Lost and found: how simple technology
can help the search for NHS efficiency

NHS organisations are currently in the middle of a challenging long-term efficiency drive to deliver around '20 billion in savings to the health budget. But some of those savings could be right under their nose. With the health service haemorrhaging more than a '1 billion each year due to lost medical equipment, Klaus Allion, Managing Director, ANT Telecom, outlines how simple real-time location technologies cannot just help NHS hospitals deliver efficiencies, but they can also, quite literally, identify where to find them.

In April 2010, national research from the Nursing Standard revealed that the average secondary care nurse spent 23 days a year searching for missing medical equipment. In addition, 35% of nurses said that they faced daily shortages of medical supplies, while a quarter claimed that patient records and lab results went missing at least once a day. Three years later and, despite the introduction of the QIPP initiative and the widespread availability of real-time location technologies that can help alleviate the problem, many UK hospitals still rely on traditional methodology to locate key NHS assets. The net result is inefficiency. Worse still, in the absence of smart technology to track missing items ahead of real clinical need, this inefficiency is exacerbated by the procurement of unnecessary replacement equipment in order to deliver appropriate patient care. The total cost to the NHS budget is estimated to exceed £1 billion in wasted resources. The cost to patient care is unquantifiable.

Setting the context
Hospitals have a large and comprehensive asset-base, ranging from beds and incubator pumps to wheelchairs and mobile scanners. It’s estimated that a typical NHS hospital may have around 5000 assets, much of which is mobile. In addition, they also have a huge volume of paper-based patient records. Managing all of these assets, safely and efficiently, is a difficult process – the secondary care environment is both complex and dynamic, and care pathways can take clinicians, patients, their records and, of course, medical equipment on varied journeys through the course of the average day. At present, many trusts operate without an efficient means of tracking assets as they move through the hospital, and when things go missing this can lead to delays in treatment, sub-optimal use of NHS resources and bottlenecks in the system. In austere times where cash-starved healthcare organisations are challenged by the twin objective of delivering improvements in the quality of care as well as operational cost-savings, the current approach to managing NHS assets is unsustainable.

Fundamentally, the effective management of hospital equipment can help speed up the delivery of care and accelerate patient flow through the system. This is particularly important at key touch-points such as admission, discharge and outpatients clinics. But the technology also has applications across other key areas of hospital care.

Finding the solution
A simple, cost-effective solution is not only within reach, it is already established in some of the UK’s most proactive trusts. These hospitals are using real-time location systems (RTLS) to help transform service delivery, identify areas of inefficiency and accelerate care pathways for the benefit of patients. Crucially, the systems, which deploy unique ‘tags’ to track and locate items, can be seamlessly integrated into an NHS organisation’s existing wireless network. This helps nurses detect missing medical equipment at times of urgent clinical need, and prevents them having to leave their ward to conduct often fruitless searches. What’s more, RTLS provides hospitals with greater visibility and control of their assets, improving stock control and, in the process, protecting budget that may previously been wasted on buying unnecessary replacements.

Innovative applications
Paging patients
RTLS technology can be used to improve the patient experience, particularly in busy out-patient areas. In some trusts, outpatients are being given badges that enable them to leave the waiting room and await their appointment in more comfortable settings such as the hospital café or restaurant. The badges carry an ‘active tag’, enabling hospital staff to alert patients when their consultation is ready, as well as helping to identify patients’ whereabouts. Once again, this improves productivity – preventing nurses from having to leave busy clinics to locate patients, and providing a more efficient mechanism for managing appointments. The system also provides reassurance for patients that they may be able to leave the clinic without fear of missing their place in the queue, and gives them the choice to step outside of the often congested and oppressive waiting room environment.

Patient safety
Patient badges are also being used to help protect vulnerable patients. For example, some trusts are using the technology to safeguard against mental health patients leaving secured environments without the knowledge of clinical staff or carers. When this occurs, the active tag triggers an alarm that alerts the clinical team and helps them locate the patient quickly and efficiently.

Patient records
RTLS technology can also help improve the management of patient records. With the implementation of a fully-operational EPR system still some way off, NHS hospitals must develop a more efficient way of managing confidential paper-based records. Evidence indicates that the misplacement of patient records and lab reports is an all-too-common problem within NHS hospitals – but the implications for patient care are far-reaching. Delays in treatment or diagnosis can have damaging repercussions. At the very least, misplaced records can cause unnecessary interruptions to care and lead to operational inefficiency.

In truth, even when electronic healthcare is finally established in the UK, digitizing all of what is likely to be a huge amount of historical patient information will not be realistic. Trusts will still need the ability to manage the legacy of paper-based records that date back beyond a certain point. There is much more that can be done in this regard.

At present, the paperless NHS is perhaps best considered to be a longer-term goal. But the paper-efficient NHS can easily be introduced tomorrow. The use of simple – and inexpensive – ‘passive tags’ provides an easy mechanism to track, locate and secure confidential patient records.

Collective responsibility
There is little doubt that real-time location systems can help prevent the inefficient use of hospital resources, and at the same time drive real improvements in patient care. But progress, like the delivery of QIPP efficiencies, will be a collective responsibility. In a multi-disciplinary environment where ‘assets’ pass through numerous departments across busy hospitals, a culture of collaboration is required for all stakeholders to understand the benefits of RTLS and, more importantly, the implications of failing to act. The appropriate implementation of RTLS will often rely upon an experienced system integrator facilitating holistic dialogue between all parties – including nurses, clinicians, engineering and maintenance staff – to establish individual needs and develop a business case for a solution that delivers benefits for all.

Increasingly, proactive trusts are running small-scale pilots of real-time location systems and are rapidly discovering – and, crucially, addressing – inefficiencies within their operations. Since RTLS technology works over the existing medical-grade WI-FI networks present in all NHS hospitals, it does not require additional infrastructure and pilots can therefore be implemented quickly and cost-effectively. The barriers to progress are therefore minimal – but the time to act is now.

Real-time location technology goes to the very heart of the four pillars of the QIPP initiative   - using Innovation to drive Quality, Productivity and Prevention in the NHS. As local health economies struggle in the cold snap of austerity, NHS organisations are continually battling to find much-sought efficiency savings. With RTLS they could, quite literally, find more than they ever thought possible.