How Royal Wolverhampton centralized workflow decisions to reduce length of stay

The Royal Wolverhampton NHS Trust invested in RTLS, which automatically identifies and tracks the location of objects or people in real time through the use of badges, location sensors, and software. All 4,000 staff who have direct contact with patients—including nurses, doctors, allied health professionals, and porters—wear electronic location tracking badges. In addition, beds and equipment are tagged, and patients wear wristbands to track their location at all times. This information populates an organization-wide dashboard giving leaders and staff real-time visibility of all patients, staff, beds, and equipment.

Initially, Wolverhampton invested in RTLS technology to track hand hygiene compliance among staff. They had some success, but found that it was hard to use the system to accurately monitor compliance. However, their RTLS investment didn’t go to waste, as the real-time data provided an accurate and timely picture of where staff, patients, and equipment were in the hospital. As a result, leaders decided to use the system to improve patient flow.

Implementation Tip

Securing clinician buy-in on RTLS

Staff at the Royal Wolverhampton NHS Trust initially had concerns about RTLS tracking their locations. Leaders held open discussions with staff to discuss how the tracking information would be used. They assured staff that location data would be used only when relevant to patient and safety care, never to monitor their behavior. These discussions helped gain buy-in and, over time, staff recognized the power of RTLS to improve care and efficiency.

To further secure clinician buy-in, we recommend creating a policy document that outlines how RTLS data will and will not be used. Additionally, throughout the process be sure to consult with change management experts, human resources, and key leaders to ensure staff cooperation and adoption of RTLS technology.

Technology considerations

For most organizations, implementing the RTLS technology costs between $750 and $1,500 per bed. Beyond the up-front cost of the technology and installation, the RTLS system requires ongoing software licensing—The Royal Wolverhampton NHS Trust spends about £200,000 (approximately $245,000) per year on licenses.

Vendors estimate that it can take between 4 and 12 months to implement a patient flow system, depending on the functionality used and the size of the implementation.

There are many different types of RTLS technology on the market, and it’s common for technologies to be used in combination depending on an organization’s needs. Excerpts of the summary comparison of major RTLS technologies and tips to implement RTLS at your organization appear below.

Find the full version of these tables in the Supporting Artifacts section on page 12 of the PDF.

Over a year after repurposing their RTLS investment for patient flow, leaders realized that improved visibility from real-time data wasn’t resulting in fewer care delays. They realized this was because patient placement was still operating in silos. For example, one capacity team member told us that it wasn’t uncommon for them to think a bed was open on a unit and alert a doctor that a patient could be admitted, then find out that the bed had already been filled. They’d have to scramble to find another open bed.

To change this, leaders at The Royal Wolverhampton NHS Trust decided to pair the RTLS technology with a command center-–one central location where all the people, processes, and information come together to make organization-wide workflow decisions. Royal Wolverhampton NHS calls their command center the “Care Traffic Control Center.”

The Care Traffic Control Center is staffed by a centralized team physically located in one place. They monitor and respond to RTLS data in real time. This co-located patient flow team includes a variety of clinical and non-clinical roles. Below is a table that outlines the command center staff roles and responsibilities.

With the exception of the unit-based patient flow assistants, The Royal Wolverhampton NHS Trust already employed all of the staff for the command center. Previously, staff were based on specific units. When Wolverhampton implemented the command center, staff were centralized.

Securing clinician buy-in

To get the patient flow team on board with the Care Traffic Control Center. To overcome this, The Royal Wolverhampton NHS Trust decided to parallel process. For one week, part of the team continued working the way they always had–-walking the wards, calling for updates–-while the rest of the team monitored the real-time data. The approach worked, and the patient flow team realized the new data was accurate and enabled them to do more to oversee and manage beds.

The centralized patient flow team uses real-time data to make workflow decisions as an organization rather than at the unit level. For example, the team uses a real-time view of bed status to direct admissions. The patient flow team can easily see which patients need a bed and which beds are free. Prior to implementing this centralized system, staff tracked bed status manually by walking the halls and making countless phone calls to the units. As a result, the tracking system was almost always out-of-date, leading to suboptimal bed placement for patients. The table below outlines how the centralized team uses real-time data for several other workflow decisions.