A little bit of followup on our previous post on hospital hand-hygience. Eliminating hospital-acquired infections requires achieving a nearly perfect performance on many different fronts. From quarantine of suspect new admissions (e.g., nursing home patients), staff hand-hygiene, to efficient forensic analysis when the presence of an infection is discovered. The latter case illustrates to me the potentially enormous impact that technology might have on the infection control and the larger issue of medical errors.
The Freakonomics podcast that motivated my little bit of research mentioned the potential application of automated location tracking. First, imagine that every patient, every staff member, every piece of equipment, every parcel of drugs or apparatus is identified and real-time located by an RFID tag. An almost trivial application of that real time information is described in this vendor promotion Elpas Hand Hygiene Compliance Monitoring Solution:
(…) Each caregiver is issued an Elpas Active Identity Badge. So when the caregiver uses a hand washing station or sanitizer, a nearby Elpas LF Exciter triggers the personal badge tag worn by the caregiver to transmit hand washing event messages that identifies the caregiver and the time that the specific dispenser was used.
Elpas RTLS Readers relay this time-critical hand hygiene data over the hospital’s Ethernet network to the Eiris Command & Control Server that provides hand hygiene compliance reporting and alerting.
Hospital administrators can use the Elpas Hand Hygiene Solution to generate detailed compliance reports per caregiver or per examination room. This documentation can be beneficial in monitoring staff compliance with hospital hand hygiene policies and to trace the source of infection transfers.
The Elpas Hand Hygiene Solution can also alert administrators of non-compliance incidents in real-time as well as alerting those caregivers to their non-compliant status prior to providing care.
So the system can alert the doctor that they need to rectify their hygiene before contacting this patient; and of course can perform logging of compliance exceptions. With this feedback, and the appropriate hospital administration priorities, soon there won’t be any un-corrected exceptions.
Now, imagine a hypothetical infection case: a patient is discovered to be infected with MRSA. Besides quarantine and treatment, one would expect the hospital staff to urgently want to know “How did this happen? “. Who and what has been in contact with this patient during the time window of possible infection? The imagined RTLS system will “know” the time-location web of interactions involving this patient. Just one of the more obvious questions comes back to the hand-hygiene topic: were there compliance exceptions for any of the staff interacting with the infected patient? That knowledge would at least guide us to give high priority to those staff (I have no idea what best practice reactions are to this sort of case).
If Sebastian Thrun and colleagues can program a self-driving car, it won’t be long before the technical capability exists to produce in seconds an analysis of the time-location history, allowing hospital response staff to establish possible infection-sources ranked from most- to least-probable. Is it a fixed contamination (staff coffee maker, elevator); a staffer; a mobile blood-pressure monitor? How many hours/days does it take today when humans have to paw through reams of paper records to reconstruct the time-location history? The longer it takes to solve the puzzle the more infections.
There are already a number of competitors entering this field. Deployment seems to be starting with the easy and obvious: tracking hospital equipment and supplies, etc. – i.e., Walmart comes to hospital inventory control. Next seems to be error prevention priorities (is the correct patient about to get an amputation of the correct limb?; correct drug delivery?; etc.).
So far I’ve not found any public case study information demonstrating important successes in infection control or medical errors from an RTLS implementation – but I am hopeful. If not RTLS, then we need some another impartial technology to overcome our human fallibility. Meanwhile, more people will continue to die (in the US) from hospital-acquired infections than from AIDs.
A few other sources I noted:
Building a Smart Hospital using RFID technologies (2006, the obvious applications)