With a click of a mouse, we can keep track of anyone and anything in our hospital's day surgery unit. That 7:30 rotator cuff repair? Click. The surgeon's threading his first suture and PACU is preparing a bed. The hernia set needed in half an hour? Click. It's been sterilized, packed and sent to the ORs, intact and on time.

So what's our secret? Hidden cameras? Global positioning satellites? Radar navigation systems? Nope. We get our omniscient powers from patient and instrument tracking systems that use tiny sensors and barcodes to let staff monitor the progress of each case and maximize patient flow. Before working with tracking technology seven years ago, we made do with endless phone chatter and word of mouth. Now I think we'd be lost without it. Here's a look at our trials and tribulations with this technology.

Ahead of the curve, for a bit
Our first taste of tracking software was sweet. With a quick glance at displays positioned throughout the facility, staff could tell if patients were in pre-op, when they entered the OR, what the status of the procedure was and when patients reached PACU. But as is the case with anything driven by computers and networks, our time spent in front of the technology curve was short lived. While the patient tracking system was an improvement over phone call updates, we soon realized that nurse compliance with the system's requirements was lacking.

Tracking patients depended on nurses remembering to manually update the patients' status at computer workstations positioned in pre-op, the OR and PACU. To complicate matters, our hospital also upgraded the campus' software to include electronic medical records. The EMR system didn't match our patient tracking software. While escorting patients throughout the surgery unit, staff had to enter patient data into two incompatible systems: first the EMR program and then the tracking system to update the patient's location. It was a cumbersome process, one that deterred staff compliance. In the end, the automated potential of the latest and greatest technology was subject to the inconsistency of human error. Our high-tech unit quickly reverted to back-and-forth phone calls and circulating nurses to track patients. It was time for an upgrade.

Watch and learn
We mounted infrared sensors to the wall in each pre-op room, OR and PACU bay. They detect patients' movements by reading small sensors attached to IV tubing. As patients are wheeled from pre-op to the OR, the sensors pass through infrared fields in each location, automatically updating the progress on the system's displays.

Now the tracking of patients is completely automated. It works much like the express lanes at your local highway tollbooths. And like before the upgrade, the system also updates the status of individual cases, from induction of anesthesia to closing. That update is broadcast to terminals throughout the day unit.

Our staff is very happy with the system's improvements. The automated updates of patient locations improved our management of patient flow and the accuracy of the patient's true location along the surgical route. A quick glance at computer terminals positioned throughout the unit lets staff read and react to movements without direct communication. As soon as the surgeon begins to close, for instance, the patient's display changes color, pushing the PACU staff into action.

We don't have a dedicated employee in charge of monitoring and managing patients through the facility; rather, it's my responsibility and that of the surgical team leaders. At the start of each day, we'll look at scheduled cases, identify potential trouble spots and plan accordingly. When that targeted time approaches, say late morning, we'll watch the tracking system closely and navigate through bottlenecks by shifting staff or trying to move patients more quickly from the area in front of the log jam.

We'll often use patient tracking information to manage PACU beds. We can see when the patient will be coming from the OR, and if PACU is already full, we can divert the patient to our inpatient PACU in another wing of the hospital. This helps us manage the flow between Stage 1 and Stage 2 recovery areas. We also have a special screen in the physician lounge with information updated every 30 seconds regarding which ORs are in use by which surgeons, the status of cases and which cases are scheduled next.

The patients' escorts like the tracking system, too. We installed a computer cubicle in our waiting room where family members can enter the identification number assigned to their friend or relative for an instant update on the procedure's status.

Besides avoiding headaches from mangled schedules, I love the data the systems collect. With patients' travels throughout our facility recorded accurately and consistently, I can generate reports that drill down beneath the surface. For example, I'm able to document which surgeons are habitually late, which actually use the block times they request and which start their first cases on time.

Where's that instrument set?
Now that we've discussed the benefits of tracking patients, let's turn our attention to tracking instruments. Members of our sterile processing team work at a computer station. They scan the laser barcode affixed to each instrument as they reconstruct sets that had been separated for cleaning and sterilizing. The tracking system records the scanned instruments, creating an automated inventory of every instrument we use.

The online inventory is a huge asset in a large hospital setting. Before we implemented the technology, human error accounted for the return of incomplete instrument sets from sterile processing. That caused delays and steamed surgeons as staff ran to replace the missing tools with instruments from other rooms. It was a quick fix that set off a chain reaction of mismatched instrument sets. Unorganized sets were returned to sterile processing, where techs inherited the thankless job of sorting out troubles that they had inadvertently begun.

Even instrument sets sent to ORs intact stood a good chance of being returned incorrectly. At the end of cases involving numerous sets opened in the sterile field, techs and nurses often throw the wrong instruments in the wrong containers during breakneck room turnovers. Even though instruments were accounted for in sterile processing, it was a time-consuming chore to sort and re-assign them to the proper set.

Now we've essentially eliminated human error from our instrument inventory management. When the sterile processing staff builds sets, a quick scan of the instrument's barcode lets them know which tool belongs where. If the instrument doesn't belong with the set they're packaging, they'll set it aside and use the tracking system to locate its proper place. OR staff can also locate missing instruments with a quick call upstairs to sterile processing.

Remember the users
I won't say the high-tech tracking of patients and instruments helps increase the number of cases we perform each day, but it does help us manage the ones already scheduled. As an auxiliary department of a large health network, our unit sometimes hosts overflow cases from the hospital's main ORs. Before we installed an automated tracking system, inquiring about open rooms required a phone call, which often came too late to accommodate the request. Now staff at the main ORs can quickly determine breaks in our schedule and easily shift cases to our facility that might have otherwise been cancelled.

When looking into a tracking system, consider its usability and interface capabilities. As we discovered, the promises of increased efficiencies and cost savings will remain unfulfilled if nurses don't understand how to use the system or simply find it too difficult to. We're happy with our current setup, but not satisfied. We still want our EMR software to communicate with the hospital's tracking systems. They will shortly, as we've made the necessary steps to interface the two.

The financial outlay for the technology can be significant - prices vary dramatically based on configurations and facility size - but the investment made sense for us because of the many ORs we run, and the staff and supplies we use to run them. Does it make sense for physician-owned surgery centers in small communities to invest in tracking technology? Probably not. The predictable schedules at those facilities may make the systems cost-prohibitive. But for larger freestanding facilities and hospital outpatient departments, RFID can be an invaluable tool.