Background

In order for an hospital to improve its performance, the starting point is undoubtedly the efficiency of operational processes involving staff (doctors, nurses) and the optimization of the use of hospital assets (medical devices, stretchers, wheelchairs , …). A study conducted by the consulting firm Gartner estimated that every year between 10% and 20% of the inventory of hospital assets is misallocated or even lost. In the worst cases this causes a loss of up to 5,000 USD / year per single bed.

The improvement of the performance of an hospital also passes from the perception of safety that is guaranteed to the staff, with particular reference to nurses and first aid workers. Episodes of emergency, aggression, violence are more and more frequent and cause in the staff a sense of insecurity and evident precariousness.
Localization technologies (RTLS, Real-Time Locating Systems) provide real-time data to identify the patterns of movement of assets and people and to have all the information necessary to make informed decisions, to rationalize workflows, improve patient care and operator safety.

Challenge

Within the ATLAS project, an RTLS solution was implemented in collaboration with a primary Tuscan hospital. The aim of the project was to respond to customer needs, validating the technological solutions developed within the ATLAS project.In particular, the hospital center has expressed some specific operational needs:

• check the presence of patients in the rooms/wards;

• receive alarm alerts in real time if the patient leaves the ward without authorization;

• equip the nursing staff with wearable devices equipped with an alarm call button, in order to receive geo-localized alarm reports within the department;

• reduce the search time for medical devices (medical devices, medicine trolleys, wheelchairs, stretchers, etc.) for the purpose of improving operational processes and increasing the rate of use of resources.

Solution

The solution developed and implemented adopts the MeshCube platform, which uses Wirepas Mesh 2.4GHz technology. This technology is based on a wireless infrastructure of devices that work both as a router for communication within the network and as reference anchors for indoor localization. The communication network is of the mesh type, that is the information that starts from each node, arrives at the monitoring software, through a multi-hop propagation. The mesh network is self-configuring, this means that the information that starts from each node arrives at the monitoring software through a multi-hop propagation.
Plus, the network is self-scalable: the addition of nodes is managed transparently and automatically, using high-security connection and authentication protocols.

The tags, applied to individual hospital assets or worn by staff and patients, periodically scan the nearby anchor nodes, and send the location information to the monitoring software. Thanks to the reduced energy consumption of the devices, which allows battery operation of the anchors, it was possible to implement the entire system without laying a single meter of cable. The installation of the entire infrastructure, which involved an entire hospital department, was carried out in less than half a day’s work by two operators.

A Wirepas Ultra Zero anchor has been installed in every room of the ward (patient rooms, clinics, nurses rooms, …). The anchors are installed on the ceiling, while the gateway has been installed in the department’s reception area, positioned approximately in the center of the department itself. Through the mesh network, all anchors communicate through the gateway with the MeshCube software. A high-level application software, interfaced via REST http API, was developed to provide staff with a simple and intuitive dashboard to access system data.

Each patient, upon entering the ward, is equipped with a Wirepas SafeBand, made with hypo-allergenic materials and compatible with cleaning and sanitizing procedures. The bracelet is equipped with a nurse call button and integrates the fall detection functionality with localized alarm through the positioning system integrated in MeshCube. The nursing and medical staff were instead equipped with a Wirepas SafeX Lite device, which is worn in the pocket of the gown, but which guarantees the same functionality.

Lastly, a Wirepas Slim Tag was applied to all medical devices in the department, used for the identification and tracking of devices. The tag is applied in such a way that any break-in attempts are detected by the advanced movement detection algorithms, in order to send an automatic alarm signal.

In order to integrate a real-time control of exits not authorized by the ward (by patients or medical devices), an access control system in Bluetooth Low Energy technology has been implemented at the access gate, created by means of two antennas able to detect not only the transit but also the direction. The access control subsystem is integrated via MQTT within MeshCube. All system tags are configured, through the MeshCube network configuration interface, to enable both periodic location on the mesh network and real-time location of transits on the gate via Bluetooth Low Energy beaconing.

Results

The MeshCube technology, developed in the ATLAS project and adopted in the project that involved a hospital center in Tuscany, made possible to offer a single RTLS infrastructure for multiple functions: personnel tracking, asset tracking, identification and localization of alarm events , control of unauthorized exits. The first results have already highlighted a decrease in the search times for medical devices and an improvement in the rate of use of resources.

The innovative MeshCube solution made possible to develop a totally wireless infrastructure. The absence of wired infrastructure translates into low design and installation costs and allows perfect adaptability even in the case of retrofit installations on existing buildings. In fact, in the market of RTLS solutions for healthcare, ATLAS has developed a unique model: while the existing RTLS solutions are aimed at Smart Hospitals, ATLAS is aimed at every hospital structure, even those technologically older, with the aim of transform them into Smart Hospitals with a limited economic investment.
Another rewarding element of the developed solution is the fact that it does not require the use of third-party communication infrastructures (for example hospital WiFi network). This guarantees the service manager complete control of the functionality and operation of the system, in all its hardware and software components, from the periphery (tags, anchors) to the center (application software).