Real-time locating systems to improve healthcare delivery: A systematic review

Abstract

Objective Modern health care requires patients, staff, and equipment to navigate complex environments to deliver quality care efficiently. Real-time locating systems (RTLS) are local tracking systems that identify the physical locations of personnel and equipment in real time. Applications and analytic strategies to utilize RTLS-produced data are still under development. The objectives of this systematic review were to describe and analyze the key features of RTLS applications and demonstrate their potential to improve care delivery. Materials and Methods We searched MEDLINE, SCOPUS, and IEEE following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Inclusion criteria were articles that utilize RTLS to evaluate or influence workflow in a healthcare setting. We summarized aspects of relevant articles, identified key themes in the challenges of applying RTLS to workflow improvement, and thematically reviewed the state of quantitative analytic methodologies. Results We included 42 articles in the final qualitative synthesis. The most frequent study design was observational (n = 24), followed by descriptive (n = 12) and experimental (n = 6). The most common clinical environment for study was the emergency department (n = 12), followed by entire hospital (n = 7) and surgical ward (n = 6). Discussion The focus of studies changed over time from early experience to optimization to evaluation of an established system. Common narrative themes highlighted lessons learned regarding evaluation, implementation, and information visibility. Few studies have developed quantitative techniques to effectively analyze RTLS data. Conclusions RTLS is a useful and effective adjunct methodology in process and quality improvement, workflow analysis, and patient safety. Future directions should focus on developing enhanced analysis to meaningfully interpret RTLS data.

Improving Care Delivery: Location Timestamps to Enhance Process Measurement of a Clinical Workflow

“… 18 Our work complements this growing body of the literature. 10 Our institution implemented RTLS to pilot and test multiple use cases, including personnel management, equipment location, and QI support. Ours is one such use case.…”

“… 7 – 9 However, best practices for the most effective and efficient use of RTLS capabilities for clinical workflow have yet to be defined. 10 Nevertheless, this technology can help pinpoint key areas where clinical improvements can be most effective. 11 …”

Perspectives of Certified Registered Nurse Anesthetists on Endoscopy Room Delays

“…It seems that CRNAs have to physically chase down colleagues and equipment. A real-time locating system may reduce the tracking effort and help collect and quantify workflow delays and further streamline the processes [23]. Moreover, EMR usability and unintended consequences of health information technologies have been a major research topic in medical informatics [24] [25] and should be researched further with a focus on CRNAs and endoscopy units.…”

Principles for Designing and Developing a Workflow Monitoring Tool to Enable and Enhance Clinical Workflow Automation

“…We also focused on the secondary use of EHR and RTLS data for clinical workflow analysis which has been a major research topic in clinical informatics in recent years. [29][30][31] When collecting workflow data, it is important to keep in mind the key elements, that is, actors, actions, artifacts, and outcomes, 32 to make sure the data collection is comprehensive. This is particularly important because some data collection methods are time-and resource-consuming (e.g., interviews and TMS).…”