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When New York's historic St. Vincent's hospital filed for bankruptcy in April 2010, it was $1 billion in debt and was losing $10 million every month. St. Vincent's was just one of many New York hospitals facing financial obstacles that could ultimately result in Chapter 11.
U.S. hospitals are under enormous pressure to remain profitable. In 2008, more than 100 New York hospitals combined spent $3 billion more for patient care than they earned. This statistic is not surprising, considering that only three out of 10 patient cases were profitable and Medicare and Medicaid paid only 70 cents per dollar that was spent for patient care.
Hospital executives have been forced to take severe actions to save money and improve efficiency, while reducing staff and support services. But there is a limit on how much a hospital can save by trimming human resources and still achieve high-quality patient care. The questions hospital executives must answer are: How can we do more with less and how can we be more efficient?
 Metrics of Efficiency
In New York hospitals, the average patient stay is 6.6 days. If this average could be scaled down to the national average of 5.5 days, the combined savings, according to the New York Department of Health, would exceed $3 billion.
At the same time, hospitals faced other significant expenses related to the increasing number of costly equipment required for patient care. Because this equipment is mobile, the hospitals often lost track of them and had to rent or buy additional pieces in order to serve patients.
Optimizing asset utilization and decreasing patient wait times are some of the ways hospitals can improve efficiency and throughput. But to make these improvements, hospital executives need a clear picture of the current state of operations and how processes work. They should consider where staff, patients and equipment are at any given time, where bottlenecks exist in patient flow or staff workflow, and if idle equipment in other departments might be utilized more efficiently throughout the facility. Having this type of detailed assessment of current operations for decision-making purposes is feasible with the right technology,
That technology is called a real-time location system (RTLS). Used in hospitals worldwide, RTLS immediately mitigates overstocking of equipment and can provide valuable real-time information from everyday operations. The most popular type of RTLS runs on existing Wi-Fi networks, which are in use at 90 percent of hospitals today as the de facto standard for wireless data and voice connectivity.
The University of Kentucky Medical Center implemented its RTLS system in 2009, targeting improvements in asset management after the annual cost of rental equipment reached $400,000 in 2008. Using RTLS to track 3,000 pieces of mobile medical equipment, facility staff realized that they were needlessly renting additional units. With better visibility into asset utilization, the hospital was able to reduce rental expenses down to $48,000, creating savings of over $350,000 in less than 1 year.
To deploy RTLS over Wi-Fi networks, a hospital only needs to make an investment in RTLS software and wireless tags, which is almost immediately offset by savings in equipment rental or purchase. By using the Wi-Fi access point signals, the system calculates the real-time location of each piece of tagged equipment and person, and provides that information on a floor plan maps, creates reports on asset utilization and workflows, triggers alarms and sends messages and work orders.
RTLS has been around since late 1990s. But it was only in 2002, when the first Wi-Fi-based RTLS system was introduced, that this market began on its growth trajectory. Before that innovation, RTLS was a complicated and cost-prohibitive technology to install, with wireless antennas and hardware installations in every room. Using the existing Wi-Fi network eliminated the need for proprietary RTLS infrastructure, which dramatically reduced the cost of RTLS, enabled a fast, positive ROI and reduced installation times from months to just few weeks. What was needed was simply the RTLS tags and software, which used highly sophisticated location algorithms, to achieve a pinpoint accuracy using the existing Wi-Fi network.
Building on Existing Technology Infrastructure
Because Wi-Fi is already used for clinical data transmission and voice over IP calls, it has a secured coverage enterprisewide. Vendors promoting solutions that do not use Wi-Fi technology often claim that adding thousands of tags to the existing network can bring down the hospital's critical communication backbone. However, that myth has been debunked by hospitals running Wi-Fi RTLS systems with tens of thousands of tags that have experienced no adverse impact on their wireless connectivity.
While Wi-Fi-based RTLS is the most elegant and least expensive solution, there are ways that it can be improved. Because location is determined by the signal strength between the Wi-Fi tag and access point, this solution sometimes cannot easily determine the difference between the location of a particular hospital bed or the bed next to it, nor can it detect a paper thin wall or curtains.
The most practical solution to enable this "micro-zone" detection accuracy is to use an inexpensive assisting technology, such as infrared (IR) light. For example, Wi-Fi wristband tags also could use an IR detector that detects an IR transmitter installed above the bed, enabling the system to wirelessly report that a patient is in her bed.
Micro-zone location detection using IR also can be used to detect how often staff members are washing their hands in order to decrease hospital acquired infections. If the physician is entering the patient room and has not been detected washing his hands, the Wi-Fi badge hanging from his neck will beep and display the message: "Wash your hands!"
Looking Ahead
In the hospital of the future, RTLS will enable real-time dashboards with information about key processes. With RTLS, hospital management will be able to quickly assess bottlenecks in patient flow, issues with asset utilization, compliance with health and safety procedures, and other key metrics. This operational information from mobile assets and people will be available to facilitate rapid decision-making, which can significantly improve operations and efficiency for delivery of better care at a lower cost. That is what today's technology can do in an effort to save our hospitals tomorrow.
Antti Korhonen is the president and CEO of Ekahau, Inc., which introduced the first Wi-Fi-based RTLS solution in 2002. The Ekahau RTLS solution is now used in more than 300 hospitals, as well as by manufacturing, retail and industrial companies, government agencies and the military.
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