No more running to the nurses' station to check the schedule. No more waiting around pre-op wondering when the next OR will be free. No more scurrying from room to room looking for the patient whose consent forms are missing. No more phoning to see if there's a recovery bay ready. These are just some of the inefficiencies we've been able to eliminate with our automated patient tracking system. Here's how it works, from patient check-in to discharge.

Check-in
When the receptionist checks the patient in for surgery, she registers him with the tracking system and assigns him a badge outfitted with ultrasound tracking technology. Sensors located in every room, hallway and corridor are able to track the patient's whereabouts with fairly accurate precision (down to the individual bay level) as long as the patient and his badge remain within the perioperative perimeter. Personnel in the pre-op staging area are alerted when the patient is registered and ready.

Pre-op staging
The nurse attaches the patient's badge (about 2 inches by 1 inch) to the patient's wristband. When shopping for tracking systems, we particularly wanted badges that were small and not intrusive to the care process. A long battery life is also an important consideration; ours run a year or more before needing to be replaced.

The tracking system has several features that make the staging area nurse's job — preparing the patient for surgery — easier and more streamlined. A screen connected to the patient tracking software lets her enter data on how the patient is progressing through the pre-operative process and to notify other members of the surgical team of any particular concerns associated with the patient, such as allergies. She enters this important information into the system as "alerts" that are then broadcast to all the areas where we display patient tracking information (reception, pre-op, ORs, PACU, nurses' station). Alerts are signified by a yellow icon similar to a "caution" road sign so they're easily identifiable when glancing at the patient tracking system.

Another type of notification, called a "roadblock," indicates there is an important step missing in the process and the patient can't proceed until it's resolved. For example, if a patient is missing his informed consent or pre-surgical anesthesia assessment, a bright red "stop sign" icon will show up next to the patient in the system. Once the nurse, physician or other team member clears the roadblock, the patient can proceed to the next step.

In the OR
When all roadblocks are clear, the system will indicate that the patient is ready for surgery. Back in the OR, the surgical team has another screen with patient tracking information that displays both the patient they're currently working on and the next patient in line. If the OR nurse sees there's a roadblock with the next patient, she can anticipate the potential delay or notify the surgeon if the roadblock is an action he needs to perform. Once she's ready for the next patient and the tracking system indicates that patient is ready for surgery, she will go into the staging area to get the patient (no need to call and find out his status first) and bring him into the OR. Typically, the OR nurse will remove the patient tracking wristband and place it by his chart so that it doesn't interfere with positioning or get buried under blankets. As the patient is moved from pre-op staging to the OR, everyone with access to the tracking system can see his movement — there's no need for manual data entry or user intervention of any kind.

A simple touchscreen at the nurses' station in the OR runs through a series of automatic, standardized prompts to notify others when certain milestones are reached, such as the surgeon's arrival in the OR and the end of the procedure. With one tap of the screen, the nurse indicates these stages of the surgical process, which lets post-op teams know how the case is progressing.

PACU and room turnover
When the OR nurse pushes the button for "surgery end," the tracking system automatically notifies PACU staff and housekeeping/room turnover teams (via both tracking screens and automatic pages) that the patient is going to be leaving the OR soon. This information lets them prepare a recovery bay and then send notification back to the OR with the bay number and when the bay is ready. Meanwhile, automatic pages triggered by system events alert the turnover team when it's time to mobilize. This way, they can get to the OR as soon as the case is over and begin preparing the room for the next case. When a PACU bed is ready, the OR nurse is notified via the tracking system (no need to call the PACU station) and the patient is transported to his designated recovery area. All the patient's movements, including times and duration in the different areas, are recorded automatically via the tracking system, giving us useful data from which to track pre-op, OR and recovery times.

Discharge
When patients leave the perioperative perimeter, whether to be admitted to a different department or to be sent home, their badges are left at the OR front desk and unassigned, closing out the cycle of tracking for that patient. We chose badges that could be easily cleaned and disinfected between patients with alcohol wipes that don't damage the hardware.

All about communication
The biggest benefit we've realized from patient tracking is improved communication, which in turn improves efficiency. At the day-to-day level, the tracking system provides a great way to broadcast vital pieces of information to large groups of people seamlessly and with little to no user intervention or data entry. Monitors at the front and back of each OR display the surgical schedule with real-time patient tracking information so all members of the surgical team can view the schedule at any time. We also have big banks of monitors in the staging area and in PACU that scroll through the patients in that area and show the whole schedule. Physicians, administrators and other stakeholders who are given permissions can also access the data remotely via the web or handheld devices so they can track how well the schedule is progressing throughout the day and plan their schedules accordingly. For the longer term, the system lets us measure with pinpoint accuracy the efficiency of our current processes and identify ways to improve our workflow.

The system works so well because we tailored it to our needs and are constantly tweaking it. While there are many benefits to installing an automated patient tracking system, be aware that it takes a lot of planning and forethought on your end if it's going to be successful. You really need to understand your current workflow; map it out in detail, and map out how you want your future processes to be, too. Then shop around for a tracking system that will work well within your current system and help facilitate your plans for improvement. You don't want software and tracking technology to define your processes — it should be the other way around.