members

and equipment

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Results

Results

• Improve patient flow and

reduce wait times.

• Provide real-time data

about patient visits (ie.

room status, wait and

alone time alerts,

physician assist).

• Improve

communication and

coordination among

providers, staff, and

operation management.

RTLS has allowed us to better utilize

space while growing specialties:

• Utilization: 2016 > 2018 = 4% increase (36% to 40%)

• Clinic Growth: 2016 > 2018 = 19% increase

RTLS has allowed us to better utilize

space while growing specialties:

• Utilization: 2016 > 2018 = 4% increase (36% to 40%)

• Clinic Growth: 2016 > 2018 = 19% increase

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Quality & Safety RTLS support the clinic staff by:

• Being able to understand the exposure risk in hours vs

weeks

• Communication with Staff and Patients on level of exposure

risk

• Locate the patient and minimize the risk of exposing others

RTLS support the clinic staff by:

• Being able to understand the exposure risk in hours vs

weeks

• Communication with Staff and Patients on level of exposure

risk

• Locate the patient and minimize the risk of exposing others

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Continuous Improvement

RTLS supports Quality &

Process Improvement

Activities

• Increases data sample size

• Decreases time to collect data

RTLS does not replace

Process Improvement

Activities

• Go & See / Time Study

• Value Stream & Process Mapping

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Using RTLS Data to build comprehensive simulation models (Probability “Monte Carlo” Simulation)

What would happen if we change

the current scheduling structure?

Current Structure Split Structure

Simulation Model

loaded with RTLS data

Potential Outcomes

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Using RTLS data to manage space utilization and patient experience

Balanced

Approach

Balanced

Approach

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RTLS enables more complete process analysis

Significantly bigger

sample size compared

to manual data

collection

This is just one clinic for 6 months!

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RTLS data enables individual monitoring and customized solutions

Prompted the conversations with Dr. “M” and adjustments of scheduling

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RTLS data enables us to identify true root causes and optimal solutions

A clinic argued delays in the laboratory were causing patients to arrive after scheduled clinic

appointment time, disrupting provider schedules.

The clinic proposed to schedule lab appointment 2 hours (instead of 1 hour) prior to clinic

appointment to mitigate lab delays.

Patient 1: No lab prior to the clinic appointment. Arrived at CSC and 3rd FL on time

Patient 2: 5 minutes wait at Lab. Patient arrived at CSC 1 hour late.

Patient 3: 1 minute wait at Lab. Patient arrived in CSC only 12 minutes prior to the Clinic appointment

time. Still arrived at 3rd FL on time.

Patient 4: No lab prior to the clinic appointment. Pt. arrived at CSC only 2 minutes prior to the clinic

appointment.

Patient 5: No lab prior to the clinic appointment. Arrived at CSC and 3rd FL on time

Patient 6: No lab prior to the clinic appointment. Pt. arrived at CSC only 1 minutes prior to the clinic

appointment.

Patient 7: 1 minute wait at Lab. Patient had another appointment in 3 D&T. Still arrived at the clinic on

time

Patient 8: No lab prior to the clinic appointment. Arrived at CSC and 3rd FL on time

Patient 9: 4 minute wait at Lab. Arrived at CSC and 3rd FL on time

Patient 10: 13 minute wait at Lab. Patient could have arrived at 3rd FL on time, but for some reason, the

patient spent 21 minutes in cafeteria, arrived at clinic 26 minutes late .

Analysis of 500 patients

with significant clinic

wait time revealed that

the proposed solution

would be a very costly

one without much

impact

On average, 74 pts/day require lab prior to cardiology appointment:

74 hours of unnecessary pt. waiting, staff resources, space avoided!

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Continuous Improvement

RTLS – is key

tool in the

continuous

improvement

journey

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• Rodney L. Haas

• rhaas@umphysicians.umn.edu

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