Implementation of a RFid Solution to Track Medical Devices. L. Michael Fraai, M.S., CCE Director, Biomedical Engineering Brigham and Women s Hospital

Transcription

1 Implementation of a RFid Solution to Track Medical Devices L. Michael Fraai, M.S., CCE Director, Biomedical Engineering Brigham and Women s Hospital

2 Objectives Technology evaluation Process to develop an ROI model for this technology Pilot decision and results Lessons learned

3 Brigham and Women s Hospital 777 Licensed beds 146 ICU beds 489 Telemetry beds 43 Operating rooms

4 Brigham & Women s Hospital BWH employs more than 12,000 people; 3,000 physicians, fellows and residents; more than 1,000 researchers; and 2,800 nurses Inpatient admissions totaled approximately 44,000 in 2009 The Emergency Department treated 54,000 patients in 2009 In 2008, Shapiro Cardiovascular Center opened which now combines Cardiovascular Medicine, Cardiac Surgery and Vascular Surgery in one location In 2009, BWH performed the nation's 2nd successful face transplant BWH has ~19,000 patient care devices in the Biomed inventory

5 Tracking System + + =

6 Business Problem Patient Care Equipment inventory shrinkage ( loss ) and rental is estimated at $420K per annum Inefficiency due to time spent looking for equipment Potential delays in admission, care and/or reduction of time with the patient Diversion (Impact) Inability to locate equipment leads to hoarding and stashing of costly assets which lowers utilization rates or use of other more expensive technologies in place of more cost efficient items For example a portable monitor instead of a telemetry unit

7 Business Problem Budgetary pressures both capital and operational Case Mix Index (CMI) and the need for real-time availability of assets Space constraints Virtual storage use Admission process and diversion Evolving care models across units

8 Qualitative Problem Negative impact on employee (quality of work life) and patient satisfaction Hospital survey results Time employees spend looking for patient care technology Outcome of the Hospital s Safety walk rounds I can t find devices to take care of my patients There is not enough of this syndrome IV Pumps Portable monitors Telemetry transmitters Pacers

9 Analysis Process Multi-disciplinary team Established goals Metrics Technology assessment Developed a potential ROI Pilot hypothesis and technology acceptance

10 The Team Biomedical Engineering IS Nursing Administration Executive sponsors and funding ($) Other adhoc members: Value analysis Materials Management/Contract Security

11 The Goals Define mutually acceptable project goals up front to avoid project creep What is the hospital trying to achieve? Loss prevention Rental reduction Theft deterrent Quality of work life improvement Workflow improvement

12 Project Metrics Metric Method Loss Rate Application use Alarm Activation Alarm notification and retrieval Establish baseline inventory at start, and measure asset loss at predetermined intervals Use a counter within the application to determine frequency of use Determine frequency of alarm activation upon defined portal exists Determine frequency of alarm notification and successful return of asset to the area of use

13 Technology Analysis Criteria Matrix Which criteria are important for our institution? Spectrum Use Other wireless systems Resolution Need

14 Criteria Matrix Cost of Project with desired resolution Company Size/Profile Maintenance Cost Battery life and cost/tag Compatible with BWH wireless infrastructure Scalable Infrastructure Architecture Compatible with IS infrastructure

15 Spectrum Management Technology Basics: Where the Waves Are VHF Band MHz Everyone is moving out Locators WMTS Band MHz Philips M2600 GE Apex SpaceLabs etc. WMTS Band MHz MHz?????? ISM Band MHz Frequency in MHz UHF Band MHz Philips M2600 SpaceLabs Most are moving out. ISM Band MHz MDE ISM Band MHz Philips M3/M4 GE Dash Protocol MicroPaq SpaceLabs etc. khz = 1,000 Hz MHz = 1000 khz GHz = 1000 MHz From: Michael Dempsey

16 A Hospital Floor..

17 Resolution Need What is the resolution need vs. cost? What are the assets being tracked with respect to the resolution? Refresh rate, Active vs. Passive systems

18 The ROI Analysis Define what will be accomplished / tracked How will you achieve the cost benefit? Hard ROI Saving or expense prevention Capital expenditure, rental reduction Cost center effect Soft ROI Saving on qualitative measures Improved staff and operation efficiency, delay reduction, reduce diversion, quality of work life improvement

19 ROI Analysis & Savings Targets Before pilot: 23 pacers (Inventory: 80) 40 transmitters (Inventory: 326) In 2010 replaced ~10% of telemetry transmitters due to misplacements Currently not renting IV pumps but pressure for IV pump availability Note: Does not include wheelchairs and other equipment that could be tracked with full hospital rollout.

20 The Pilot Decision Early technology stage Technology maturity Company profiles? Standards? Other solutions that were tried? Manual process improvement Hawthorne effect Developed a pilot to test the concept, hypothesis and technology

21 The Pilot

22 Pilot Tested a limited number of devices High loss Used in a defined geography 3 floors and one OR service (Cardiac) Later learned that alerts were important to users

23 Pilot Assets Transmitter 12-lead ECG Cable Pacer Potential operations compromise Patient Data Compromise in operations (Lots) Horizontal movement tracking Revenue ($) Vertical movement tracking

24 Asset Movement

25 Pilot Results

26 Use of System Application Use Average/Week Average Use/Week Week

27 Pilot Results Item Total number in use Cost Historical loss rate/year Target loss rate/year Pilot loss rate Target Savings Pilot Savings Yearly Savings (Extrapolated) Transmitters 77 $ 1, $ 11, $ 8, $ 8, Pacers 32 $ 4, $ 44, $ 52, $ 52, lead cables 20 $ $ 5, $ 5, $ 5, Total $ 60, $ 66, $ 66, Pilot Cost Cost Installation Cost $ 80, FTE for trial $ 7,680 Total $ 87,680 Additional benefits: Regulatory compliance (SMs, etc) Quality of work life for location of Pacers Productivity tool Note: Consistent loss rate! This is a tool for a process

28 Product Decision Model Quantitative Measures Device Estimated Cost Quantity Cost/Device Wheelchair $ $ 5,660 Transmitter $ 1, $ 937 IV Pump $ 3, $ 379 Monitor (Portable) $ 19, $ 79 Cost/sq. ft $ 3 ROI Model Qualitative Measures Quality of work life improvement Improved staff efficiency

29 ROI Analysis & Expected Results

30 Item Total number in Cost/Unit Current loss rate Annual Cost of Current Loss Target Loss Rate Potential Annual Savings use % Rate % Transmitters 227 $ 1,600 9% $ 32,000 0% $ 32,000 Pacers 99 $ 4,400 36% $ 158,400 50% $ 136, lead cables 88 $ % $ 26,400 90% $ 24,000 Defibrillators 146 $ 9,520 1% $ 9,520 0% $ 9,520 Monitors 18 $ 13,310 6% $ 13,310 0% $ 13, $ 239,630 $ 215,230 IV Pump $50/mo x 12 months 300 $ 600 $ 180,000 50% $ 90,000 Total 878 $ 419,630 $ 305,230 Investment Application, Installation and IS Cost $ 1,499,774 Operational Cost Annual Cost Software Maintenance Cost $ 26,400 Administrative Dbase Support Person (with Benefits - 28%) $ 51,200 Yearly Tag Replacement (2%) 120 $ 3,600 Total $ 81,200

31 Lessons Learned

32 Lessons Learned Get buy-in upfront Commitment from the customers and hospital! Ongoing process over time! Inevitable changes that will have to be implemented IS closet work to accommodate additional cabling or switch blades Contingency expenses Example: Renovation work which requires re-configuration Beepers Additional receiver for alarm change configuration

33 Lessons Learned Results are actionable items How will a tracking system improve the hospital s operation? Who will track and retrieve the located assets? Who will monitor the reports?

34 Lessons Learned Tag size and placement Infection control Support while in clinical use Devices are getting smaller and lighter Does take resources to complete this project!! Long-term support for battery replacement processes Long term support for tag association for additional device support Software maintenance for upgrades & new functionality testing

35 Alarm Configuration - Before

36 Alarm Configuration - After Will add coverage in the soiled utility room

37 Changes in Accountability Culture Changes Data for analysis Collaborative effort Nursing Biomedical Engineering IS Support staff to accept and use the technology It s not my job syndrome It is not my responsibility How to present the changes and solution

38 Training Develop the training content based on the audience that will use the technology Not everyone is computer savvy Combine didactic and computer based training tools Develop tools to sustain the training and provide for Just in Time training. Train on effective use of the technology features Device names! Location names!!! Train on obtaining the necessary system reports BME Support How to use it? How to answer questions? Tag associations and process Battery changes

39 An Update Scaled to entire hospital; across 2 buildings and third building is being completed Training Use of super users More involvement of front line staff Used system for new building device re-deployment effort which was successful Device names, location names and running reports (favorites)!!! Increased use of the system by satisfied users. Have to do a follow up to ensure we are meeting our project goals

40 Summary System can be used as an enabler with associated process changes System can be used as a tool to track mobile and portable devices ROI can be achieved with process changes and accountability and have to be sustained System is a tool to achieve efficiency Implementation requires a multi-disciplinary approach System can also help with : Compliance with regulatory agencies JCAHO inspection to locate devices Minimize potential admission delays Minimize potential patient care delays due to portable equipment unavailability

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