1. Michelin, Cindy
  2. Michelin, David MD, MPH

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When patients arrive at the Cowell Family Cancer Center in Traverse City, Mich., they are asked to wear a small, plastic badge with a push button. Inevitably, they immediately ask: "Why do I have to wear this thing?" We are glad they challenge us, as the query often prompts a conversation around the use of the badge and the benefits associated with it.

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To start the dialogue, we provide an overview of what the badge actually is and how it works. We explain that by transmitting signals to our real-time locating system (RTLS), the badge, which is also worn by clinicians and staff members, communicates where patients, physicians, and others are located as they move about the clinic. This is especially important in cancer care as patients tend to see a variety of caregivers and receive an array of services spanning over multiple floors. In essence, the RTLS acts as an air traffic control system, monitoring and enhancing the movement and communication of patients and staff members throughout our large facility, which spans three floors and includes more than 30 exam and procedure areas and more than 40 infusion chairs.


We further explain to patients that when they wear the badges, the system identifies when physicians and other staff members are finished with a patient and ready for the next encounter. As a result, staff and physicians know which rooms and chairs are available and which need to be turned over; exactly where the patient is in the treatment process; how long the patient has been in treatment; which clinicians and staff have already seen the patient and who needs to see him next; and the status of lab orders and medications.


The patients' curiosity, however, typically extends beyond the "what" and "how" to the more pertinent "why." More specifically, they want to understand what's in it for them. As a result, we explain the RTLS system can help with the following:


Keep patients safe. Because the badge monitors location, it enables us to immediately know when patients wander into an unauthorized location or leave the building. In addition, if patients are in distress, they can push the button on their badge to send an alert for help. The system immediately notifies staff members-and the patient's needs are quickly met. As such, we are better able to keep patients out of harm's way, a comforting notion for those receiving cancer care in our facility.


Reduce wait times. When patients wear badges, the RTLS can pinpoint exactly where they are and how long they've been waiting and call out patient status-such as "ready to be seen," "with physician," or "in X-ray." The RTLS can also track room status and, therefore, identify where patients and caregivers need to go next. As such, the RTLS helps the patient visit progress at a much faster pace, reducing time spent in the waiting room, as well as non-productive time spent waiting for the next stage of care. The result is more time spent receiving care, less time spent waiting, and a shorter overall length of stay.


Enhance communication. The system also enables us to more effectively communicate with patients. Previously, staff members would not be aware of the fact that at patient was waiting in a room for 30 minutes. Now, even if patients do have to wait for a physician, the system makes it possible for a staff member to be alerted of the excessive wait time and explain the situation putting the patient at ease. For example, a medical assistant could go into the room and explain that the physician is delayed in surgery instead of merely leaving the patient to wonder what is happening.


Improve overall performance. By collecting real time data and then analyzing it, we can identify workflow trends and pinpoint where improvements are needed. With this passively collected data, our administrators can run reports on patient care milestones such as wait time, "door-to-doctor" time, exam or treatment duration, overall length of stay, and more-for any given time frame or for any number of variables, offering a previously unattainable level of business intelligence.


For example, by analyzing the RTLS data, we recently noticed patients were waiting far too long in our infusion clinic. So, we handed this data over to a company that created new scheduling templates, making it possible for us to more efficiently use the infusion chairs. Under the new system, one individual nurse is no longer assigned several difficult treatments in a row. Instead, the workload is more evenly distributed to all nurses, making it possible to more efficiently move patients through the clinic.


Convincing Health Care Professionals

While we have grown accustom to explaining the benefits of RTLS to patients, when we first implemented the system in August 2016, we had to explain the benefits of the solution to all of our physicians and staff members as well.


We gained physician buy-in by making sure the RTLS was helping them with their goal of serving their patients in a timely, uninterrupted, and focused manner. The system helps improve workflow so consult rooms can be optimally utilized. For example, nurses and medical assistants immediately know when a physician has entered into a consult room. As such, the physician does not have to open the door and look for a staff member to help complete the exam, which interrupts his care with the patient.


In addition, because staff members immediately realize when rooms are vacated, the rooms can be cleaned quicker-and physicians can more immediately use the room to treat their next patient. The system also makes it possible for various members of the care team to communicate more effectively. For instance, the RTLS will alert pharmacists when it is time to mix medications, making it possible to ensure that drugs are not prepared early and then discarded because patients are not ready for treatment. This automation not only enhances the delivery time of medications to patients, it is also a cost savings for our facility.


In the final analysis, while patients, physicians, and staff members all seem to initially question the use of the RTLS, they have come to acknowledge its benefits. With this system in place, physicians are finding they can more efficiently see patients, spending more time in care-related activities and less time spinning their wheels trying to locate staff, patients, or supplies. While physicians have not increased the number of patients seen, they have noticed they have been able to spend more time in direct patient care and are able to leave the clinic on time, as they no longer need to work into the evening completing paperwork and other miscellaneous tasks. In addition, nurses, medical assistants, and other staff members also spend more time in patient care and less time on non-value added activities. As a result, we are on our way towards providing better clinical care, while also improving patient, staff, and physician satisfaction.


CINDY MICHELIN is Oncology Business Analytics Coordinator and DAVID MICHELIN, MD, MPH, is Gynecologic Oncologist, both at Cowell Family Cancer Center in Traverse City, Mich.


3 Tips to Gain RTLS Buy-In

Although it's important to let patients, staff, and physicians experience the benefits of RTLS first hand to gain buy-in, here are three tips that could help to improve the process.


1. Rely on a team of super-users. Super-users understand exactly how the RTLS works as well as its many benefits. As such, they are able to elicit support from all staff members.


2. Use the right lingo. Because patients need to be comfortable with using RTLS, it's important to choose your words wisely. If staff members use the wrong vernacular, they could quickly turn patients off. For example, we refrain from calling the RTLS a "tracking" system, as many patients do not want to feel like they are being followed or monitored. Instead, we emphasize the safety and clinical care benefits that emerge when wearing an RTLS badge.


3. Get a physician on your side. It's important to recruit a physician champion from the get-go. As such, the physician can offer a clinical perspective as the implementation team addresses specific RTLS goals that affect the physician's workflow and their care delivery. The physician will be able to communicate these patient-centered goals to peers and outline how they positively impact their work day.