Pervasive Observation Medicine: The
Application of RFID to Improve Patient
Safety in Observation Unit of Hospital
Emergency Department
Chang-I Chena,b, Cheng-Yaw Liub, Yu-Chuan Lia,b, Chia- Cheng Chao b,c， Chien-Tsai Liu a, Chieh-Feng Chena,b, Ching-Feng Kuand
a
Graduate Institute of Medical Informatics, Taipei Medical University
b
Taipei Medical University, Municipal Wan Fang Hospital
c
National Chen Chi University MIS Graduate School
d
Chungtai Institute of Health Sciences and Technology, Department of Health Care Administration
Abstract
Over the past decade, observation medicine has become an important component of emergency medicine. There are several settings in which observation medicine has been useful and valuable.(1) RFID as the patient identification ， not only generates the on-line laboratory data and radiology report via hand-held wireless PDA，this RFID system help physician stream-line patient admission to acute bed or ICU in the emergency department more effectively。
Keywords:
Radio Frequency Identification (RFID); Observation Unit (OU); Patient Safety
1. Background
As part of an interdisciplinary study of patient safety and quality improvement, we implemented the RFID framework in the observation unit of emergency department, defined as a real-time observation utility by medical management, and of the informatics framework enhancement that resulted from patient safety of quality improvement.
METHODS. We are applying RFID technology into emergent medical setting then
reviewing 10,000 patients in the observation unit and its records from the emergency department of selected acute care, non-psychiatric hospitals in Taipei, Taiwan in 2004. We then developed wireless web-based RFID framework to implement the real-time safety reminders such as the laboratory and radiology reports to the physician who can make decision promptly to the patients in the observation unit.
laboratory and radiology results is largely reduced within 30 percent due to the RFID system. Observation hours is reasonably decreased by the physician who could actively receiving patient’s updated clinical data to make clinical decision via web-based informatics system.
CONCLUSIONS. We are planning to monitor the effectiveness of pervasive RFID system
from these factors, such as length of waiting for acute bed admission， and the potential delayed diagnosis.(2) When these common ER factors can be greatly improved from the adoption of RFID and many practice emergency department quality issues will gain a better result as the application of RFID.
2. Introduction
Emergency medicine in Taiwan is in the face of major change and overcrowding. National Health Insurance (NIH) reimburse emergency department (ED) services as 30% lower pay out-patient basis, as the results, The phrase ‘pervasive Observation Medicine’ describes the use of pervasive RFID technologies in emergency department of observation unit(OU), including making clinical diagnosis more effectively while patients’ diseases on progressing.(3) These observation areas cater for certain categories of patients with surgical, medical, psychosocial and/or medical specialist consulting needs who can be discharged within 24–48 hours. OU has tended to be condition specific need to outpatient follow up or inpatient but tailored to local needs and interests or more often, lack of alternative pathways within the hospital.(3)
RFID technology is already being deployed across the pharmaceutical and many healthcare industries to improve patient identification of patient safety.(4) The focus on this study is the patient care centered, in which the RFID technology will be used to remind in charge physician to track patient’s medical instruments as well as patients and hospital personnel. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has recently stated new safety goals that should further expedite the process of RFID implementation in this field.(5) It is not difficult to conclude that RFID technology should become a critical success factor for the medical center of the 21st century in terms of both improved patient safety and improved ED clinical decision on the real-time data can be obtained by the physician via wireless PDA.(6)
3. Results
On the monthly ED patients around 5,500, we are applying RFID technology into emergent medical setting then reviewing 5,000 patients in the observation unit on the eight-month period, and its records from the emergency department of selected acute care, non-psychiatric hospitals in Taipei, Taiwan in 2004. We then developed wireless web-based RFID framework to implement the real-time safety reminders such as the laboratory and radiology reports to the physician who can make decision promptly to the patients in the observation unit. Radio frequency identification (RFID), which has focused for its application to inventory control and supply management, can also be implemented in a patient ID wristband system as a substitute in conjunction with, wireless PDA scanner for real-time data collection such as medication administration. (7) The good news is that emerging technologies are available to tap into these potential benefits for improving patient safety.
Using these devices for quick but secure access to essential data can enhance timely clinician decision-making and save lives, improve the flow and ensure security of patient information at the point of care. Wireless technology can provide approach to clinical
information further reducing barriers to safe medication delivery.(7) Compared to bar coded bracelets in use at many hospitals today, RFID bracelets are welcomed by patients because they are far less interfering.
Upon admission, patients receive a paper-thin bracelet embedded with a small RFID chip containing information such as the patient's birth date, ID number, blood type, allergy, doctor's name, medication and other essential medical information.
The application of new technology RFID to improve the patients safety of OU of emergency department had been used from the Sept. 2004.
Table 1 show the 5,010 patients of the length of waiting for acute admission patient used new medical devices RFID from the September, 2004. to the April, 2005 and versus another 3,923 patients not used medical technology RFID from the Jan. 2004 to the Aug. 2004.
Table 1 - Differentiate the used RFID from not used RFID Length of waiting for acute bed admission
It has been shown that the patients using the medical new device RFID has decreased length of waiting (P=0.014) Medical new technology RFID can make process effectively.
Table 2 shows the 1,096 patients of the length of waiting for ICU used new devices RFID from the Sept. 2004 to April, 2005 which compared with 537 patients not used RFID from the Jan. 2004 to the Aug. 2004.
Characteristics Not used RFID Used RFID
Patient No. 3,923 5,010
Length of waiting (LOW) for acute bed
Mean 303.6 77.2
SD 225.3 48.8
Not used RFID vs Used RFID P Value = 0.014
Physician Checked with wireless PDA Reader H IS D at a Bas e App lic at ions
RFID Tags for Patient ID & Clinical management
Tags Tags Tags Tags TagsR FI D Tags
Real-time safety data to the physician
E D Triage R FI D Bracelet
To Patien t
Reader
La b & R adiology Dat a to P DA
Patien t Basic Data Excha nged with HI S
E D R FID Observation Syste m
Table 2 - Differentiate the used RFID from not used RFID Length of waiting for ICU admission
It has been shown that the patients using the medical new device RFID has decreased length of waiting for ICU(P=0.026). Medical new technology RFID can make clinical decision process effectively. Physicians or clinician decision can improve patient safety and medical delivery on well-ordered.
4. Discussion
On this study, ED patients who may need short-term observation and /or treatment. There are patients who may not be very reliable in follow-up who might fit into a brief diagnostic work in an observation unit (OU) or get initial therapy in the OU. About 5-7% of all emergency department patients could benefit from an observation unit.(8) The OU may help improve relations with the medical staffs, and improve public relations by improving emergency department(ED) efficiency and turn-around times. The setting of the RFID systems may be used to track patients, doctors and expensive equipment in hospitals. RFID tags can be attached to the ID bracelets of all patients or just patients requiring special attention, or in predictable critical conditions of patients treated in the observation unit of the emergency so their location can be monitored continuously.(9)
Improvements in emergency department patients’ safety are the most importance work, and will improve staff training, and depend on a combined access including regular monitoring of practice, a better understanding of the causes of errors, a reduction in the complexity of routine procedures taking advantage of new technology.(10) Further development of the systems is needed to enable staff to carry out bedside caring procedures efficiently and accurately.(11)
A small number of studies using new technology RFID for the patient safety in hospitals have shown promising results in preventing errors. Although the effectiveness of RFID system shown a significant improvement on the basis of length of waiting for acute bed (P=0.014) and ICU (P=0.026) respectively. There are several other factors which may contribute the change such as the High Risk Reminder (HRR) on the critical value of lab. test and radiology report, computerized consulting system, these should perform further study to find out the correlation with RFID.
5. Conclusion
The use of new technology RFID to improve the patients’ safety of ER is very promising. (8) Supporter of the RFID system believes RFID tag will improve rapid access to vital medical information on unconscious or uncommunicative patients. RFID will eventually replace bar-code technology at the bedside. But RFID can provide safety in so many ways
Characteristics t used RFID Used RFID
Patient No. 537 1,096
Length of waiting (LOW) for ICU
Mean 236.7 73.1
SD 166.0 76.9
because it can present so much more information than a bar code.(12) Above all, early studies suggest can cut medical error rates greatly.
With the application of RFID system, emergency department(ED) based observation unit are becoming effectively evaluated for the assessment and treatment of patients whether who may require inpatient or ICU management or monitoring.(13) The RFID based observation unit can be of great value to patient care. Although the concept of the OU is considered good practice especially in minimizing clinical risk, within the framework of RFID, it introduce the concept of wireless medical informatics environment which combined the safety mechanisms of high risk reminder (HRR), pervasive observation management (POM), and there has been significant progress to further develop and improve the quality which is safety centered of OU in ED practice.
6. Reference
[1] Ross, M.A., & Graff, L.G. (2001). Principles of observation medicine. Emergency Medicine Clinics of North America, 19(1), 1–18.
[2] Ross, M.A., & Graff, L.G. (2001). Principles of observation medicine. Emergency [3] Medicine Clinics of North America, 19(1), 1–18.
[4] Ross, M.A. (1998). Guidelines and clinical pathways. In L.G. Graff (Ed.), Observation units implementation and management strategies (pp. 23–36). Dallas, TX: American College of Emergency Physicians.
[5] Barcode identification for transfusion safety. Current Opinion in Hematology. 11(5):334-338, September 2004. Murphy, M F a,b; Kay, J D.S
[6] Abrahamsen, Cathie RN, MSN Washington taps into healthcare technology [Departments: Tech update] Nursing Management (Springhouse) © 2005 by Lippincott Williams & Wilkins, Inc. Volume 36(3) March 2005 pp 52-55
[7] Poon, E., Blumenthal, D., Jaggi, T., Honour, M., Bates, D., and Kaushal, R.: “Overcoming Barriers to Adopting and Implementing Computerized Order Entry Systems in U.S. Hospitals, ”Health Affairs, 23:184–90, 2004.
[8] Sensmeier, Joyce RN, BC, CPHIMS, MS Transform workflow through selective implementation. Nursing Management. 35(12):46-51, December 2004.
[9] Kohn, C and Henderson, C. W. (2004), “RFID-enabled medical equipment management programs to reduce costs,” Managed Care Weekly Digest, 5/10/2004, 94-95
[10] Ward, Rod MA Ed, BSc, RGN, RNT NEWS. CIN: Computers, Informatics, Nursing. 23(3):115-118, May/June 2005.
[11] Sensmeier, Joyce RN, BC, CPHIMS, MS Transform workflow through selective implementation. Nursing Management. 35(12):46-51, December 2004.
[12] 2004. Featherly, K.: “Emerging Technologies,”Healthcare Informatics. 21(1): 29–38,
[13] Committee on Quality of Healthcare in America, Institute of Medicine, Crossing the Quality Chasm: A New Health System for the 21st Century, Institute of Medicine National Academy Press, 2001.
[14] Ward, Rod MA Ed, BSc, RGN, RNT NEWS. CIN: Computers, Informatics, Nursing. 23(3):115-118, May/June 2005
Address for correspondence
Yu-Chuan (Jack) Li, M.D., Ph.D.
President, Taiwan Assoc of Medical Informatics Professor and Chief, Graduate Institute of Med Info Vice Superintendent, Wan Fang Hospital
Taipei Medical University, Taipei, Taiwan email: jack@tmu.edu.tw | http://li.tmu.edu.tw/
