Saving time and money with RTLS

February 05, 2020
by Sean Ruck, Contributing Editor
Judy Travis is the senior director of support services at Texas Health Presbyterian Hospital Dallas, part of the Texas Health Resources system. She’s also a Lean Six Sigma Black Belt, which means when a department’s not working well, Travis often gets called in to fix it.

That was the case in 2017 when she was tapped to assess the RTLS (real time locator system) that was initially deployed in 2009. Six years had passed between its initial deployment and Travis being put in charge of looking into the system’s use and efficacy. The system was intended to save the organization money by optimizing the use of rental equipment and minimizing redundant rentals as well as helping to decrease the need for new equipment purchases. Use of the RTLS system allowed staff to save considerable time spent in searching for critical equipment. At the outset, the RTLS deploy was deemed very successful. It played the usual role of an RTLS, giving staff the ability to know what equipment was on campus, what was in use and what was available.

The system’s early success led to too much of a good thing and scope creep occurred without the requisite “feed and watering” as Travis terms it. The individuals who were part of the initial deployment left for other facilities within Texas Health Resources. The RTLS was handed over to another group who expanded its use to include patient tagging.

By the time Travis was asked to take a look, there was about $300K being spent on the system, but it was largely wasted funds as the system was barely being used and that raised big questions. “I was asked to determine if we keep it, discontinue it, or use it in another fashion,” Travis says.

Travis set about gathering information. She also gathered a few allies for the task. “I pulled in a finance person and another young lady who works very close with me who’s very good at building relationships and seeing the big picture,” she recalls.

She also used tools from her Lean Six Sigma training, with the biggest being brainstorming. To that end, she gathered the house supervisors, who according to Travis, are the nurses basically running everything in the hospital as far as bed and patient movement. She also recruited nurse managers and housekeeping to find out who — if any of them — was using the RTLS and how they were using it. If they weren’t using it, she wanted to find out why they weren’t. Once everyone was gathered for brainstorming and feedback, it was clear there was value in the system. It just needed that feeding and watering.

That meant it had to be looked at to make sure it was working correctly and that its utilization was valid. The investigation was eye-opening. Tags had dead batteries, monitors had dead batteries, meaning those items were offline and had to be found without the help of the system they’re supposed to fuel. In some cases, equipment was mislabeled by tag, meaning the system would indicate one type of asset assigned to a tag, but when a staff member located that asset, it would be something other than what was inventoried. Still other tags were just being put to poor use. Travis gave the example of finding a tag on a television bolted to a wall. And finally, tags were walking out the door — to the tune of $30K over the course of two months — on the wrists of patients.

According to Travis’ research, there were eight or nine thousand tags around the facility with no one going into the system to make use of them. Pushing forward, she developed her plan. It not only required changing of batteries, but also changing of habits and processes.

Travis realized one of the key hurdles was to get everyone on board with using the system right and also making smarter use of tags. The brainstorming and input from potential user groups spanned about seven months. Presentations were made to the CEO, CFO and CNO two or three times, to explain the opportunities for savings that the system could provide if it was made efficient. An inventorying was done. Tag usage was reduced from that 8,000 or 9,000 to about 5,000. And a new department, dubbed the “Mission Control” team, was created. Staffed by eight to 10 full-time employees, the Mission Control team serves as the operational support for an RTLS system. Daily, this team uses the RTLS system to maintain par levels of equipment on each nursing unit, cleaning equipment as necessary.

Travis also made sure that the company behind the organization’s RTLS was aware that they needed to be a partner, not just a provider. Patient tagging was removed and the system was redeployed with asset and staff tagging only. A formal RTLS committee was developed to approve or deny all items tagged. Any new use of tags had to be discussed and justified and then maintained so that the system continued to be streamlined and efficient.

The results of Travis’ work will continue to emerge over the years, but the numbers are promising already. “After we redeployed, we had the finance manager go over the numbers. We were able to have a contribution margin of over $400K. That’s the cost of the system, full-time employee salaries and benefits. That’s our hard savings,” says Travis.