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Real-Time Locating System

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Real-Time Locating System (RTLS)

St. Michael is an acute care facility based in Alabama. The healthcare facility boasts of a 1,000 bed capacity that is run through a manual admission model. The local community hospitals refer their patients to the hospital after requesting for a consultation with a specialist doctor. Patients arrive at the facility in wheelchairs and ambulances which increases the population of sick patients along the hallways (California Healthcare Foundation, 2011).  Some of the patients are assigned to the wrong floors which increases the level of hallway stays. Consequently, the most overcrowded hospital areas include:-

  • The emergency departments that deal with critical conditions such as accidents.
  • The inpatient section that deals with the admission of new patients.

Change Project Plan

The purpose of this project plan is to propose the implementation of a patient transfer center to handle all patient referrals from other hospitals. The center will be characterized by a call center for handling all incoming referrals. Therefore, all admission information will be managed from this central system including bed placements and emergency room requests. A Real-time locating systems (RTLS) tracking system will be implemented to keep track the locations of all inpatient admissions and shared medical equipment (“How to Prevent Corridor Clutter in Hospitals,” n.d). A 30 minute parking rule will be implemented within the facility to notify personnel whether equipment is close to violating the Line Safety Code.

Assessment of environment

Current practices

During the swine flu pandemic the hospital faced increased pressure to its emergency and in-patient departments. The inefficiencies in the current system created unnecessary delays to the delivery of healthcare to patients (Pearl, 2018). The hospital corridors ended up being used as waiting rooms for patients who have been admitted to the hospital. The patients were forced to wait in trolleys placed along the hospital corridors or in ambulances for over 12 hours before finding a vacant bed (Triggle, 2018). The delays in the admission process have been blamed on the amount of paper work required to transfer patients form the emergency departments or operating rooms into the wards. Medical personnel are forced to create makeshift dividers along the corridors to provide privacy to the patients.

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The hospital structure

The number of carts or equipment found along the corridors can reach a maximum of 240 at any particular time. This includes supply carts, rolling walkers, treatment carts, oxygen tanks, and patient beds (Mitchell, 2006). A higher rate of foot traffic is witnessed along the hallways during housekeeping, emergency situations, serving of meals and shift changes. The other category of non-wheeled clutter included linen bags, IV poles, housekeeping, and food service carts. This category of equipment contributed to more than 1% of the overall foot traffic along the corridors.

Source:Patient waiting in hallways (Solomon, 2019).

The need for change

The Joint Commission (TJC) has identified corridor clutter as a top safety standard for patients that can lead to hospital incompliance (“The Joint Commission,” n.d). The commission cites the Life Safety Code as a requirement for all exit paths within a hospital. This includes emergency exits and fire escape. This code requires hospitals to clear all obstructions, clutter and unattended items along the corridors or egress (“How to Prevent Corridor Clutter in Hospitals,” n.d). Clear hallways enhance patient safety during emergency situations such as terror attacks or fire among others. Clear hallways make it easier for medical personnel to quickly evacuate and relocate the patients as visibility is enhanced.

Advantages of change

            Clearing all clutter along the hospital hallways will enhance the hallway throughput rates and capacity. This will be achieved by redesigning the patient admissions process, centralizing bed placements and tracking the status of new referrals. The benefits to the hospital will be to:-

  • Reduce transfer time between facilities to one day.
  • Increase patient flow along sensitive areas by 80%.
  • Reduce the nursing time for finding patient information and medical supplies by 50%.
  • Reduce the number of registration personnel and admission time by 90%.
  • Reduce the average patient waiting time to less than 30 minutes.
  • Reduce the rate of ambulance diversions and unseen patients by 50%.

Cost and resources

Developing a central referral and call center will cost the institution a minimum of $1 million. This cost will include the underlying technological infrastructures, servers, tracking systems and the supporting soft-wares. A bedside registration and discharge system will be introduced to enhance the bed allocation and patient discharge process. A discharge lounge will set aside to fast track the release of patients from the hospital. An outpatient area will be created to cater for patients who do not need full registration or admission into the hospital (“California Healthcare Foundation,” 2011). An emergency zone will be created to manage placements of patients coming from the emergency department or the operating rooms. These patients will be provided with tags that will automatically update their locations as they are transferred to new rooms. The medical equipment such as wheel chairs and gurneys will be stored in adjacent rooms facing sensitive areas such as the laboratory, imaging rooms or operating rooms.

Source:  (“Managing Corridor Clutter,” n.d)



The goal of this project is to enhancing the mobilization of referral of patients between facilities by enhancing access to medical equipment.


  • Minimize the number of equipment parked along the corridors.
  • Set a 30 minute parking rule for non-essential medical equipment.

Phases of change

Such a large scale organizational change will require a shift in corporate culture and the relationships between the medical personnel (Burnes, 2004). The hospital will utilize Kurt Lewin’s 3-step model to change to sustaining the required operational changes.

Phase 1: The 10 most clutter prone areas will be identified and prioritized for de-cluttering with the help of the medical staff. Zoning areas will be used to prioritize regular inspections and deployment of environmental service staff for clearing of clutter.

Phase 2: Zoning areas will be clearly labeled using warning signs to notify the personnel that they are within a compliance checkpoint area. These signs will include additional information regarding safety laws that does not entertain clutter along the corridors.

Phase 3: All medical equipment coming into the hospital will be attached with radio frequency tags. Network sensors and transceivers will be installed along these sensitive zones to track unattended and idle clutter along the corridors for more than 20 minutes. This information will be communicated to the hospitals information system for immediate action.

Phase 4: The bed management system will send automated messages to the room managers for quick identification of vacant beds (Boulos & Berry, 2012). A discharge alert system will send information direct to the hospital dashboard to reduce patient wait period. This will increase the patient flow along the hallways thereby improving admission rates.

Phase 5: Patient information will be automatically captured using hospital cards or electronic health records (EHR) for easy management of referrals from other hospitals. This electronic information management system will automatically notify caregivers of any patient who has waited for too long by sending alerts to the admission dashboard.


The implementation of a patient transfer and call center will take a minimum of 6 months. The supporting tracking technologies and information systems will require a go-live period of three months to acquaint the staff to the new system. This will include a pre-implementation assessment period of one month. The steps to clear the hospital hallways will take a period of two months which will run from July –October 2019.

Mobilization the driving forces

The hospital staff will be increased to handle the high traffic periods such as natural disasters, fire or terrorism attacks. The disaster management plan will include an incident commander that will control the flow of new patients. The incident commander will use the hospital tracking system to assign hospital beds and medical equipment required for each emergency situation (California Healthcare Foundation, 2011). A touch screen will be installed to manage all bedside requests such as IV pumps, supply carts and oxygen tanks among others. This information will be updated directly to the hospitals information system.

Minimizing restraining forces

Lewin’s first-step to change states that employee behavior are maintained through a status quo (Burnes, 2004). Therefore, in order to create long term change such behaviors have to be destabilized, unlearnt or unfrozen before new routines are adopted. The tracking system will require medical personnel to issue physical tags to patients. These tags will have to be worn around the wrist for easy identification of the patient at all times. Therefore, the nurses will undergo an intensive training program on the technical aspects of the new devices, their installation process and how they work (“California Healthcare Foundation,” 2011). All medical personnel will be responsible for ensuring equipment are used and stored in their set locations.

Plan of evaluation

Lewin’s second stage to change states that the motivation to adopt new technologies does not necessarily translate to long term change (Burnes, 2004). New forces can easily undo years of hard work due to difficulty in technological adoption or employee fear. Training programs will be used to assure the medical personnel of the importance of the new system in enhancing patient care rather than monitoring personnel productivity. In addition to that an environmental excellence initiative will be implemented within the institution to regularly award positive improvements (“California Healthcare Foundation,” 2011). Standards met will ensure the success of the project.


Training and education

During the roll out of the new tracking system, an in-house vendor will manage the training programs for the system. A training log will be provided to all employees as part of the induction process that will be included in the professional development records.  The training logs will monitor the new system for any inefficiency and provide remedies for deficit skillsets (“Medicines & Healthcare Products Regulatory Agency,” 2015). The training programs will be done regularly to keep the medical personnel up to date with any new updates to the system.


The evaluation of the tracking system will be based on usability, ease of connectivity to hospital information systems and coordination of hospital resources. Once the system reaches a stable point of adoption, the third stage of Lewin’s theory will become easier to adopt. This includes refreezing of new work behaviors to prevent a relapse into the old routines (Burnes, 2004). As a result the hospital will implement quarterly audit mechanism to reinforce any positive achievements made in the past (“Duke-Margolis Center for Health Policy,” 2016). The success of this project will enhance the hospitals certification by The Joint Commission (TJC). The new system will also reduce the regulatory burden on the hospital through active surveillance and reporting of any healthcare safety gaps.


The purpose of this plan was to reduce the level of overcrowding within St. Michael hospital emergency department. The challenges of these overcrowded hallways include the undocumented deaths due to long waiting lines (Paiva, Brito2 & Leiva-Marcon, 2018). An inefficient admission system creates cluttered hallways, long admission times, prolonged hospital stay and delayed provision of critical lifesaving healthcare. This leads to medical errors that could be easily prevented by automating the critical hospital processes.


Boulos, M. N. K., & Berry, G. (2012). Real-time locating systems (RTLS) in healthcare: a condensed primer. International journal of health geographics, 11(1), 25.

Burnes, B. (2004). Kurt Lewin and the planned approach to change: a re‐appraisal. Journal of Management Studies, 41(6), 977-1002.

California Healthcare Foundation (2011). Using Tracking Tools to Improve Patient Flow in Hospitals. Accessed on July 5, 2019 from https://www.chcf.org/wp-content/uploads/2017/12/PDF-UsingPatientTrackingToolsInHospitals.pdf

Duke-Margolis Center for Health Policy (2016). Better Evidence on Medical Devices: A Coordinating Center for a 21st Century National Medical Device Evaluation System. healthpolicy.duke.edu. Accessed on July 5, 2019 from https://healthpolicy.duke.edu/sites/default/files/atoms/files/med-device-report-web.pdf

Medicines & Healthcare Products Regulatory Agency (2015). Managing Medical Devices . Guidance for healthcare and social services organizations. Accessed on July 5, 2019 from https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/421028/Managing_medical_devices_-_Apr_2015.pdf

Mitchell, J. M. (2006). Impact on carpet tile in a hospital patient unit corridor: an observational case study. Master of Interior Design Degree thesis, Gainesville: University of Florida.

Pearl, R. (2018). Saving America’s Hospitals: It’s Time To Stop Wasting Time And Lives. Forbes News, Forbes Media LLC. Accessed on July 5, 2019 from https://www.forbes.com/sites/robertpearl/2018/01/30/saving-americas-hospitals-2/#33c2c97f241c

Solomon, S. (2019).   Corridor Nation: As hospitals gasp for funds, patients wait out in the hallways. THE TIMES OF ISRAEL. Accessed on July 5, 2019 from https://www.timesofisrael.com/corridor-nation-as-hospitals-gasp-for-funds-patients-wait-out-in-the-hallways/

Triggle , N. (2018).  ‘Patients ‘dying in hospital corridors’. BBC News, The BBC. Accessed on July 5, 2019 from https://www.bbc.com/news/health-42572116

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