Wireless in the ED
Taking emergency departments to the next level
Wireless technology can dramatically improve throughput in hospitals. This is especially true in emergency departments because the mobility and size of wireless devices can reduce the time from triage to discharge and improve efficiency at various touch points along the way.
By starting in the emergency department, investments in wireless technology also can help a hospital update many other aspects of its operations, from patient care to staff communications and financial performance. Wireless systems can grow along with hospitals as they become increasingly sophisticated, expand their services or build new facilities.
The choices of wireless technologies for emergency departments have been growing. As the number of systems increases, their benefits and capabilities have also expanded. Wireless technology can improve throughput by facilitating the following:
Better patient tracking and monitoring. Wireless patient tracking systems decrease throughput times because they provide real-time patient location and status. This information enables staff to direct patient flow, schedule tests and share patient status and emergency department census data with the rest of the hospital. Using wireless technology, hospitals can even improve room turnaround times by directly informing the environmental services department that an area is ready to be cleaned and staged for the next patient.
Says Chris Massaro, clinical technology manager at ISS Solutions, Wilkes-Barre, Pa., a consultant to Geisinger Health System’s Wyoming Valley Division, also in Wilkes-Barre, wireless physiological monitors allow ED clinicians to “monitor patients in their rooms or during transport anywhere in the hospital.”
Immediate diagnostic testing and quicker test results. Wireless point-of-care testing equipment enables doctors to conduct immediate diagnostic testing, which supports treatment decisions. This is especially important for emergency departments because time is often a factor for critically ill patients. Examples include wireless electrocardiograms, handheld ultrasound equipment and point-of-care lab equipment that can produce near-immediate results. Hospitals can use this equipment to send results directly to a physician’s personal digital assistant (PDA) as well as a patient’s medical record.
Improved staff communications. Wireless reach-and-respond devices improve efficiency among staff by enabling clinicians to communicate directly with one another rather than having to use pagers or telephones. Newer systems even provide hands-free equipment that is activated by voice command.
The emergency department staff of Geisinger Health System uses wireless, voice-activated devices to communicate directly with one another—both inside and outside of the hospital.
Error reductions. Wireless computers help reduce errors because staff can record treatments and physicians’ orders at a patient’s bedside and put this information directly into the patient’s electronic chart. Newer tablet computers are extremely durable and able to withstand rigorous use in a health care setting. New silicone-coated keyboards and accessories also can be completely cleaned, which helps prevent the spread of infection.
Wireless emergency department equipment is most useful when it can be integrated with other hospital systems, and preferably with multiple systems. Effective integration yields the best return on investment and reduces the number of separate systems that are required. Technology should be robust and satisfy the optimal number of issues while remaining within budget.
For hospitals seeking to retrofit their existing technology, or even planning a technology upgrade as part of a renovation or new building project, the first step is to convene an interdisciplinary committee so that the hospital can make appropriate equipment selections for its emergency department’s needs.
To be most effective, this committee should include representatives from information technology and the emergency department management, staff and physicians. It is also important to include members of the facilities, clinical engineering, registration, security, pharmacy and lab departments.
It is essential for hospitals to manage the process carefully from the start and get consensus because systems integration requires buy-in from different groups of caregivers and support departments. During the planning stage, the hospital administration should carefully consider each person’s and department’s agenda and concerns because this input is essential to the planning process. Each representative will have his or her own issues, as well as specific patient-care scenarios and events for which the wireless equipment will be used in the emergency department.
Projects can escalate if not monitored closely. For instance, what may seem like a small Wi-Fi pilot project can quickly grow into something much bigger. Hospitals should plan for implementation and beyond, since a wireless system will require additional information technology support.
Researching the technology
It is important for institutions to be realistic about the types of equipment that will be acceptable to staff, especially if a hospital is using wireless technology for the first time. Every hospital has its own culture and mission as well as its own vision for going wireless. When starting the research and testing phase, hospital administrators and emergency department staff should do the following:
Determine which systems or equipment need immediate improvement. This allows a hospital to plan an implementation platform and schedule around them. Administrators should review the problems or challenges in emergency department throughput that have been identified and need to be addressed. If these areas have already been prioritized, it will facilitate the equipment selection process.
Avoid redundancies to maximize efficiency and reduce costs. A hospital should consider new technologies for an emergency department that can be integrated most smoothly and completely with current or previously approved systems, such as the emergency department information system (EDIS), laboratory information system (LIS), radiology information system (RIS) or electronic medical records.
In January 2009, for example, Lenox Hill Hospital in New York will install wireless, bedside label printers in its patient care areas. Caregivers will be able to scan a patient’s bar code into a printer that can poll the hospital’s LIS for tests ordered for that patient and then print the labels for those tests directly at his or her bedside.
Train staff on using the technology. Ease of use will speed integration of wireless technology in the emergency department and support compliance with new processes and protocols. User-friendly technologies will be easiest for emergency department staff to use and therefore improve throughput. Complexity should be avoided, if at all possible. It is also important for a hospital to be comfortable with its vendors and their support teams because it will need to rely on them to successfully implement new systems.
Carefully calculate costs. This should include hardware and software expenses, ongoing support and maintenance, security, infrastructure, integration with existing systems and staff training. The costs of wireless systems vary widely based on the application, type of system, scope of the deployment (department, floor, building or campus), status of the existing wired infrastructure and knowledge and experience of staff who will be using it. To reduce costs as technology changes, some vendors are willing to forecast and specify costs for upgrades and future expansion, thereby capping future expenses for new features and capabilities.
Reviewing the selections
Each hospital should research and test potential systems before purchasing or implementing wireless technology. This will ensure that the technology supports the right systems and fits within the hospital’s budget.
Most vendors are willing to set up a product demonstration for a committee or staff. Alternatively, a hospital can conduct a vendor fair where staff can compare the features and capabilities of software and hardware produced by different companies.
Most importantly, a hospital should evaluate selected equipment by trialing it—or actually using it—so the administration and staff can determine whether it will deliver the desired results.
Staff should pay attention to equipment details that may seem insignificant but are important for actual use. For example, the images on the wireless devices should be clear in all lighting situations, and the screens and selections should be intuitive. Handheld equipment should be comfortable and not too heavy to carry and hold.
Staff should also test computer carts to see if they maneuver easily and fit within the treatment rooms. Likewise, a hospital should consider whether patient care supplies and accessories will have to be changed in order to accommodate the new equipment. Battery power is also a factor, since certain equipment may require expensive batteries that must be replaced frequently.
Like wired systems, wireless devices for emergency departments require that hospitals address configuration, management, maintenance, monitoring, upgrades and data security. Any wireless system will require infrastructure equipment to support it, including rack space, power and cooling.
Whether a wireless system installation is a retrofit of an existing emergency department or part of a renovation or new construction project, the hospital should understand how the physical configuration of an emergency department may influence what systems can be selected and how they are implemented. For example, brick and block walls may impede or block signals, creating a need for additional Wi-Fi access points or radio-frequency identification (RFID) system receivers and their infrastructure.
A wireless site survey can provide the foundation for a system’s design. If a hospital is retrofitting an emergency department to include a wireless system, it has the ability to perform a detailed site survey. A retrofit will require the health care facility to install cabling into existing spaces that are always occupied and critical to patient care. Inserting wireless equipment as part of a renovation or new construction project will allow for better planning and easier installation, but coverage questions must be addressed early in the design process.
It is essential for a hospital to set a firm “go-live” date and then to work toward it vigorously. One of the biggest challenges to successful wireless implementation is the use of parallel systems. In other words, a hospital may prefer to maintain a wired system in case there are delays in full implementation of the wireless system. However, operating a parallel system can often hinder efficiency and slow down the progress of throughput improvement goals. It may also prevent full utilization and acceptance of the new equipment.
Monitoring the system
Information security has been a primary concern for many health care facilities. Recent encryption improvements, which provide greater security and privacy for sensitive patient data, have resolved many of these issues. Critical security configurations include intrusion prevention, detection, firewalls, network segmentation and access control.
System monitoring is critical to maintaining service levels in the emergency department and predicting problems before they occur. Wireless systems require the same close attention as other systems. Because the antennas and access points for wireless systems are typically hung from ceilings or located within walls, physical maintenance can sometimes be disruptive to emergency department patients and clinical staff. It is therefore imperative to integrate automated notifications of network and security anomalies in the system, so problems can be resolved quickly.
In addition, the hospital’s information technology department will need to be vigilant about maintaining the emergency department’s wireless systems. A health care facility will need to rely on its information technology department to provide ongoing staff support, system administration and help desk services, and to facilitate compliance with the Health Insurance Portability and Accountability Act.
With a wide range of wireless systems and equipment currently available, health care facilities must plan and implement carefully when it comes to upgrading an emergency department technology infrastructure.
Most importantly, the hospital’s own team must work together and make a strong commitment to the wireless conversion to ensure the successful realization of the system’s goals.
Gloria A. Cascarino is director of medical equipment planning and Steven M. Newman is director of IT and security solutions for Francis Cauffman Architects, headquartered in Philadelphia. They can be reached at firstname.lastname@example.org and email@example.com, respectively.