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After conducting research for this project I have come to the conclusion that RTLS systems are pivotal to the increasing need for better hospital workflow. Research surrounding RTLS systems are often based on the monetary gains that will be provided, but it is also important to look at what these systems are doing for patient care. A properly implemented system will decrease wait times, improve equipment utilization, allow nurses to provide care that patients love, and will allow patients to be more autonomous with their care. With all these positive outcomes, along with the potential to save a great deal of money, these systems can be at the forefront of improved patient care. Being that I am in the MSN/MBA program, I am always on the look out for new and improved systems. I predict that through the combination of vendors, hospital administrators, and great NI's, RTLS systems are soon going to become mandated just as EMR systems have. Like many things in healthcare, it is going to be the responsibility of nurses to adapt and inherit the traits of these new systems. By doing so, we will continue to ensure that our patients are receiving the best, and safest care possible.

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Cost is a major factor when looking at RTLS systems. Like EHR, RTLS systems require a great deal of monetary input. Costs surrounding software, hiring of "superusers" from the vendor, and costs affiliated with the purchase of required equipment are all things that medical facilities must take into consideration. Other potential problems of the system include; weak communication between devices, faulty systems, system hacking, patient privacy, and delay in results of monetary benefit. Recently a study conducted by the The Journal of the American Medical Association found that " RFID induced potentially hazardous incidents in medical devices" (Van der Togt et. al., 2008). The study found that the WiFi used to communicate in the RTLS systems have the potential to interfere with other forms of communication like defibrillators, Ultrasound technology, and and EMR systems. It is recommended that health facilities test the program before implementing it to make sure it is compatible with what is already in place.

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"In healthcare facilities, RTLS can be used to locate portable assets and equipment, locate staff quickly and efficiently, and improve workflow. Hospital throughput of patients can be improved by ensuring the correct medical staff and equipment are in the correct place at the right time" (Boulos and Berry, (2012). With the proper implementation of an RTLS system, hospital and patient care flow can be improved on a grand scale. Again, the results of these programs are contingent on the proper educating and compliance by hospital staff. Here is a case study that was completed by a medical facility that implemented the Versus Technology RTLS system.
http://www.versustech.com/pdf/Versus_Case_Study_Nor-Lea_Medical_Clinic.pdf

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When researching RTLS systems there are only a handful of leading companies in the business. The largest and most advanced system is developed by Versus Technology. Other companies include; CenTrak, Airista Flow, and AwarePoint. We will discuss Versus since it has developed the most recent and up to date system. Versus Technology, which is now being utilized by Johns Hopkins University has made incredible upgrades in the world of RTLS's. Here is a 10 minute video describing the system and what it can do for a medical facility.

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Experience the Advantage of RTLS Automation

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We, as nurses, are well aware of the amount of wasted time throughout the day. Time is wasted looking for patients, finding placement, finding supplies, locating help, and on a busy day struggle with overall work flow. According to a study completed by Nursing Times (2009) "More than one-third of nurses spend at least an hour finding items of equipment during an average hospital shift". Though one hour does not sound like a great deal of time, that is time that we could spending with out patients.
RTLS also shows the use of equipment. Boulos and Berry (2012) state that "Because personnel find it difficult to locate portable equipment when they need it, they sometimes “hide” (or “hoard”) it, so that they may find it when required; this practice exacerbates the problem." By applying portable tracking devices to equipment two things occur; First, staff are more efficient at locating equipment for quicker use, and second constant tracking of equipment "saves time and money, and reduces theft and accidental loss" (Boulos and Berry, 2012).

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RTLS systems build on the well established EMR, and IT systems already in place at a medical facility. Nursing Informatics (NI) plays an important role in the development, installing, and implementation of these systems. Training staff on the use of these systems, along with compliance falls onto the shoulders of the NI. In addition, the NI must be proficient at observing reports made by the system. This will ensure that the information being developed and sent to administration is accurate and properly reflecting what is happening on the unit. Finally, the NI will be the person in charge of implementation. This requires the distribution of tags to the nurses, as well as software installation into equipment that is already in place. During the "Go live" phase of implementation it will be up to the NI to educate the nurses and Doctors, on proper use of the system so that it will be used to its fullest capabilities at all times.

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What is Real-Time Locating Systems? Boulos and Berry (2012) define Real-Time Locating Systems (RTLS) as "local systems for the identification and tracking of the location of assets and/or persons in real or near-real-time".
These systems contain several different working pieces to achieve an ultimate goal of better work flow. Systems achieve this by the utilization of wireless information about patient data, patient placement, equipment location, and information regarding patient care. This information then can be uploaded into the patient chart, as well as develop reports, which is sent to healthcare administrators and nursing supervisors about overall workflow and patient care.

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- Benefits Demos. (n.d.). Retrieved October 03, 2016, from http://www.versustech.com/rtls-healthcare-demo/
- Kamel Boulos, M. N., & Berry, G. (2012). Real-time locating systems (RTLS) in healthcare: a condensed primer. International Journal of Health
Geographics, 11, 25. http://doi.org/10.1186/1476-072X-11-25
- Nurses waste 'an hour a shift' finding equipment. (n.d.). Retrieved October 03, 2016, from https://www.nursingtimes.net/nurses-waste-an-hour-a-   shift-finding-equipment/1987381.article
- Van der Togt R, Jan van Lieshout E, Hensbroek R, Beinat EE, Binnekade JM, Bakker PM. Electromagnetic Interference From Radio Frequency Identification Inducing Potentially Hazardous Incidents in Critical Care Medical Equipment. JAMA. 2008;299(24):2884-2890. doi:10.1001/jama.299.24.2884.

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With all this wasted money, it is pivotal that medical facilities find a way to decrease the amount of wasted resources and to develop ways to create a safe and effective work flow. Real-time locating systems (RTLS) are being developed and improved everyday to aide in the development of this need to improve work flow.

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The situation described above is one that is far to familiar to nurses. In todays  healthcare system far too much money is wasted on errors, poor time management, and poor patient flow.

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You, as a Medical Surgical Nurse, arrive for your scheduled shift and begin receiving report from the night nurse. During report you get a call from the charge nurse stating that you are getting an admission from the Emergency Room. Within five minutes your admission has arrived. You are still receiving report on your other patients, you have no idea what room is available, you have no idea where any equipment is currently at on the unit, and you have received minimal information on your new patient. You begin to feel overwhelmed, then you remember you hospital has implemented a Real-time Locating System.