Assessment of a Real-Time Locator System to Identify Physician and Nurse Work Locations

Li, R.; Marafino, Ben J; Nielsen, Derek; Baiocchi, Mike; Shieh, Lisa

doi:10.1001/jamanetworkopen.2019.20352

Cited by 8 publications

(10 citation statements)

References 5 publications

(2 reference statements)

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“…Not unexpectedly and consistent with prior findings [ 14 , 32 ], we observed that nurses, compared to physicians, had the majority of interactions (81% of entrances and 85% of the time) with patients under evaluation for COVID-19. Thus, telemedicine technologies may hold greater potential to impact nursing workflows to decrease transmission risk in a pandemic compared to other health care clinicians; however, additional research is needed to understand what elements of nursing work can be done virtually while maintaining high-quality patient care [ 33 ].…”

Section: Discussionsupporting

confidence: 92%

“…Stanford Health Care (SHC) launched an RTLS platform (Midmark) in conjunction with the opening of a new hospital building in late 2019. Infrared and radiofrequency sensors were installed in every patient care room, and staff were given RTLS badges to wear alongside their name badge [ 14 , 26 ]. The RTLS system required line of sight between the room sensor and staff member’s badge to trigger.…”

Section: Methodsmentioning

confidence: 99%

“…These data may then be visible on a live monitor or recorded on a database log for further analysis, where it may provide operational or research value. For example, an RTLS can be used to measure and improve health care delivery [13] by helping understand patterns of staff movement [14][15][16][17][18] and monitoring operational efficiency [19,20]. The quantitative information from an RTLS can be analyzed to predict patterns in clinical workflows [21].…”

Section: Introductionmentioning

confidence: 99%

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Using a Real-Time Locating System to Evaluate the Impact of Telemedicine in an Emergency Department During COVID-19: Observational Study

Patel¹,

Vilendrer²,

Kling³

et al. 2021

J Med Internet Res

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Background Telemedicine has been deployed by health care systems in response to the COVID-19 pandemic to enable health care workers to provide remote care for both outpatients and inpatients. Although it is reasonable to suspect telemedicine visits limit unnecessary personal contact and thus decrease the risk of infection transmission, the impact of the use of such technology on clinician workflows in the emergency department is unknown. Objective This study aimed to use a real-time locating system (RTLS) to evaluate the impact of a new telemedicine platform, which permitted clinicians located outside patient rooms to interact with patients who were under isolation precautions in the emergency department, on in-person interaction between health care workers and patients. Methods A pre-post analysis was conducted using a badge-based RTLS platform to collect movement data including entrances and duration of stay within patient rooms of the emergency department for nursing and physician staff. Movement data was captured between March 2, 2020, the date of the first patient screened for COVID-19 in the emergency department, and April 20, 2020. A new telemedicine platform was deployed on March 29, 2020. The number of entrances and duration of in-person interactions per patient encounter, adjusted for patient length of stay, were obtained for pre- and postimplementation phases and compared with t tests to determine statistical significance. Results There were 15,741 RTLS events linked to 2662 encounters for patients screened for COVID-19. There was no significant change in the number of in-person interactions between the pre- and postimplementation phases for both nurses (5.7 vs 7.0 entrances per patient, P=.07) and physicians (1.3 vs 1.5 entrances per patient, P=.12). Total duration of in-person interactions did not change (56.4 vs 55.2 minutes per patient, P=.74) despite significant increases in telemedicine videoconference frequency (0.6 vs 1.3 videoconferences per patient, P<.001 for change in daily average) and duration (4.3 vs 12.3 minutes per patient, P<.001 for change in daily average). Conclusions Telemedicine was rapidly adopted with the intent of minimizing pathogen exposure to health care workers during the COVID-19 pandemic, yet RTLS movement data did not reveal significant changes for in-person interactions between staff and patients under investigation for COVID-19 infection. Additional research is needed to better understand how telemedicine technology may be better incorporated into emergency departments to improve workflows for frontline health care clinicians.

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Section: Discussionsupporting

confidence: 92%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Using a Real-Time Locating System to Evaluate the Impact of Telemedicine in an Emergency Department During COVID-19: Observational Study

Patel¹,

Vilendrer²,

Kling³

et al. 2021

J Med Internet Res

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show abstract

“…The importance of a hands-on physical examination—both for diagnostic and therapeutic purposes—is evidenced in the literature [ 51 , 52 ], but how to best adapt these learnings to patients are under isolation precautions remains an open question. Nurses were reported to use telemedicine more frequently than physicians, while also maintaining a frequent physical presence within the room, which is perhaps unsurprising given that nurses spend approximately 6-fold more time at the patient bedside than physicians in non–COVID-19 settings [ 53 , 54 ]. These COVID-19 data further validate past qualitative work, which suggests that nurses use telemedicine as a bridge to in-person care and “batch” care activities, such that physical assessment, medication delivery, meal delivery, and sanitation protocols all occur in a single room entry [ 27 , 55 ].…”

Section: Discussionmentioning

confidence: 99%

Patient Perspectives of Inpatient Telemedicine During the COVID-19 Pandemic: Qualitative Assessment

Vilendrer¹,

Sackeyfio²,

Akinbami³

et al. 2022

JMIR Form Res

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Background Telemedicine has been adopted in the inpatient setting to facilitate clinical interactions between on-site clinicians and isolated hospitalized patients. Such remote interactions have the potential to reduce pathogen exposure and use of personal protective equipment but may also pose new safety concerns given prior evidence that isolated patients can receive suboptimal care. Formal evaluations of the use and practical acceptance of inpatient telemedicine among hospitalized patients are lacking. Objective We aimed to evaluate the experience of patients hospitalized for COVID-19 with inpatient telemedicine introduced as an infection control measure during the pandemic. Methods We conducted a qualitative evaluation in a COVID-19 designated non–intensive care hospital unit at a large academic health center (Stanford Health Care) from October 2020 through January 2021. Semistructured qualitative interviews focused on patient experience, impact on quality of care, communication, and mental health. Purposive sampling was used to recruit participants representing diversity across varying demographics until thematic saturation was reached. Interview transcripts were qualitatively analyzed using an inductive-deductive approach. Results Interviews with 20 hospitalized patients suggested that nonemergency clinical care and bridging to in-person care comprised the majority of inpatient telemedicine use. Nurses were reported to enter the room and call on the tablet far more frequently than physicians, who typically entered the room at least daily. Patients reported broad acceptance of the technology, citing improved convenience and reduced anxiety, but preferred in-person care where possible. Quality of care was believed to be similar to in-person care with the exception of a few patients who wanted more frequent in-person examinations. Ongoing challenges included low audio volume, shifting tablet location, and inconsistent verbal introductions from the clinical team. Conclusions Patient experiences with inpatient telemedicine were largely favorable. Although most patients expressed a preference for in-person care, telemedicine was acceptable given the circumstances associated with the COVID-19 pandemic. Improvements in technical and care team use may enhance acceptability. Further evaluation is needed to understand the impact of inpatient telemedicine and the optimal balance between in-person and virtual care in the hospital setting.

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“… 18 However, they require trained observers shadowing participants and have logistical challenges and high costs. Methods that use a real-time locating system (RTLS) 19 , 20 may be a more scalable approach for graduate medical training programs. 21…”

Section: Introductionmentioning

confidence: 99%

Use of a Real-Time Locating System to Assess Internal Medicine Resident Location and Movement in the Hospital

et al. 2022

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Assessment of a Real-Time Locator System to Identify Physician and Nurse Work Locations

Abstract: had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Cited by 8 publications

References 5 publications

Using a Real-Time Locating System to Evaluate the Impact of Telemedicine in an Emergency Department During COVID-19: Observational Study

Using a Real-Time Locating System to Evaluate the Impact of Telemedicine in an Emergency Department During COVID-19: Observational Study

Patient Perspectives of Inpatient Telemedicine During the COVID-19 Pandemic: Qualitative Assessment

Use of a Real-Time Locating System to Assess Internal Medicine Resident Location and Movement in the Hospital

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