Implementing a Real Time Location Service for medical device tracking

As part of the 2023/24 wireless trial, NHS England collaborated with Mid Cheshire Hospitals NHS Foundation Trust to implement a Real-Time Location Service (RTLS) system across their treatment centres and operating theatres. RTLS allows for the accurate wireless tracking of vital medical equipment, saving staff time.

The trial delivered transformative results, including:

This deployment will also reduce future costs of buying and leasing medical equipment in future years, by reducing losses and ensuring that equipment is ordered based on data on actual need, rather than anecdotal evidence.

The trust provides acute care to around 300,000 people in the Cheshire area, employing over 5,000 members of staff. Leighton Hospital, where this trial took place has 540 beds. This case study covers the first phase of RTLS implementation during which the solution has enabled live tracking of high-value medical devices, enhanced workflow for frontline and maintenance teams, and - most importantly - created more time for patient care. Currently, 450 devices, including infusion pumps, bladder scanners, and patient trolleys in operating theatres are being tracked.

Through positive staff engagement throughout the rollout, additional use cases were identified and quickly implemented, making RTLS an integral part of daily operations. The goal is for the system to eventually track all 7,500 medical assets across the hospital, further streamlining processes and improving care.

For an introduction to the technologies discussed in this case study see An introduction to Real Time Location Systems.

Calibrated and functional medical devices are essential for delivering quality healthcare. It's crucial to know their location, ensure they’re in good condition, and verify they’ve been properly maintained.

Failure to do so can lead to faulty or missing devices, effecting the quality of patient care and financially impacting the trust. This can cause delays in patient treatment on common procedures, such as drug transfusions, and increased costs due to time lost by clinicians and the need to purchase more devices than necessary to cover lost and defective devices.

"Prior to the RTLS system being rolled out at the trust, locating infusion pumps was infuriating, leading to some staff stockpiling the devices. Since the system has come in, the loan store is rarely not stocked, and we have the re-assurance that if it is, EBME staff have been alerted and will be in the process of re-stocking. This saves valuable nursing time and we look forward to additional efficiencies as the system is rolled out further."

Jackie Cox, Chief Nursing Information Officer, Mid Cheshire Hospital Foundation Trust

An external audit commissioned by the trust revealed challenges in tracking high-value medical devices, such as infusion pumps. Prior to the trial, the inability to track devices led to missed maintenance, increased wear and tear, higher risk of failure, and staff spending excessive time searching for missing equipment. This created a hoarding culture where departments held onto available, working devices through necessity.

To address this, the trust piloted an RTLS system to track infusion pumps across the hospital. Tags attached to the pumps report their real-time location via the Wi-Fi 6 network. These pumps are crucial for controlled fluid and drug delivery, making it vital to ensure they’re always where they should be and properly maintained, especially given their high cost.

The hospital implemented an RTLS network across its premises, tagging 400 infusion pumps with radio-frequency identification (RFID) and Bluetooth Low Energy (BLE) tags over 3 months.

Find out more in our RTLS technology guide.

These small, discreet tags provide real-time location data through the hospital's connectivity infrastructure (Figure 1) . RTLS can also track passive tags, like barcodes, for stationary assets such as beds, while active tags are used for mobile devices.

Figure 1: An anonymised system topology of the RTLS deployment at Mid Cheshire

Once the tag is operational, the location of the tag can be seen in the RTLS software interface. An example of this is shown in Figure 2. This provides real-time information on the location, device information, and maintenance status of each device tagged, through both desktop and mobile devices.

Figure 2: Tag search example

The deployment started with 200 tags and focused training for users, led by the medical engineering team. This approach built confidence in returning infusion pumps to the appropriate location, maintaining device availability through defined par levels. If inventory drops below this, staff are alerted to recover devices.

The solution also streamlined preventative maintenance. Engineers can quickly and easily update maintenance records by pressing a button at defined locations, reducing administrative tasks and errors.

After the pilot, 450 active tags now track various mobile devices, and 5,900 passive tags are being rolled out to track stationary assets, enhancing efficiency for engineers and estates teams. 

The trial didn't include tracking people at this stage due to complex information governance requirements around lone worker safety, but this will be explored later. The system also enables alerts for misplaced devices, ensuring timely recovery and availability.

The RTLS rollout at Mid Cheshire exceeded expectations, delivering immediate results and benefits. The trust can now follow best practices for medical device management, ensuring devices are cleaned and returned to stores after use, a process confirmed within 24 hours of going live.

Tracking all 450 active devices is simple, with real-time and historical tracking available via an intuitive interface. This has allowed frontline staff to quickly locate devices, saving an estimated 30 minutes per day per staff member. Critical incidents involving infusion pump unavailability have more than halved, and remaining incidents highlight the need for additional pumps, a key insight made possible by RTLS.

RTLS has also streamlined planned maintenance (PPM) and device disinfection. No tracked device has missed its PPM, reducing the risk of device failure and avoiding unnecessary replacements, potentially saving the trust a significant portion of its £1.7m equipment budget. This also frees up engineering staff time and reduces clinical risks.

The passive tag system has enhanced general asset management, with GS1 compliant barcodes allowing staff to scan and access asset records easily. This system also provides historical data for auditing.

"Knowing the location of devices scheduled for pre-planned preventative maintenance is essential in reducing clinical risk by preventing device failure. Since we have implemented RTLS at the trust, all tagged devices can be ordered by maintenance date and my team can prioritise those whose maintenance window is approaching."

Jon Ollerhead, Medical Engineering Manager, Mid Cheshire Hospital Foundation Trust

Ongoing staff engagement has been crucial to the success of the deployment. Staff have contributed new use cases, such as monitoring fridge temperatures to prevent damage to sensitive items like blood and drugs. This feedback-driven approach has helped integrate RTLS into clinical, IT, and estates workflows, emphasising the importance of involving all stakeholders in the process.

Following their deployment, Mid Cheshire has identified the following lessons and recommendations for organisations wanting to deploy a similar solution.

1. Ensure estate maps are up to date

The initial maps of the wards and wireless access points were inaccurate due to recent building work, leading to incorrect ward locations for some infusion pump searches. This was resolved quickly by updating the maps, but highlights the importance of ensuring accuracy, especially with ongoing changes to building layouts, ward designs, and wireless access points. If a ward reconfiguration has occurred recently, maps should be verified for accuracy. The trust also found that accurately applying zones in the software was time-consuming, but necessary to avoid significant troubleshooting later.

2. Conduct a full wireless coverage survey with the most up-to-date floor plans

RTLS systems triangulate their location based off signal strength to nearby wireless access points. This means that the coverage of the area where devices will be needs to be sufficient, else tracking will not be accurate. A wireless survey completed prior to the deployment of an RTLS system can identify areas where additional access points may be required to improve coverage.

NHS England have investigated how NHS organisations can bring this capability in-house for working with Sussex Community Hospitals, with more details available in the Sussex Community wireless trial summary.

3. Ensure intended workflows are easy for staff to complete

The goal of the RTLS deployment was to enhance the tracking and maintenance of medical devices. While the 'return to base' workflow is ideal, devices are not always returned as needed, impacting both maintenance and device availability across the hospital.

By making the return-to-base process transparent and effortless, device availability and maintenance can be improved. This can be achieved by reducing the effort required from staff, or even eliminating it entirely by having engineering and estates teams actively collect unused devices. This approach allows frontline staff to focus more on patient care.

4. Plan for continued use and expansion

Following the initial success of the RTLS system, ongoing maintenance and expansion are necessary to sustain its benefits, including reducing time spent by staff searching for assets. Mid Cheshire anticipated this outcome at the trial's start and made decisions accordingly. The solution will remain cost-effective at scale and continue to deliver value. The benefits were so significant that the trust's medical device group approved purchasing asset tags for all future medical devices.

The lessons learned and expertise of the Mid Cheshire trial also had a positive impact on another RTLS trial, ran by Princess Alexandra NHS Foundation Trust to track mobile devices and drug locker keys, available in our implementing RTLS for asset tracking and capacity management guide.

The implementation of the RTLS system for a growing list of medical devices at Mid Cheshire has been extremely successful and provides strong evidence that the benefits could be replicated elsewhere. There have been significant improvements in operational efficiency, cost savings, and patient care through providing frontline staff more time. These benefits will continue to grow and scale as the system is scaled up throughout the trust, with the ultimate intention of improving staff quality of life and saving time and money that can be better used on supporting patient care.

If you would like to share your experiences of using RTLS in NHS settings or would like advice on the technology please get in touch at [email protected].