Implementing RTLS for asset tracking and capacity management

Princess Alexandra Hospital NHS Trust are an acute organisation that serve over 250,000 local patients, with 419 beds at the Princess Alexandra Hospital site in Harlow, Essex.

NHS England worked in collaboration with Princess Alexandra Hospital NHS Trust to support their implementation of a Real Time Location System (RTLS) to support asset management and patient flow by integrating with their electronic health record (EHR) system.

For an overview of RTLS and these applications see An introduction to Real Time Location Systems.

Problem statement

Ensuring a hospital trust runs smoothly comes with many challenges. One of the less obvious challenges is the organisation and tracking of assets and people, whether medical assets, room availability, or even patient locations.

Frontline staff require timely access to medical devices that are shared around the hospital, and finding them can present a challenge. Tracking these devices also supports preventative maintenance, ensuring assets are checked regularly and reducing the risk of failure.

These are both critical for patient safety, as the misplacing or mechanical failure of a medical device can result in clinical incidents and wasted time, both of which can worsen patient outcomes.

Patient location and flow tracking within the trust is currently reliant upon updating digital records manually. This is often inconsistent and frequently leads to delays in records being updated (whether from patient discharge or timely logging of bed cleaning for example) which means equipment and beds being underutilised.

Effective capacity management can reduce waiting times for patients, improve patient flow through the hospital, and optimise the use of limited resources.

These requirements mean that any solution implemented by the trial would need to:

• allow for the automatic location tracking (by room) and logging of medical assets
• provide a holistic view of wait times for equipment or demonstrate better use of equipment shared between areas
• interact with the trust’s new EHR system to create an accurate single data set accessible by all staff
• support improvements to device maintenance and patient flow monitoring 
• be easy to use and understand by clinicians and estates teams

To address their requirements, the trust used 2 types of RTLS tags to track important assets – active and passive.

1. 'Active' tags: these can both transmit and receive information from beacons, such as a Wi-Fi access point, allowing for live location tracking of the tag within the estate. In this trial the trust used active tags on wheelchairs, beds and other medical assets to be tracked in real time by the RTLS system.
2. 'Passive' tags: these are either a small tag that can be pinged via radio frequency identification (RFID) when needed, or a barcoded sticker that can be manually scanned with a reader to access and update the asset record. 

As active tags can provide real time location tracking they are better suited for tracking mobile assets, such as infusion pumps or wheelchairs.

Passive tags are less expensive and have a longer operational lifespan, so are better suited for static items, such as beds.

Together, these addressed the 2 main use cases identified – by tagging important items, they could be a) located on demand (a common request from clinical staff) and b) maintained and serviced regularly.

The trust also investigated using RTLS to track the movements of occupied beds and wheelchairs throughout the hospital. By doing this, patient flow information could be utilised to model and improve the journeys that patients are taken on, reducing congestion at busy times, and supporting more efficient route planning.

The initial scope was limited to asset management, with an aim to include patient flow monitoring at a later date. Tags were then chosen based on their suitability for the use case, with size, shape and battery life considered. This allowed for the tags to be appropriately attached to the medical equipment without impacting the use of the devices. For example, when tagging smaller items such as mobile handsets, smaller tags were used as larger tags would be cumbersome and could impact performance.

The trust chose to prioritise tagging commonly needed mobile assets, including desktop computers on wheels (DoWs) and wheelchairs along with theatre equipment including intravenous (IV) pumps and patient temperature management equipment, know as Bair Huggers.

By implementing this system, Princess Alexandra NHS Foundation Trust aimed to realise the following benefits:

1. Capacity management and demand forecasting

Allocation of resources (beds, equipment, staff), including overall capacity and contingency reserves during peak demand, to be managed based on current and expected states of the hospital.

2. Improve discharge KPIs (including time to discharge)

Indirect patient tracking, by tracking items patients are on such as beds and wheelchairs, can increase the efficiency of cleaning and reallocating beds and rooms, along with other post-discharge duties. This supports staff involved in patient discharge by making best use of resources and equipment to allow for efficient patient discharge once medically stable.

3. Track assets accurately in real time

Having the live location of a device accurate to within approximately 1m allows staff to rapidly locate DoWs and wheelchairs, saving time spent searching for equipment.

Additionally, this could change the culture around the hospital, with clinicians feeling less need to keep hold of working devices as they would be both easier to locate and in good working order due to regular maintenance checks.

Accurate location tracking of equipment has been found to save 30 minutes per day for clinical staff. Read how Mid Cheshire achieved this in their NHS England supported RTLS trial: Implementing a Real Time Location Service for medical device tracking.

4. Integration of device maintenance records into the tracked identifier

Using the RTLS solution allows for all asset location history (routes taken and time active) to be digitally recorded. This data supports the planning and scheduling of preventative maintenance activities through the asset management system. The system can then flag jobs to maintenance staff, reducing the administrative burden, aid with identifying recurrent issues and keeping devices up to date.

Each of the benefit areas outlined above aims to simplify or automate an existing process that was previously managed manually. This automation will free up clinician time and effort and reduce human error in recording and logging data.

The first stage of the trial was establishing a small proof-of-concept (PoC) zone in the hospital to test the system and its integration with their EHR records. Once established, active RFID tags were placed on the wheelchairs and beds to be tracked within the area.

The outcomes of this initial pilot found that the deployment of RTLS was limited in functionality and effectiveness in two areas; location accuracy and presentation of location data. 

Location data

The PoC was only capable of reporting location data as a list view rather than a map view, impacting ease of use and interpretation of the data for users.

In a list view, RTLS tags only return the location of the asset in a table format (for example Asset 1 is located in Room A), whereas a map view shows where the asset is located on a map of the hospital. User testing showed that using a map view is significantly more intuitive than a list, allowing for quicker location of assets.

Location accuracy

The initial PoC delivered asset tracking accuracy of approximately 6m, which did not meet requirements. The poor location tracking accuracy also meant that tags may report their location incorrectly. For example, if a device was in a room that shares a Wi-Fi access point with an adjacent room, it could report as the nearby room instead.

This issue was compounded by the naming conventions for rooms within the hospital, as different teams used have different names for the same rooms. This caused confusion for users when reporting bed locations using the list view, as they were unfamiliar with the names presented in the list. If the clinical and estates teams refer to the same room by a different name, then a list view can only ever be relevant to one group of staff, rather than all of them.

After these issues were discovered, the trust moved to implement a more refined RTLS solution. The accuracy of the system was significantly higher and supported accurate location display via a map view. The refined RTLS solution was also confirmed to integrate fully into their EHR system, allowing for trust-wide use of capacity management functions.

Following these steps, the PoC zone was widened to include tracking of additional priority assets in the theatre department, including protected drug cabinet keys and IV pumps.

Itinerary of tags and time to deploy

DoWs (298 tags):

• The initial tagging took 2 weeks, using a team of 4
• A MAC address locator has been implemented to assist in locating the final DOWs to tag.

Wheelchairs (31 tags):

• This tagging took 2 days with 4 members of the team.

Controlled drug keys theatres (7 tags) and theatres medical equipment (30 tags)

• This tagging took 1 hour with 1 member of the team. 
• All items were in the same location and tagging them was quick and easy.

One of the lessons learned from tagging equipment was that finding and tagging deployed items was difficult, required resource time and was inefficient. To resolve this, a process was developed to ensure items are tagged upon purchase by the IT or EBME teams, before they are deployed elsewhere. The trust have implemented this approach for all new wheelchairs and equipment purchased.

Reduction in time spent searching for assets

The average time spent locating missing devices has decreased from an hour on average to 10 minutes, helping clinical staff spend their time more effectively. The tables below shows a breakdown of time spent to locate each asset before and after implementation of the RTLS solution.

Improved inventory management - IT team and ward staff can now quickly identify if DoWs assigned to specific wards are in the right areas.

Improved staff experience - Clinicians and hospital porters using the solution have reported that they feel more confident and able to plan around having access to assets when they need them, supporting more efficient care delivery and a reduction in frustration.

The trust has received feedback from the theatre team that the RTLS solution has  been used to locate misplaced theatre keys multiple times with keys located within 10 minutes on each occasion and a retrieval rate of 100%.

Positive feedback on the RTLS solution has been received from the trust’s theatre portering team:

“We have tagged 30 pieces of theatres medical equipment including Bair Hugger warming units and IV pumps, these are items that are frequently moved around, not only in the department, but the trust. When locating Bair Huggers that have been moved to other wards, this task is now taking a single member of staff around 1 hour per week in total.

Before tagging, this was taking around 8 hours a week. That means a total of 7 hours a week saving for just the 15 Bair Huggers alone for our staff.”

Due to the success of this trial, Princess Alexandra has plans to expand the scope by procuring additional tags and tracking a greater range of assets.

When conducting large scale changes to clinical ways of working like this, it can often be advantageous to roll out slowly (in both scale and impact), so issues can be mitigated and a group of 'early adopter' clinician subject matter experts can be cultivated to support others with use of the new technology.

The main lesson the trust learned is to ensure that all requirements are well defined before engaging with suppliers to provide a solution. By focussing on providing a well-researched and robust set of requirements to suppliers, health organisations can ensure that their deployment will be fit for purpose.

For NHS organisations considering utilising an RTLS solution in their organisations, it is vital that detailed user requirements are gathered from everyone who will be interacting with the system. This should include both an analysis of user’s workflows (to ascertain which parts can be made easier) and a survey to determine how they would like to interact with the system. 

Any RTLS or connectivity deployment should be made both for and with the staff using the solution.

Princess Alexandra are continuing to carefully expand their proof of concept to additional wards, with the goal of incorporating RTLS and EHR across as many of their sites as possible throughout 2025.

If you are considering or implementing an RTLS solution in your organisation, get in touch at [email protected].