HOW TO CREATE A COVID-SAFE SURGICAL

CENTER BY LEVERAGING REAL-TIME TECHNOLOGIES

by Mary Jagim, MSN, RN, CEN, FAEN | Chief Nursing Officer at Infinite Leap

an Infinite Leap company

Whitepaper

2

HOW TO CREATE A COVID-SAFE SURGICAL CENTER BY LEVERAGING REAL-TIME TECHNOLOGIES

SUMMARYSurgery centers during the pandemic recovery period will be experiencing a unique set of challenges. There will be a focus on restoring their normal surgical caseload while at the same time providing a safe environment for patients and staff, with a focus on social distancing and limiting exposure opportunities. Workflow efficiency and heightened awareness of delays will be critical.

RTLS-enabled workflow solutions provide facilities with an opportunity to leverage technology to optimize operational performance, decrease wait times and delays, and enhance communication with patients and families. The workflow solution will also help to reduce exposure points for patients such as those in check-in lines or waiting areas, creating a COVID-safe space.

The right solution will enable a surgery center to:• Communicate in real time with patients as

they arrive on campus• Eliminate wait lines for check-in• Reduce congestion in waiting areas• Decrease or eliminate patient wait times in

each phase of care • Enhance care coordination • Improve resource utilization • Facilitate OR suite turnover• Provide contact tracing for any

potential exposures• Enable comprehensive family communication• Simplify visitor management

The new generation of Real-Time Location Systems (RTLS), such as WorkflowRT for Surgery Centers, enables healthcare facilities to deploy a solution in a matter of hours, and its subscription-based pricing model makes it affordable and low-risk. The cost of implementing an RTLS-enabled patient flow solution is fully justified through an immediate impact on surgery centers’ operational efficiency combined with improved patient and staff safety opportunities.

BACKGROUND The Centers for Medicare and Medicaid Services (CMS) recommended on March 18, 2020 to delay all elective surgeries, and non-essential medical, surgical, and dental procedures, during the COVID-19 pandemic. Due to this recommendation ambulatory surgery centers that only perform elective procedures have for the most part been closed. Hospitals were instructed to triage non-elective cases and prioritize those deemed necessary or urgent.1 Delaying the elective surgeries has resulted in up to an 80% decline in surgical cases.2,3,4

The delay of elective procedures was meant to prevent the spread of COVID-19, preserve critical equipment, and ensure adequate hospital beds and healthcare worker resources. But the impact has also resulted in a delay of care for patients, a disruption in employment for many staff and providers, and a significant drop in surgical service’s revenue. Since elective surgical services contribute significantly to a hospital’s bottom line, the loss of revenue is having a major impact on the financial status of hospitals and surgery centers.

On April 19, 2020, CMS issued recommendations on re-opening health care systems in areas with a low incidence rate of COVID-19.5 The guidance provides direction on the considerations a facility needs to take prior to resuming elective surgical cases.6

Resuming elective surgical cases while protecting patients and staff from possible exposures is a multifaceted challenge. In a joint statement published by the American College of Surgeons, American Society of Anesthesiologists, Association of PeriOperative Registered Nurses, and the American Hospital Association, numerous considerations and recommendations are listed for surgery centers.7 Many of these considerations are related to the scheduling of cases and the processes around the patient experience that impact contact points with other individuals.

They include the following:• Patient messaging and communication to

provide clear instructions for patients prior to arrival onsite

• Patient arrival process at facility• Social distancing requirements in waiting

and care areas• Visitor restrictions• Limiting number of personnel in contact

with patients along with potential patient-staff contact points

• Response procedure for a COVID-19 positive patient or staff

• Scheduling consideration for the prolonged duration of operating room turnover time due to additional environmental cleaning requirements

• Strategy for operating extended hours and weekends to allow for more case capacity

DISCUSSIONAs communities begin to re-open, hospitals and surgery centers will be slowly re-opening their schedules. Extended weekday and weekend hours may be needed to address the backlog of delayed cases while maintaining appropriate spacing of cases to accommodate the extended room turnover times. There will be new challenges as they implement the processes necessary to maintain patient and staff safety. Facilities will be undertaking the difficult task of optimizing patient access and flow through the OR while limiting risks for patient and staff exposures.

Necessary priorities will include:• Patient communication• Maintaining social distancing of 6 feet apart• Eliminating waiting lines for check-in• Reducing or eliminating patient time spent in

waiting rooms• Visitor restriction and communication• Minimizing person to person contact before,

during, and after surgery• Organized and efficient room turnover process

with comprehensive cleaning protocols• Efficiently performing thorough contact tracing

to identify patients and staff in the practice at risk in the event of any exposures

• Optimize number of cases while maintaining safe environment for patients

Surgery centers must develop plans and processes now to prepare to fully reopen while providing a safe space for patients and staff. Healthcare facilities can choose to leverage technology solutions to address the challenges of

running operations in the “new normal”. However, with the economic impact on healthcare, funds for solutions will be limited. There are affordable technology solutions that have the ability to provide solutions to several of the new challenges facing surgery centers.

SOLUTIONTHE POWER OF REAL-TIME LOCATION SYSTEMSIn order to reduce risk of exposure, knowing the location, time spent in each location, and person to person contact between patients and staff will be extremely important. Real-time location systems (RTLS) offer a solution for surgery centers that provides this data in a meaningful way to support flow and throughput processes. Specifically, RTLS tools are able to provide insight into processes aimed at facilitating the patient arrival process, enhancing communications, improving staff workflow and patient throughput, and reducing the risk of infections.

Traditionally, RTLS solutions tend to be cost prohibitive and time-consuming to implement. That is no longer the case with the introduction of a new generation of RTLS solutions that are affordable and easy to install. The following are examples of ways RTLS can support surgery centers in meeting their critical goals around access and safety.

STREAMLINED PATIENT ARRIVAL AND CHECK-IN PROCESSPriority one to ensuring patient and staff safety is coordinating the patient's arrival in a manner that reduces their time spent waiting near

others. Facilities will want to begin communication with the patient prior to their arrival on campus. Waiting lines to check in should be avoided. Communications, preferably through text messaging, should direct the patient to the exact location of check-in, where they pick up an RTLS badge. Once checked in, patients should be directed straight to pre-op. By using the real-time location, clinical staff in Pre-Op and the OR are immediately aware of the patient's arrival and location so that patients proceed through the phases of care in the shortest amount of time with the least amount of person to person contact.

USE OF RTLS DATA TO IMPROVE STAFF WORKFLOW AND PATIENT THROUGHPUTAs surgery centers begin opening up, they will be focused on accommodating the most number of cases possible, while limiting a patient’s time and points of contact in the facility. The standard

priorities around ontime case starts and room turnover will require heightened operational focus. By leveraging RTLS, the time a patient arrives in the OR suite and the time it takes to turn over the room are automatically captured.

When patients have RTLS badges, staff are always able to quickly know where a patient is located, what phase of care they are in, and how long they have been in any particular patient phase. This is done automatically and can also flow into an electronic health record. Furthermore, with staff wearing RTLS badges, the location of surgical team members is also known, which improves overall visibility and aids in reducing delays starting surgical cases.

As an example, in the figure below, the onsite patient list from WorkflowRT for Surgery Centers allows clinicians to see at a glance the real-time location of all patients, how long they have been

in the current phase of care, and the staff who are in the room with them. Other views provide them at-a-glance information to know which OR or prep/holding rooms are occupied and which are available. Clinicians are also able to clearly identify how long the patient has been alone, potentially waiting on a staff member or service such as discharge. By using RTLS tools, real-time views are able to highlight the key pieces of information clinicians need to efficiently advance the patient to the next phase of care. All of the data is updated automatically based on the movement of the RTLS badges.

Wall displays, such as the one below, can also be used to cue staff regarding patient status and delays in care. The wall displays provide an even more efficient option for staff to quickly look up and know the location and status of patients and/or staff.

IMPACTING ROOM TURNOVER TIMES OR room turnover is going to be a critical part of the process. Room turnover is generally accepted as one of the key processes where efficiency is critical because it drives the start of the next case and is closely tied to surgical case capacity. With RTLS, the exact movement time of the patient out of the OR suite can drive a notification to the turnover team to begin cleaning. RTLS can even help “watch the clock” to indicate the time of

turnover. With the requirement for more complex and thorough room sanitizing, assuring optimal efficiency of the turnover process will be critical. To impact the room turnover process appropriately, it must be known which areas of the room turnover need the focus—information the RTLS data will provide.

REPORTSRTLS has the ability to automatically capture (without requiring manual input from staff) data related to location, time, and duration of patients and staff. By leveraging key metrics, surgery centers are able to identify surgical delays and modify processes to gain improvements. The figures below from WorkflowRT for Surgery Centers provide an example of trend data for patient flow and room occupancy that could be used to optimize surgical capacity.

3

CONTACT TRACINGAccurate and efficient contact tracing will be a required part of resuming surgical caseloads. With the assistance of an automatically-generated contact tracing report which leverages data collected by RTLS, surgical centers can speed up the process of taking the necessary steps to minimize the spread of the disease. The contact tracing report enables the surgery center to promptly notify patients and staff about potential exposure so follow-up.

VISITORS AND FAMILYVisitor management and communications will be critical in the post-COVID era. Visitor restrictions may be in place at some sites, meaning patients may only be allowed one person to accompany them, or they may be required to come alone. Communication will be of utmost importance to give patients and families peace of mind by knowing they will be receiving ongoing updates throughout the surgical visit. RTLS can enable a number of tools to support communication. As an example, WorkflowRT for Surgery Centers offers the following features:

• Family View BoardIf families are able to be inside the facility, a family view board, as seen in the following example, can be displayed in the waiting area providing visual updates on the patient's progress.

REFERENCES1. Centers for Medicare & Medicaid Services (CMS).

(2020). CMS Releases Recommendations on Adult Elective Surgeries, Non-Essential Medical, Surgical, and Dental Procedures During COVID-19 Response. Retrieved from https://www.cms.gov/newsroom/press-releases/cms-releases-recommendations-adult-elective-surgeries-non-essential-medical-surgical-and-dental

2. Mehrotra. A et al. (2020). “What Impact Has COVID-19 Had on Outpatient Visits?,” Commonwealth Fund, Apr. 23, 2020. Retrieved from https://doi.org/10.26099/ds9e-jm36

3. Respaut, R, Spaulding, R. (2020). U.S. Hospitals Halt Lucrative Procedures Amid Coronavirus, Job Cuts Follow. Reuters, March 23, 2020. Retrieved from https://www.reuters.com/article/us-health-coronavirus-usa-hospitals/u-s-hospitals-halt-lucrative-procedures-amid-coronavirus-crisis-job-cuts-follow-idUSKBN21I388

4. Luthi,S et al. (2020). Hospitals Bid for $100 Billion in Next Coronavirus Package. Politico, March 19, 2020. https://www.politico.com/news/2020/03/19/hospitals-coronavirus-funding-138383

5. Centers for Medicare & Medicaid Services (CMS). (2020). CMS Issues Recommendations to Re-Open Health Care Systems in Areas with Low Incidence of COVID-19. Issued April 19. Retrieved from https://www.cms.gov/newsroom/press-releases/cms-issues-recommendations-re-open-health-care-systems-areas-low-incidence-covid-19

6. Centers for Medicare & Medicaid Services (CMS). (2020). Recommendations for Re-Opening Facilities to Provide Non-emergency Non-COVID-19 Healthcare: Phase I. Retrieved from https://www.cms.gov/files/document/covid-flexibility-reopen-essential-non-covid-services.pdf

7. American College of Surgeons (ACS), (2020). Joint Statement: Roadmap for Resuming Elective Surgery after COVID-19 Pandemic. Issued April 17. Retrieved from https://www.facs.org/covid-19/clinical-guidance/roadmap-elective-surgery

©2020 Prompt.Health - an Infinite Leap company. All original content in this publication is copyright material belonging to Infinite Leap. Any re-use or reproduction without the expressed, written consent of the copyright owner is strictly prohibited.

ABOUT THE AUTHORMary Jagim, MSN, RN, CEN, FAENChief Nursing Officer at Infinite Leap

Mary Jagim has over 30 years of experience in emergency nursing, healthcare leadership, public policy, and healthcare consulting. She served as president of the Emergency Nurses Association in 2001 and was a member of the IOM Study on the Future of Emergency Care in the US Health System. In her current position, Mary serves as the Chief Nursing Officer at Infinite Leap, the premier healthcare consulting group and solutions provider for real-time technologies. Mary is one of the leading experts in the implementation and use of real-time location in healthcare. With her practical expertise in emergency preparedness, she assists healthcare systems with leveraging technology to provide a safer environment for patients and staff.

ABOUT PROMPT.HEALTHPrompt.Health, an Infinite Leap company, provides easy and affordable real-time technology solutions that make a big impact on patient experience and safety, increased capacity and access, and improved staff satisfaction.

• Visitor ManagementIf visitors are allowed to accompany patients, keeping track of visitors and identifying one visitor per patient can be a challenge. The same workflow tools that support patient flow can assist with visitor management. As an example, WorkflowRT for Surgery Centers allows staff to identify a patient’s designated visitor and communicate with them. The figure below illustrates tools for visitor management.

• Automated Messages and Custom MessagingAs patients advance through the phases of the surgical experience, from check-in to pre-op to surgery and then on to recovery, the movement of their badge generates automated updates to families or any recipients the patient has identified. Custom messages may also be sent at any time. This messaging tool keeps families informed while easing the level of effort by staff. A sample of automated messages for a surgical site is shown below.

BACKGROUND The Centers for Medicare and Medicaid Services (CMS) recommended on March 18, 2020 to delay all elective surgeries, and non-essential medical, surgical, and dental procedures, during the COVID-19 pandemic. Due to this recommendation ambulatory surgery centers that only perform elective procedures have for the most part been closed. Hospitals were instructed to triage non-elective cases and prioritize those deemed necessary or urgent.1 Delaying the elective surgeries has resulted in up to an 80% decline in surgical cases.2,3,4

The delay of elective procedures was meant to prevent the spread of COVID-19, preserve critical equipment, and ensure adequate hospital beds and healthcare worker resources. But the impact has also resulted in a delay of care for patients, a disruption in employment for many staff and providers, and a significant drop in surgical service’s revenue. Since elective surgical services contribute significantly to a hospital’s bottom line, the loss of revenue is having a major impact on the financial status of hospitals and surgery centers.

On April 19, 2020, CMS issued recommendations on re-opening health care systems in areas with a low incidence rate of COVID-19.5 The guidance provides direction on the considerations a facility needs to take prior to resuming elective surgical cases.6

Resuming elective surgical cases while protecting patients and staff from possible exposures is a multifaceted challenge. In a joint statement published by the American College of Surgeons, American Society of Anesthesiologists, Association of PeriOperative Registered Nurses, and the American Hospital Association, numerous considerations and recommendations are listed for surgery centers.7 Many of these considerations are related to the scheduling of cases and the processes around the patient experience that impact contact points with other individuals.

They include the following:• Patient messaging and communication to

provide clear instructions for patients prior to arrival onsite

• Patient arrival process at facility• Social distancing requirements in waiting

and care areas• Visitor restrictions• Limiting number of personnel in contact

with patients along with potential patient-staff contact points

• Response procedure for a COVID-19 positive patient or staff

• Scheduling consideration for the prolonged duration of operating room turnover time due to additional environmental cleaning requirements

• Strategy for operating extended hours and weekends to allow for more case capacity

DISCUSSIONAs communities begin to re-open, hospitals and surgery centers will be slowly re-opening their schedules. Extended weekday and weekend hours may be needed to address the backlog of delayed cases while maintaining appropriate spacing of cases to accommodate the extended room turnover times. There will be new challenges as they implement the processes necessary to maintain patient and staff safety. Facilities will be undertaking the difficult task of optimizing patient access and flow through the OR while limiting risks for patient and staff exposures.

Necessary priorities will include:• Patient communication• Maintaining social distancing of 6 feet apart• Eliminating waiting lines for check-in• Reducing or eliminating patient time spent in

waiting rooms• Visitor restriction and communication• Minimizing person to person contact before,

during, and after surgery• Organized and efficient room turnover process

with comprehensive cleaning protocols• Efficiently performing thorough contact tracing

to identify patients and staff in the practice at risk in the event of any exposures

• Optimize number of cases while maintaining safe environment for patients

Surgery centers must develop plans and processes now to prepare to fully reopen while providing a safe space for patients and staff. Healthcare facilities can choose to leverage technology solutions to address the challenges of

running operations in the “new normal”. However, with the economic impact on healthcare, funds for solutions will be limited. There are affordable technology solutions that have the ability to provide solutions to several of the new challenges facing surgery centers.

SOLUTIONTHE POWER OF REAL-TIME LOCATION SYSTEMSIn order to reduce risk of exposure, knowing the location, time spent in each location, and person to person contact between patients and staff will be extremely important. Real-time location systems (RTLS) offer a solution for surgery centers that provides this data in a meaningful way to support flow and throughput processes. Specifically, RTLS tools are able to provide insight into processes aimed at facilitating the patient arrival process, enhancing communications, improving staff workflow and patient throughput, and reducing the risk of infections.

Traditionally, RTLS solutions tend to be cost prohibitive and time-consuming to implement. That is no longer the case with the introduction of a new generation of RTLS solutions that are affordable and easy to install. The following are examples of ways RTLS can support surgery centers in meeting their critical goals around access and safety.

STREAMLINED PATIENT ARRIVAL AND CHECK-IN PROCESSPriority one to ensuring patient and staff safety is coordinating the patient's arrival in a manner that reduces their time spent waiting near

others. Facilities will want to begin communication with the patient prior to their arrival on campus. Waiting lines to check in should be avoided. Communications, preferably through text messaging, should direct the patient to the exact location of check-in, where they pick up an RTLS badge. Once checked in, patients should be directed straight to pre-op. By using the real-time location, clinical staff in Pre-Op and the OR are immediately aware of the patient's arrival and location so that patients proceed through the phases of care in the shortest amount of time with the least amount of person to person contact.

USE OF RTLS DATA TO IMPROVE STAFF WORKFLOW AND PATIENT THROUGHPUTAs surgery centers begin opening up, they will be focused on accommodating the most number of cases possible, while limiting a patient’s time and points of contact in the facility. The standard

priorities around ontime case starts and room turnover will require heightened operational focus. By leveraging RTLS, the time a patient arrives in the OR suite and the time it takes to turn over the room are automatically captured.

When patients have RTLS badges, staff are always able to quickly know where a patient is located, what phase of care they are in, and how long they have been in any particular patient phase. This is done automatically and can also flow into an electronic health record. Furthermore, with staff wearing RTLS badges, the location of surgical team members is also known, which improves overall visibility and aids in reducing delays starting surgical cases.

As an example, in the figure below, the onsite patient list from WorkflowRT for Surgery Centers allows clinicians to see at a glance the real-time location of all patients, how long they have been

in the current phase of care, and the staff who are in the room with them. Other views provide them at-a-glance information to know which OR or prep/holding rooms are occupied and which are available. Clinicians are also able to clearly identify how long the patient has been alone, potentially waiting on a staff member or service such as discharge. By using RTLS tools, real-time views are able to highlight the key pieces of information clinicians need to efficiently advance the patient to the next phase of care. All of the data is updated automatically based on the movement of the RTLS badges.

Wall displays, such as the one below, can also be used to cue staff regarding patient status and delays in care. The wall displays provide an even more efficient option for staff to quickly look up and know the location and status of patients and/or staff.

IMPACTING ROOM TURNOVER TIMES OR room turnover is going to be a critical part of the process. Room turnover is generally accepted as one of the key processes where efficiency is critical because it drives the start of the next case and is closely tied to surgical case capacity. With RTLS, the exact movement time of the patient out of the OR suite can drive a notification to the turnover team to begin cleaning. RTLS can even help “watch the clock” to indicate the time of

turnover. With the requirement for more complex and thorough room sanitizing, assuring optimal efficiency of the turnover process will be critical. To impact the room turnover process appropriately, it must be known which areas of the room turnover need the focus—information the RTLS data will provide.

REPORTSRTLS has the ability to automatically capture (without requiring manual input from staff) data related to location, time, and duration of patients and staff. By leveraging key metrics, surgery centers are able to identify surgical delays and modify processes to gain improvements. The figures below from WorkflowRT for Surgery Centers provide an example of trend data for patient flow and room occupancy that could be used to optimize surgical capacity.

4

CONTACT TRACINGAccurate and efficient contact tracing will be a required part of resuming surgical caseloads. With the assistance of an automatically-generated contact tracing report which leverages data collected by RTLS, surgical centers can speed up the process of taking the necessary steps to minimize the spread of the disease. The contact tracing report enables the surgery center to promptly notify patients and staff about potential exposure so follow-up.

VISITORS AND FAMILYVisitor management and communications will be critical in the post-COVID era. Visitor restrictions may be in place at some sites, meaning patients may only be allowed one person to accompany them, or they may be required to come alone. Communication will be of utmost importance to give patients and families peace of mind by knowing they will be receiving ongoing updates throughout the surgical visit. RTLS can enable a number of tools to support communication. As an example, WorkflowRT for Surgery Centers offers the following features:

• Family View BoardIf families are able to be inside the facility, a family view board, as seen in the following example, can be displayed in the waiting area providing visual updates on the patient's progress.

REFERENCES1. Centers for Medicare & Medicaid Services (CMS).

(2020). CMS Releases Recommendations on Adult Elective Surgeries, Non-Essential Medical, Surgical, and Dental Procedures During COVID-19 Response. Retrieved from https://www.cms.gov/newsroom/press-releases/cms-releases-recommendations-adult-elective-surgeries-non-essential-medical-surgical-and-dental

2. Mehrotra. A et al. (2020). “What Impact Has COVID-19 Had on Outpatient Visits?,” Commonwealth Fund, Apr. 23, 2020. Retrieved from https://doi.org/10.26099/ds9e-jm36

3. Respaut, R, Spaulding, R. (2020). U.S. Hospitals Halt Lucrative Procedures Amid Coronavirus, Job Cuts Follow. Reuters, March 23, 2020. Retrieved from https://www.reuters.com/article/us-health-coronavirus-usa-hospitals/u-s-hospitals-halt-lucrative-procedures-amid-coronavirus-crisis-job-cuts-follow-idUSKBN21I388

4. Luthi,S et al. (2020). Hospitals Bid for $100 Billion in Next Coronavirus Package. Politico, March 19, 2020. https://www.politico.com/news/2020/03/19/hospitals-coronavirus-funding-138383

5. Centers for Medicare & Medicaid Services (CMS). (2020). CMS Issues Recommendations to Re-Open Health Care Systems in Areas with Low Incidence of COVID-19. Issued April 19. Retrieved from https://www.cms.gov/newsroom/press-releases/cms-issues-recommendations-re-open-health-care-systems-areas-low-incidence-covid-19

6. Centers for Medicare & Medicaid Services (CMS). (2020). Recommendations for Re-Opening Facilities to Provide Non-emergency Non-COVID-19 Healthcare: Phase I. Retrieved from https://www.cms.gov/files/document/covid-flexibility-reopen-essential-non-covid-services.pdf

7. American College of Surgeons (ACS), (2020). Joint Statement: Roadmap for Resuming Elective Surgery after COVID-19 Pandemic. Issued April 17. Retrieved from https://www.facs.org/covid-19/clinical-guidance/roadmap-elective-surgery

©2020 Prompt.Health - an Infinite Leap company. All original content in this publication is copyright material belonging to Infinite Leap. Any re-use or reproduction without the expressed, written consent of the copyright owner is strictly prohibited.

HOW TO CREATE A COVID-SAFE SURGICAL CENTER BY LEVERAGING REAL-TIME TECHNOLOGIES

ABOUT THE AUTHORMary Jagim, MSN, RN, CEN, FAENChief Nursing Officer at Infinite Leap

Mary Jagim has over 30 years of experience in emergency nursing, healthcare leadership, public policy, and healthcare consulting. She served as president of the Emergency Nurses Association in 2001 and was a member of the IOM Study on the Future of Emergency Care in the US Health System. In her current position, Mary serves as the Chief Nursing Officer at Infinite Leap, the premier healthcare consulting group and solutions provider for real-time technologies. Mary is one of the leading experts in the implementation and use of real-time location in healthcare. With her practical expertise in emergency preparedness, she assists healthcare systems with leveraging technology to provide a safer environment for patients and staff.

ABOUT PROMPT.HEALTHPrompt.Health, an Infinite Leap company, provides easy and affordable real-time technology solutions that make a big impact on patient experience and safety, increased capacity and access, and improved staff satisfaction.

• Visitor ManagementIf visitors are allowed to accompany patients, keeping track of visitors and identifying one visitor per patient can be a challenge. The same workflow tools that support patient flow can assist with visitor management. As an example, WorkflowRT for Surgery Centers allows staff to identify a patient’s designated visitor and communicate with them. The figure below illustrates tools for visitor management.

• Automated Messages and Custom MessagingAs patients advance through the phases of the surgical experience, from check-in to pre-op to surgery and then on to recovery, the movement of their badge generates automated updates to families or any recipients the patient has identified. Custom messages may also be sent at any time. This messaging tool keeps families informed while easing the level of effort by staff. A sample of automated messages for a surgical site is shown below.

BACKGROUND The Centers for Medicare and Medicaid Services (CMS) recommended on March 18, 2020 to delay all elective surgeries, and non-essential medical, surgical, and dental procedures, during the COVID-19 pandemic. Due to this recommendation ambulatory surgery centers that only perform elective procedures have for the most part been closed. Hospitals were instructed to triage non-elective cases and prioritize those deemed necessary or urgent.1 Delaying the elective surgeries has resulted in up to an 80% decline in surgical cases.2,3,4

The delay of elective procedures was meant to prevent the spread of COVID-19, preserve critical equipment, and ensure adequate hospital beds and healthcare worker resources. But the impact has also resulted in a delay of care for patients, a disruption in employment for many staff and providers, and a significant drop in surgical service’s revenue. Since elective surgical services contribute significantly to a hospital’s bottom line, the loss of revenue is having a major impact on the financial status of hospitals and surgery centers.

On April 19, 2020, CMS issued recommendations on re-opening health care systems in areas with a low incidence rate of COVID-19.5 The guidance provides direction on the considerations a facility needs to take prior to resuming elective surgical cases.6

Resuming elective surgical cases while protecting patients and staff from possible exposures is a multifaceted challenge. In a joint statement published by the American College of Surgeons, American Society of Anesthesiologists, Association of PeriOperative Registered Nurses, and the American Hospital Association, numerous considerations and recommendations are listed for surgery centers.7 Many of these considerations are related to the scheduling of cases and the processes around the patient experience that impact contact points with other individuals.

They include the following:• Patient messaging and communication to

provide clear instructions for patients prior to arrival onsite

• Patient arrival process at facility• Social distancing requirements in waiting

and care areas• Visitor restrictions• Limiting number of personnel in contact

with patients along with potential patient-staff contact points

• Response procedure for a COVID-19 positive patient or staff

• Scheduling consideration for the prolonged duration of operating room turnover time due to additional environmental cleaning requirements

• Strategy for operating extended hours and weekends to allow for more case capacity

DISCUSSIONAs communities begin to re-open, hospitals and surgery centers will be slowly re-opening their schedules. Extended weekday and weekend hours may be needed to address the backlog of delayed cases while maintaining appropriate spacing of cases to accommodate the extended room turnover times. There will be new challenges as they implement the processes necessary to maintain patient and staff safety. Facilities will be undertaking the difficult task of optimizing patient access and flow through the OR while limiting risks for patient and staff exposures.

Necessary priorities will include:• Patient communication• Maintaining social distancing of 6 feet apart• Eliminating waiting lines for check-in• Reducing or eliminating patient time spent in

waiting rooms• Visitor restriction and communication• Minimizing person to person contact before,

during, and after surgery• Organized and efficient room turnover process

with comprehensive cleaning protocols• Efficiently performing thorough contact tracing

to identify patients and staff in the practice at risk in the event of any exposures

• Optimize number of cases while maintaining safe environment for patients

Surgery centers must develop plans and processes now to prepare to fully reopen while providing a safe space for patients and staff. Healthcare facilities can choose to leverage technology solutions to address the challenges of

running operations in the “new normal”. However, with the economic impact on healthcare, funds for solutions will be limited. There are affordable technology solutions that have the ability to provide solutions to several of the new challenges facing surgery centers.

SOLUTIONTHE POWER OF REAL-TIME LOCATION SYSTEMSIn order to reduce risk of exposure, knowing the location, time spent in each location, and person to person contact between patients and staff will be extremely important. Real-time location systems (RTLS) offer a solution for surgery centers that provides this data in a meaningful way to support flow and throughput processes. Specifically, RTLS tools are able to provide insight into processes aimed at facilitating the patient arrival process, enhancing communications, improving staff workflow and patient throughput, and reducing the risk of infections.

Traditionally, RTLS solutions tend to be cost prohibitive and time-consuming to implement. That is no longer the case with the introduction of a new generation of RTLS solutions that are affordable and easy to install. The following are examples of ways RTLS can support surgery centers in meeting their critical goals around access and safety.

STREAMLINED PATIENT ARRIVAL AND CHECK-IN PROCESSPriority one to ensuring patient and staff safety is coordinating the patient's arrival in a manner that reduces their time spent waiting near

others. Facilities will want to begin communication with the patient prior to their arrival on campus. Waiting lines to check in should be avoided. Communications, preferably through text messaging, should direct the patient to the exact location of check-in, where they pick up an RTLS badge. Once checked in, patients should be directed straight to pre-op. By using the real-time location, clinical staff in Pre-Op and the OR are immediately aware of the patient's arrival and location so that patients proceed through the phases of care in the shortest amount of time with the least amount of person to person contact.

USE OF RTLS DATA TO IMPROVE STAFF WORKFLOW AND PATIENT THROUGHPUTAs surgery centers begin opening up, they will be focused on accommodating the most number of cases possible, while limiting a patient’s time and points of contact in the facility. The standard

priorities around ontime case starts and room turnover will require heightened operational focus. By leveraging RTLS, the time a patient arrives in the OR suite and the time it takes to turn over the room are automatically captured.

When patients have RTLS badges, staff are always able to quickly know where a patient is located, what phase of care they are in, and how long they have been in any particular patient phase. This is done automatically and can also flow into an electronic health record. Furthermore, with staff wearing RTLS badges, the location of surgical team members is also known, which improves overall visibility and aids in reducing delays starting surgical cases.

As an example, in the figure below, the onsite patient list from WorkflowRT for Surgery Centers allows clinicians to see at a glance the real-time location of all patients, how long they have been

in the current phase of care, and the staff who are in the room with them. Other views provide them at-a-glance information to know which OR or prep/holding rooms are occupied and which are available. Clinicians are also able to clearly identify how long the patient has been alone, potentially waiting on a staff member or service such as discharge. By using RTLS tools, real-time views are able to highlight the key pieces of information clinicians need to efficiently advance the patient to the next phase of care. All of the data is updated automatically based on the movement of the RTLS badges.

Wall displays, such as the one below, can also be used to cue staff regarding patient status and delays in care. The wall displays provide an even more efficient option for staff to quickly look up and know the location and status of patients and/or staff.

IMPACTING ROOM TURNOVER TIMES OR room turnover is going to be a critical part of the process. Room turnover is generally accepted as one of the key processes where efficiency is critical because it drives the start of the next case and is closely tied to surgical case capacity. With RTLS, the exact movement time of the patient out of the OR suite can drive a notification to the turnover team to begin cleaning. RTLS can even help “watch the clock” to indicate the time of

turnover. With the requirement for more complex and thorough room sanitizing, assuring optimal efficiency of the turnover process will be critical. To impact the room turnover process appropriately, it must be known which areas of the room turnover need the focus—information the RTLS data will provide.

REPORTSRTLS has the ability to automatically capture (without requiring manual input from staff) data related to location, time, and duration of patients and staff. By leveraging key metrics, surgery centers are able to identify surgical delays and modify processes to gain improvements. The figures below from WorkflowRT for Surgery Centers provide an example of trend data for patient flow and room occupancy that could be used to optimize surgical capacity.

5

CONTACT TRACINGAccurate and efficient contact tracing will be a required part of resuming surgical caseloads. With the assistance of an automatically-generated contact tracing report which leverages data collected by RTLS, surgical centers can speed up the process of taking the necessary steps to minimize the spread of the disease. The contact tracing report enables the surgery center to promptly notify patients and staff about potential exposure so follow-up.

VISITORS AND FAMILYVisitor management and communications will be critical in the post-COVID era. Visitor restrictions may be in place at some sites, meaning patients may only be allowed one person to accompany them, or they may be required to come alone. Communication will be of utmost importance to give patients and families peace of mind by knowing they will be receiving ongoing updates throughout the surgical visit. RTLS can enable a number of tools to support communication. As an example, WorkflowRT for Surgery Centers offers the following features:

• Family View BoardIf families are able to be inside the facility, a family view board, as seen in the following example, can be displayed in the waiting area providing visual updates on the patient's progress.

REFERENCES1. Centers for Medicare & Medicaid Services (CMS).

(2020). CMS Releases Recommendations on Adult Elective Surgeries, Non-Essential Medical, Surgical, and Dental Procedures During COVID-19 Response. Retrieved from https://www.cms.gov/newsroom/press-releases/cms-releases-recommendations-adult-elective-surgeries-non-essential-medical-surgical-and-dental

2. Mehrotra. A et al. (2020). “What Impact Has COVID-19 Had on Outpatient Visits?,” Commonwealth Fund, Apr. 23, 2020. Retrieved from https://doi.org/10.26099/ds9e-jm36

3. Respaut, R, Spaulding, R. (2020). U.S. Hospitals Halt Lucrative Procedures Amid Coronavirus, Job Cuts Follow. Reuters, March 23, 2020. Retrieved from https://www.reuters.com/article/us-health-coronavirus-usa-hospitals/u-s-hospitals-halt-lucrative-procedures-amid-coronavirus-crisis-job-cuts-follow-idUSKBN21I388

4. Luthi,S et al. (2020). Hospitals Bid for $100 Billion in Next Coronavirus Package. Politico, March 19, 2020. https://www.politico.com/news/2020/03/19/hospitals-coronavirus-funding-138383

5. Centers for Medicare & Medicaid Services (CMS). (2020). CMS Issues Recommendations to Re-Open Health Care Systems in Areas with Low Incidence of COVID-19. Issued April 19. Retrieved from https://www.cms.gov/newsroom/press-releases/cms-issues-recommendations-re-open-health-care-systems-areas-low-incidence-covid-19

6. Centers for Medicare & Medicaid Services (CMS). (2020). Recommendations for Re-Opening Facilities to Provide Non-emergency Non-COVID-19 Healthcare: Phase I. Retrieved from https://www.cms.gov/files/document/covid-flexibility-reopen-essential-non-covid-services.pdf

7. American College of Surgeons (ACS), (2020). Joint Statement: Roadmap for Resuming Elective Surgery after COVID-19 Pandemic. Issued April 17. Retrieved from https://www.facs.org/covid-19/clinical-guidance/roadmap-elective-surgery

©2020 Prompt.Health - an Infinite Leap company. All original content in this publication is copyright material belonging to Infinite Leap. Any re-use or reproduction without the expressed, written consent of the copyright owner is strictly prohibited.

HOW TO CREATE A COVID-SAFE SURGICAL CENTER BY LEVERAGING REAL-TIME TECHNOLOGIES

Patient location and status visibility at surgery centers

ABOUT THE AUTHORMary Jagim, MSN, RN, CEN, FAENChief Nursing Officer at Infinite Leap

Mary Jagim has over 30 years of experience in emergency nursing, healthcare leadership, public policy, and healthcare consulting. She served as president of the Emergency Nurses Association in 2001 and was a member of the IOM Study on the Future of Emergency Care in the US Health System. In her current position, Mary serves as the Chief Nursing Officer at Infinite Leap, the premier healthcare consulting group and solutions provider for real-time technologies. Mary is one of the leading experts in the implementation and use of real-time location in healthcare. With her practical expertise in emergency preparedness, she assists healthcare systems with leveraging technology to provide a safer environment for patients and staff.

ABOUT PROMPT.HEALTHPrompt.Health, an Infinite Leap company, provides easy and affordable real-time technology solutions that make a big impact on patient experience and safety, increased capacity and access, and improved staff satisfaction.

• Visitor ManagementIf visitors are allowed to accompany patients, keeping track of visitors and identifying one visitor per patient can be a challenge. The same workflow tools that support patient flow can assist with visitor management. As an example, WorkflowRT for Surgery Centers allows staff to identify a patient’s designated visitor and communicate with them. The figure below illustrates tools for visitor management.

• Automated Messages and Custom MessagingAs patients advance through the phases of the surgical experience, from check-in to pre-op to surgery and then on to recovery, the movement of their badge generates automated updates to families or any recipients the patient has identified. Custom messages may also be sent at any time. This messaging tool keeps families informed while easing the level of effort by staff. A sample of automated messages for a surgical site is shown below.

BACKGROUND The Centers for Medicare and Medicaid Services (CMS) recommended on March 18, 2020 to delay all elective surgeries, and non-essential medical, surgical, and dental procedures, during the COVID-19 pandemic. Due to this recommendation ambulatory surgery centers that only perform elective procedures have for the most part been closed. Hospitals were instructed to triage non-elective cases and prioritize those deemed necessary or urgent.1 Delaying the elective surgeries has resulted in up to an 80% decline in surgical cases.2,3,4

The delay of elective procedures was meant to prevent the spread of COVID-19, preserve critical equipment, and ensure adequate hospital beds and healthcare worker resources. But the impact has also resulted in a delay of care for patients, a disruption in employment for many staff and providers, and a significant drop in surgical service’s revenue. Since elective surgical services contribute significantly to a hospital’s bottom line, the loss of revenue is having a major impact on the financial status of hospitals and surgery centers.

On April 19, 2020, CMS issued recommendations on re-opening health care systems in areas with a low incidence rate of COVID-19.5 The guidance provides direction on the considerations a facility needs to take prior to resuming elective surgical cases.6

Resuming elective surgical cases while protecting patients and staff from possible exposures is a multifaceted challenge. In a joint statement published by the American College of Surgeons, American Society of Anesthesiologists, Association of PeriOperative Registered Nurses, and the American Hospital Association, numerous considerations and recommendations are listed for surgery centers.7 Many of these considerations are related to the scheduling of cases and the processes around the patient experience that impact contact points with other individuals.

They include the following:• Patient messaging and communication to

provide clear instructions for patients prior to arrival onsite

• Patient arrival process at facility• Social distancing requirements in waiting

and care areas• Visitor restrictions• Limiting number of personnel in contact

with patients along with potential patient-staff contact points

• Response procedure for a COVID-19 positive patient or staff

• Scheduling consideration for the prolonged duration of operating room turnover time due to additional environmental cleaning requirements

• Strategy for operating extended hours and weekends to allow for more case capacity

DISCUSSIONAs communities begin to re-open, hospitals and surgery centers will be slowly re-opening their schedules. Extended weekday and weekend hours may be needed to address the backlog of delayed cases while maintaining appropriate spacing of cases to accommodate the extended room turnover times. There will be new challenges as they implement the processes necessary to maintain patient and staff safety. Facilities will be undertaking the difficult task of optimizing patient access and flow through the OR while limiting risks for patient and staff exposures.

Necessary priorities will include:• Patient communication• Maintaining social distancing of 6 feet apart• Eliminating waiting lines for check-in• Reducing or eliminating patient time spent in

waiting rooms• Visitor restriction and communication• Minimizing person to person contact before,

during, and after surgery• Organized and efficient room turnover process

with comprehensive cleaning protocols• Efficiently performing thorough contact tracing

to identify patients and staff in the practice at risk in the event of any exposures

• Optimize number of cases while maintaining safe environment for patients

Surgery centers must develop plans and processes now to prepare to fully reopen while providing a safe space for patients and staff. Healthcare facilities can choose to leverage technology solutions to address the challenges of

running operations in the “new normal”. However, with the economic impact on healthcare, funds for solutions will be limited. There are affordable technology solutions that have the ability to provide solutions to several of the new challenges facing surgery centers.

SOLUTIONTHE POWER OF REAL-TIME LOCATION SYSTEMSIn order to reduce risk of exposure, knowing the location, time spent in each location, and person to person contact between patients and staff will be extremely important. Real-time location systems (RTLS) offer a solution for surgery centers that provides this data in a meaningful way to support flow and throughput processes. Specifically, RTLS tools are able to provide insight into processes aimed at facilitating the patient arrival process, enhancing communications, improving staff workflow and patient throughput, and reducing the risk of infections.

Traditionally, RTLS solutions tend to be cost prohibitive and time-consuming to implement. That is no longer the case with the introduction of a new generation of RTLS solutions that are affordable and easy to install. The following are examples of ways RTLS can support surgery centers in meeting their critical goals around access and safety.

STREAMLINED PATIENT ARRIVAL AND CHECK-IN PROCESSPriority one to ensuring patient and staff safety is coordinating the patient's arrival in a manner that reduces their time spent waiting near

others. Facilities will want to begin communication with the patient prior to their arrival on campus. Waiting lines to check in should be avoided. Communications, preferably through text messaging, should direct the patient to the exact location of check-in, where they pick up an RTLS badge. Once checked in, patients should be directed straight to pre-op. By using the real-time location, clinical staff in Pre-Op and the OR are immediately aware of the patient's arrival and location so that patients proceed through the phases of care in the shortest amount of time with the least amount of person to person contact.

USE OF RTLS DATA TO IMPROVE STAFF WORKFLOW AND PATIENT THROUGHPUTAs surgery centers begin opening up, they will be focused on accommodating the most number of cases possible, while limiting a patient’s time and points of contact in the facility. The standard

priorities around ontime case starts and room turnover will require heightened operational focus. By leveraging RTLS, the time a patient arrives in the OR suite and the time it takes to turn over the room are automatically captured.

When patients have RTLS badges, staff are always able to quickly know where a patient is located, what phase of care they are in, and how long they have been in any particular patient phase. This is done automatically and can also flow into an electronic health record. Furthermore, with staff wearing RTLS badges, the location of surgical team members is also known, which improves overall visibility and aids in reducing delays starting surgical cases.

As an example, in the figure below, the onsite patient list from WorkflowRT for Surgery Centers allows clinicians to see at a glance the real-time location of all patients, how long they have been

in the current phase of care, and the staff who are in the room with them. Other views provide them at-a-glance information to know which OR or prep/holding rooms are occupied and which are available. Clinicians are also able to clearly identify how long the patient has been alone, potentially waiting on a staff member or service such as discharge. By using RTLS tools, real-time views are able to highlight the key pieces of information clinicians need to efficiently advance the patient to the next phase of care. All of the data is updated automatically based on the movement of the RTLS badges.

Wall displays, such as the one below, can also be used to cue staff regarding patient status and delays in care. The wall displays provide an even more efficient option for staff to quickly look up and know the location and status of patients and/or staff.

IMPACTING ROOM TURNOVER TIMES OR room turnover is going to be a critical part of the process. Room turnover is generally accepted as one of the key processes where efficiency is critical because it drives the start of the next case and is closely tied to surgical case capacity. With RTLS, the exact movement time of the patient out of the OR suite can drive a notification to the turnover team to begin cleaning. RTLS can even help “watch the clock” to indicate the time of

turnover. With the requirement for more complex and thorough room sanitizing, assuring optimal efficiency of the turnover process will be critical. To impact the room turnover process appropriately, it must be known which areas of the room turnover need the focus—information the RTLS data will provide.

REPORTSRTLS has the ability to automatically capture (without requiring manual input from staff) data related to location, time, and duration of patients and staff. By leveraging key metrics, surgery centers are able to identify surgical delays and modify processes to gain improvements. The figures below from WorkflowRT for Surgery Centers provide an example of trend data for patient flow and room occupancy that could be used to optimize surgical capacity.

6

CONTACT TRACINGAccurate and efficient contact tracing will be a required part of resuming surgical caseloads. With the assistance of an automatically-generated contact tracing report which leverages data collected by RTLS, surgical centers can speed up the process of taking the necessary steps to minimize the spread of the disease. The contact tracing report enables the surgery center to promptly notify patients and staff about potential exposure so follow-up.

VISITORS AND FAMILYVisitor management and communications will be critical in the post-COVID era. Visitor restrictions may be in place at some sites, meaning patients may only be allowed one person to accompany them, or they may be required to come alone. Communication will be of utmost importance to give patients and families peace of mind by knowing they will be receiving ongoing updates throughout the surgical visit. RTLS can enable a number of tools to support communication. As an example, WorkflowRT for Surgery Centers offers the following features:

• Family View BoardIf families are able to be inside the facility, a family view board, as seen in the following example, can be displayed in the waiting area providing visual updates on the patient's progress.

REFERENCES1. Centers for Medicare & Medicaid Services (CMS).

(2020). CMS Releases Recommendations on Adult Elective Surgeries, Non-Essential Medical, Surgical, and Dental Procedures During COVID-19 Response. Retrieved from https://www.cms.gov/newsroom/press-releases/cms-releases-recommendations-adult-elective-surgeries-non-essential-medical-surgical-and-dental

2. Mehrotra. A et al. (2020). “What Impact Has COVID-19 Had on Outpatient Visits?,” Commonwealth Fund, Apr. 23, 2020. Retrieved from https://doi.org/10.26099/ds9e-jm36

3. Respaut, R, Spaulding, R. (2020). U.S. Hospitals Halt Lucrative Procedures Amid Coronavirus, Job Cuts Follow. Reuters, March 23, 2020. Retrieved from https://www.reuters.com/article/us-health-coronavirus-usa-hospitals/u-s-hospitals-halt-lucrative-procedures-amid-coronavirus-crisis-job-cuts-follow-idUSKBN21I388

4. Luthi,S et al. (2020). Hospitals Bid for $100 Billion in Next Coronavirus Package. Politico, March 19, 2020. https://www.politico.com/news/2020/03/19/hospitals-coronavirus-funding-138383

5. Centers for Medicare & Medicaid Services (CMS). (2020). CMS Issues Recommendations to Re-Open Health Care Systems in Areas with Low Incidence of COVID-19. Issued April 19. Retrieved from https://www.cms.gov/newsroom/press-releases/cms-issues-recommendations-re-open-health-care-systems-areas-low-incidence-covid-19

6. Centers for Medicare & Medicaid Services (CMS). (2020). Recommendations for Re-Opening Facilities to Provide Non-emergency Non-COVID-19 Healthcare: Phase I. Retrieved from https://www.cms.gov/files/document/covid-flexibility-reopen-essential-non-covid-services.pdf

7. American College of Surgeons (ACS), (2020). Joint Statement: Roadmap for Resuming Elective Surgery after COVID-19 Pandemic. Issued April 17. Retrieved from https://www.facs.org/covid-19/clinical-guidance/roadmap-elective-surgery

©2020 Prompt.Health - an Infinite Leap company. All original content in this publication is copyright material belonging to Infinite Leap. Any re-use or reproduction without the expressed, written consent of the copyright owner is strictly prohibited.

HOW TO CREATE A COVID-SAFE SURGICAL CENTER BY LEVERAGING REAL-TIME TECHNOLOGIES

Patient status information is easily viewable, helping caregivers quickly identify where they are needed next

ABOUT THE AUTHORMary Jagim, MSN, RN, CEN, FAENChief Nursing Officer at Infinite Leap

Mary Jagim has over 30 years of experience in emergency nursing, healthcare leadership, public policy, and healthcare consulting. She served as president of the Emergency Nurses Association in 2001 and was a member of the IOM Study on the Future of Emergency Care in the US Health System. In her current position, Mary serves as the Chief Nursing Officer at Infinite Leap, the premier healthcare consulting group and solutions provider for real-time technologies. Mary is one of the leading experts in the implementation and use of real-time location in healthcare. With her practical expertise in emergency preparedness, she assists healthcare systems with leveraging technology to provide a safer environment for patients and staff.

ABOUT PROMPT.HEALTHPrompt.Health, an Infinite Leap company, provides easy and affordable real-time technology solutions that make a big impact on patient experience and safety, increased capacity and access, and improved staff satisfaction.

• Visitor ManagementIf visitors are allowed to accompany patients, keeping track of visitors and identifying one visitor per patient can be a challenge. The same workflow tools that support patient flow can assist with visitor management. As an example, WorkflowRT for Surgery Centers allows staff to identify a patient’s designated visitor and communicate with them. The figure below illustrates tools for visitor management.

• Automated Messages and Custom MessagingAs patients advance through the phases of the surgical experience, from check-in to pre-op to surgery and then on to recovery, the movement of their badge generates automated updates to families or any recipients the patient has identified. Custom messages may also be sent at any time. This messaging tool keeps families informed while easing the level of effort by staff. A sample of automated messages for a surgical site is shown below.

7

BACKGROUND The Centers for Medicare and Medicaid Services (CMS) recommended on March 18, 2020 to delay all elective surgeries, and non-essential medical, surgical, and dental procedures, during the COVID-19 pandemic. Due to this recommendation ambulatory surgery centers that only perform elective procedures have for the most part been closed. Hospitals were instructed to triage non-elective cases and prioritize those deemed necessary or urgent.1 Delaying the elective surgeries has resulted in up to an 80% decline in surgical cases.2,3,4

The delay of elective procedures was meant to prevent the spread of COVID-19, preserve critical equipment, and ensure adequate hospital beds and healthcare worker resources. But the impact has also resulted in a delay of care for patients, a disruption in employment for many staff and providers, and a significant drop in surgical service’s revenue. Since elective surgical services contribute significantly to a hospital’s bottom line, the loss of revenue is having a major impact on the financial status of hospitals and surgery centers.

On April 19, 2020, CMS issued recommendations on re-opening health care systems in areas with a low incidence rate of COVID-19.5 The guidance provides direction on the considerations a facility needs to take prior to resuming elective surgical cases.6

Resuming elective surgical cases while protecting patients and staff from possible exposures is a multifaceted challenge. In a joint statement published by the American College of Surgeons, American Society of Anesthesiologists, Association of PeriOperative Registered Nurses, and the American Hospital Association, numerous considerations and recommendations are listed for surgery centers.7 Many of these considerations are related to the scheduling of cases and the processes around the patient experience that impact contact points with other individuals.

They include the following:• Patient messaging and communication to

provide clear instructions for patients prior to arrival onsite

• Patient arrival process at facility• Social distancing requirements in waiting

and care areas• Visitor restrictions• Limiting number of personnel in contact

with patients along with potential patient-staff contact points

• Response procedure for a COVID-19 positive patient or staff

• Scheduling consideration for the prolonged duration of operating room turnover time due to additional environmental cleaning requirements

• Strategy for operating extended hours and weekends to allow for more case capacity

DISCUSSIONAs communities begin to re-open, hospitals and surgery centers will be slowly re-opening their schedules. Extended weekday and weekend hours may be needed to address the backlog of delayed cases while maintaining appropriate spacing of cases to accommodate the extended room turnover times. There will be new challenges as they implement the processes necessary to maintain patient and staff safety. Facilities will be undertaking the difficult task of optimizing patient access and flow through the OR while limiting risks for patient and staff exposures.

Necessary priorities will include:• Patient communication• Maintaining social distancing of 6 feet apart• Eliminating waiting lines for check-in• Reducing or eliminating patient time spent in

waiting rooms• Visitor restriction and communication• Minimizing person to person contact before,

during, and after surgery• Organized and efficient room turnover process

with comprehensive cleaning protocols• Efficiently performing thorough contact tracing

to identify patients and staff in the practice at risk in the event of any exposures

• Optimize number of cases while maintaining safe environment for patients

Surgery centers must develop plans and processes now to prepare to fully reopen while providing a safe space for patients and staff. Healthcare facilities can choose to leverage technology solutions to address the challenges of

running operations in the “new normal”. However, with the economic impact on healthcare, funds for solutions will be limited. There are affordable technology solutions that have the ability to provide solutions to several of the new challenges facing surgery centers.

SOLUTIONTHE POWER OF REAL-TIME LOCATION SYSTEMSIn order to reduce risk of exposure, knowing the location, time spent in each location, and person to person contact between patients and staff will be extremely important. Real-time location systems (RTLS) offer a solution for surgery centers that provides this data in a meaningful way to support flow and throughput processes. Specifically, RTLS tools are able to provide insight into processes aimed at facilitating the patient arrival process, enhancing communications, improving staff workflow and patient throughput, and reducing the risk of infections.

Traditionally, RTLS solutions tend to be cost prohibitive and time-consuming to implement. That is no longer the case with the introduction of a new generation of RTLS solutions that are affordable and easy to install. The following are examples of ways RTLS can support surgery centers in meeting their critical goals around access and safety.

STREAMLINED PATIENT ARRIVAL AND CHECK-IN PROCESSPriority one to ensuring patient and staff safety is coordinating the patient's arrival in a manner that reduces their time spent waiting near

others. Facilities will want to begin communication with the patient prior to their arrival on campus. Waiting lines to check in should be avoided. Communications, preferably through text messaging, should direct the patient to the exact location of check-in, where they pick up an RTLS badge. Once checked in, patients should be directed straight to pre-op. By using the real-time location, clinical staff in Pre-Op and the OR are immediately aware of the patient's arrival and location so that patients proceed through the phases of care in the shortest amount of time with the least amount of person to person contact.

USE OF RTLS DATA TO IMPROVE STAFF WORKFLOW AND PATIENT THROUGHPUTAs surgery centers begin opening up, they will be focused on accommodating the most number of cases possible, while limiting a patient’s time and points of contact in the facility. The standard

priorities around ontime case starts and room turnover will require heightened operational focus. By leveraging RTLS, the time a patient arrives in the OR suite and the time it takes to turn over the room are automatically captured.

When patients have RTLS badges, staff are always able to quickly know where a patient is located, what phase of care they are in, and how long they have been in any particular patient phase. This is done automatically and can also flow into an electronic health record. Furthermore, with staff wearing RTLS badges, the location of surgical team members is also known, which improves overall visibility and aids in reducing delays starting surgical cases.

As an example, in the figure below, the onsite patient list from WorkflowRT for Surgery Centers allows clinicians to see at a glance the real-time location of all patients, how long they have been

in the current phase of care, and the staff who are in the room with them. Other views provide them at-a-glance information to know which OR or prep/holding rooms are occupied and which are available. Clinicians are also able to clearly identify how long the patient has been alone, potentially waiting on a staff member or service such as discharge. By using RTLS tools, real-time views are able to highlight the key pieces of information clinicians need to efficiently advance the patient to the next phase of care. All of the data is updated automatically based on the movement of the RTLS badges.

Wall displays, such as the one below, can also be used to cue staff regarding patient status and delays in care. The wall displays provide an even more efficient option for staff to quickly look up and know the location and status of patients and/or staff.

IMPACTING ROOM TURNOVER TIMES OR room turnover is going to be a critical part of the process. Room turnover is generally accepted as one of the key processes where efficiency is critical because it drives the start of the next case and is closely tied to surgical case capacity. With RTLS, the exact movement time of the patient out of the OR suite can drive a notification to the turnover team to begin cleaning. RTLS can even help “watch the clock” to indicate the time of

turnover. With the requirement for more complex and thorough room sanitizing, assuring optimal efficiency of the turnover process will be critical. To impact the room turnover process appropriately, it must be known which areas of the room turnover need the focus—information the RTLS data will provide.

REPORTSRTLS has the ability to automatically capture (without requiring manual input from staff) data related to location, time, and duration of patients and staff. By leveraging key metrics, surgery centers are able to identify surgical delays and modify processes to gain improvements. The figures below from WorkflowRT for Surgery Centers provide an example of trend data for patient flow and room occupancy that could be used to optimize surgical capacity.

CONTACT TRACINGAccurate and efficient contact tracing will be a required part of resuming surgical caseloads. With the assistance of an automatically-generated contact tracing report which leverages data collected by RTLS, surgical centers can speed up the process of taking the necessary steps to minimize the spread of the disease. The contact tracing report enables the surgery center to promptly notify patients and staff about potential exposure so follow-up.

VISITORS AND FAMILYVisitor management and communications will be critical in the post-COVID era. Visitor restrictions may be in place at some sites, meaning patients may only be allowed one person to accompany them, or they may be required to come alone. Communication will be of utmost importance to give patients and families peace of mind by knowing they will be receiving ongoing updates throughout the surgical visit. RTLS can enable a number of tools to support communication. As an example, WorkflowRT for Surgery Centers offers the following features:

• Family View BoardIf families are able to be inside the facility, a family view board, as seen in the following example, can be displayed in the waiting area providing visual updates on the patient's progress.

REFERENCES1. Centers for Medicare & Medicaid Services (CMS).

(2020). CMS Releases Recommendations on Adult Elective Surgeries, Non-Essential Medical, Surgical, and Dental Procedures During COVID-19 Response. Retrieved from https://www.cms.gov/newsroom/press-releases/cms-releases-recommendations-adult-elective-surgeries-non-essential-medical-surgical-and-dental

2. Mehrotra. A et al. (2020). “What Impact Has COVID-19 Had on Outpatient Visits?,” Commonwealth Fund, Apr. 23, 2020. Retrieved from https://doi.org/10.26099/ds9e-jm36

3. Respaut, R, Spaulding, R. (2020). U.S. Hospitals Halt Lucrative Procedures Amid Coronavirus, Job Cuts Follow. Reuters, March 23, 2020. Retrieved from https://www.reuters.com/article/us-health-coronavirus-usa-hospitals/u-s-hospitals-halt-lucrative-procedures-amid-coronavirus-crisis-job-cuts-follow-idUSKBN21I388

4. Luthi,S et al. (2020). Hospitals Bid for $100 Billion in Next Coronavirus Package. Politico, March 19, 2020. https://www.politico.com/news/2020/03/19/hospitals-coronavirus-funding-138383

5. Centers for Medicare & Medicaid Services (CMS). (2020). CMS Issues Recommendations to Re-Open Health Care Systems in Areas with Low Incidence of COVID-19. Issued April 19. Retrieved from https://www.cms.gov/newsroom/press-releases/cms-issues-recommendations-re-open-health-care-systems-areas-low-incidence-covid-19

6. Centers for Medicare & Medicaid Services (CMS). (2020). Recommendations for Re-Opening Facilities to Provide Non-emergency Non-COVID-19 Healthcare: Phase I. Retrieved from https://www.cms.gov/files/document/covid-flexibility-reopen-essential-non-covid-services.pdf

7. American College of Surgeons (ACS), (2020). Joint Statement: Roadmap for Resuming Elective Surgery after COVID-19 Pandemic. Issued April 17. Retrieved from https://www.facs.org/covid-19/clinical-guidance/roadmap-elective-surgery

©2020 Prompt.Health - an Infinite Leap company. All original content in this publication is copyright material belonging to Infinite Leap. Any re-use or reproduction without the expressed, written consent of the copyright owner is strictly prohibited.

HOW TO CREATE A COVID-SAFE SURGICAL CENTER BY LEVERAGING REAL-TIME TECHNOLOGIES

Real-time status of OR rooms and other care locations

ABOUT THE AUTHORMary Jagim, MSN, RN, CEN, FAENChief Nursing Officer at Infinite Leap

Mary Jagim has over 30 years of experience in emergency nursing, healthcare leadership, public policy, and healthcare consulting. She served as president of the Emergency Nurses Association in 2001 and was a member of the IOM Study on the Future of Emergency Care in the US Health System. In her current position, Mary serves as the Chief Nursing Officer at Infinite Leap, the premier healthcare consulting group and solutions provider for real-time technologies. Mary is one of the leading experts in the implementation and use of real-time location in healthcare. With her practical expertise in emergency preparedness, she assists healthcare systems with leveraging technology to provide a safer environment for patients and staff.

ABOUT PROMPT.HEALTHPrompt.Health, an Infinite Leap company, provides easy and affordable real-time technology solutions that make a big impact on patient experience and safety, increased capacity and access, and improved staff satisfaction.

7

• Visitor ManagementIf visitors are allowed to accompany patients, keeping track of visitors and identifying one visitor per patient can be a challenge. The same workflow tools that support patient flow can assist with visitor management. As an example, WorkflowRT for Surgery Centers allows staff to identify a patient’s designated visitor and communicate with them. The figure below illustrates tools for visitor management.

• Automated Messages and Custom MessagingAs patients advance through the phases of the surgical experience, from check-in to pre-op to surgery and then on to recovery, the movement of their badge generates automated updates to families or any recipients the patient has identified. Custom messages may also be sent at any time. This messaging tool keeps families informed while easing the level of effort by staff. A sample of automated messages for a surgical site is shown below.

BACKGROUND The Centers for Medicare and Medicaid Services (CMS) recommended on March 18, 2020 to delay all elective surgeries, and non-essential medical, surgical, and dental procedures, during the COVID-19 pandemic. Due to this recommendation ambulatory surgery centers that only perform elective procedures have for the most part been closed. Hospitals were instructed to triage non-elective cases and prioritize those deemed necessary or urgent.1 Delaying the elective surgeries has resulted in up to an 80% decline in surgical cases.2,3,4

The delay of elective procedures was meant to prevent the spread of COVID-19, preserve critical equipment, and ensure adequate hospital beds and healthcare worker resources. But the impact has also resulted in a delay of care for patients, a disruption in employment for many staff and providers, and a significant drop in surgical service’s revenue. Since elective surgical services contribute significantly to a hospital’s bottom line, the loss of revenue is having a major impact on the financial status of hospitals and surgery centers.

On April 19, 2020, CMS issued recommendations on re-opening health care systems in areas with a low incidence rate of COVID-19.5 The guidance provides direction on the considerations a facility needs to take prior to resuming elective surgical cases.6

Resuming elective surgical cases while protecting patients and staff from possible exposures is a multifaceted challenge. In a joint statement published by the American College of Surgeons, American Society of Anesthesiologists, Association of PeriOperative Registered Nurses, and the American Hospital Association, numerous considerations and recommendations are listed for surgery centers.7 Many of these considerations are related to the scheduling of cases and the processes around the patient experience that impact contact points with other individuals.

They include the following:• Patient messaging and communication to

provide clear instructions for patients prior to arrival onsite

• Patient arrival process at facility• Social distancing requirements in waiting

and care areas• Visitor restrictions• Limiting number of personnel in contact

with patients along with potential patient-staff contact points

• Response procedure for a COVID-19 positive patient or staff

• Scheduling consideration for the prolonged duration of operating room turnover time due to additional environmental cleaning requirements

• Strategy for operating extended hours and weekends to allow for more case capacity

DISCUSSIONAs communities begin to re-open, hospitals and surgery centers will be slowly re-opening their schedules. Extended weekday and weekend hours may be needed to address the backlog of delayed cases while maintaining appropriate spacing of cases to accommodate the extended room turnover times. There will be new challenges as they implement the processes necessary to maintain patient and staff safety. Facilities will be undertaking the difficult task of optimizing patient access and flow through the OR while limiting risks for patient and staff exposures.

Necessary priorities will include:• Patient communication• Maintaining social distancing of 6 feet apart• Eliminating waiting lines for check-in• Reducing or eliminating patient time spent in

waiting rooms• Visitor restriction and communication• Minimizing person to person contact before,

during, and after surgery• Organized and efficient room turnover process

with comprehensive cleaning protocols• Efficiently performing thorough contact tracing

to identify patients and staff in the practice at risk in the event of any exposures

• Optimize number of cases while maintaining safe environment for patients

Surgery centers must develop plans and processes now to prepare to fully reopen while providing a safe space for patients and staff. Healthcare facilities can choose to leverage technology solutions to address the challenges of

running operations in the “new normal”. However, with the economic impact on healthcare, funds for solutions will be limited. There are affordable technology solutions that have the ability to provide solutions to several of the new challenges facing surgery centers.

SOLUTIONTHE POWER OF REAL-TIME LOCATION SYSTEMSIn order to reduce risk of exposure, knowing the location, time spent in each location, and person to person contact between patients and staff will be extremely important. Real-time location systems (RTLS) offer a solution for surgery centers that provides this data in a meaningful way to support flow and throughput processes. Specifically, RTLS tools are able to provide insight into processes aimed at facilitating the patient arrival process, enhancing communications, improving staff workflow and patient throughput, and reducing the risk of infections.

Traditionally, RTLS solutions tend to be cost prohibitive and time-consuming to implement. That is no longer the case with the introduction of a new generation of RTLS solutions that are affordable and easy to install. The following are examples of ways RTLS can support surgery centers in meeting their critical goals around access and safety.

STREAMLINED PATIENT ARRIVAL AND CHECK-IN PROCESSPriority one to ensuring patient and staff safety is coordinating the patient's arrival in a manner that reduces their time spent waiting near

others. Facilities will want to begin communication with the patient prior to their arrival on campus. Waiting lines to check in should be avoided. Communications, preferably through text messaging, should direct the patient to the exact location of check-in, where they pick up an RTLS badge. Once checked in, patients should be directed straight to pre-op. By using the real-time location, clinical staff in Pre-Op and the OR are immediately aware of the patient's arrival and location so that patients proceed through the phases of care in the shortest amount of time with the least amount of person to person contact.

USE OF RTLS DATA TO IMPROVE STAFF WORKFLOW AND PATIENT THROUGHPUTAs surgery centers begin opening up, they will be focused on accommodating the most number of cases possible, while limiting a patient’s time and points of contact in the facility. The standard

priorities around ontime case starts and room turnover will require heightened operational focus. By leveraging RTLS, the time a patient arrives in the OR suite and the time it takes to turn over the room are automatically captured.

When patients have RTLS badges, staff are always able to quickly know where a patient is located, what phase of care they are in, and how long they have been in any particular patient phase. This is done automatically and can also flow into an electronic health record. Furthermore, with staff wearing RTLS badges, the location of surgical team members is also known, which improves overall visibility and aids in reducing delays starting surgical cases.

As an example, in the figure below, the onsite patient list from WorkflowRT for Surgery Centers allows clinicians to see at a glance the real-time location of all patients, how long they have been

in the current phase of care, and the staff who are in the room with them. Other views provide them at-a-glance information to know which OR or prep/holding rooms are occupied and which are available. Clinicians are also able to clearly identify how long the patient has been alone, potentially waiting on a staff member or service such as discharge. By using RTLS tools, real-time views are able to highlight the key pieces of information clinicians need to efficiently advance the patient to the next phase of care. All of the data is updated automatically based on the movement of the RTLS badges.

Wall displays, such as the one below, can also be used to cue staff regarding patient status and delays in care. The wall displays provide an even more efficient option for staff to quickly look up and know the location and status of patients and/or staff.

IMPACTING ROOM TURNOVER TIMES OR room turnover is going to be a critical part of the process. Room turnover is generally accepted as one of the key processes where efficiency is critical because it drives the start of the next case and is closely tied to surgical case capacity. With RTLS, the exact movement time of the patient out of the OR suite can drive a notification to the turnover team to begin cleaning. RTLS can even help “watch the clock” to indicate the time of

turnover. With the requirement for more complex and thorough room sanitizing, assuring optimal efficiency of the turnover process will be critical. To impact the room turnover process appropriately, it must be known which areas of the room turnover need the focus—information the RTLS data will provide.

REPORTSRTLS has the ability to automatically capture (without requiring manual input from staff) data related to location, time, and duration of patients and staff. By leveraging key metrics, surgery centers are able to identify surgical delays and modify processes to gain improvements. The figures below from WorkflowRT for Surgery Centers provide an example of trend data for patient flow and room occupancy that could be used to optimize surgical capacity.

8

CONTACT TRACINGAccurate and efficient contact tracing will be a required part of resuming surgical caseloads. With the assistance of an automatically-generated contact tracing report which leverages data collected by RTLS, surgical centers can speed up the process of taking the necessary steps to minimize the spread of the disease. The contact tracing report enables the surgery center to promptly notify patients and staff about potential exposure so follow-up.

VISITORS AND FAMILYVisitor management and communications will be critical in the post-COVID era. Visitor restrictions may be in place at some sites, meaning patients may only be allowed one person to accompany them, or they may be required to come alone. Communication will be of utmost importance to give patients and families peace of mind by knowing they will be receiving ongoing updates throughout the surgical visit. RTLS can enable a number of tools to support communication. As an example, WorkflowRT for Surgery Centers offers the following features:

• Family View BoardIf families are able to be inside the facility, a family view board, as seen in the following example, can be displayed in the waiting area providing visual updates on the patient's progress.

REFERENCES1. Centers for Medicare & Medicaid Services (CMS).

(2020). CMS Releases Recommendations on Adult Elective Surgeries, Non-Essential Medical, Surgical, and Dental Procedures During COVID-19 Response. Retrieved from https://www.cms.gov/newsroom/press-releases/cms-releases-recommendations-adult-elective-surgeries-non-essential-medical-surgical-and-dental

2. Mehrotra. A et al. (2020). “What Impact Has COVID-19 Had on Outpatient Visits?,” Commonwealth Fund, Apr. 23, 2020. Retrieved from https://doi.org/10.26099/ds9e-jm36

3. Respaut, R, Spaulding, R. (2020). U.S. Hospitals Halt Lucrative Procedures Amid Coronavirus, Job Cuts Follow. Reuters, March 23, 2020. Retrieved from https://www.reuters.com/article/us-health-coronavirus-usa-hospitals/u-s-hospitals-halt-lucrative-procedures-amid-coronavirus-crisis-job-cuts-follow-idUSKBN21I388

4. Luthi,S et al. (2020). Hospitals Bid for $100 Billion in Next Coronavirus Package. Politico, March 19, 2020. https://www.politico.com/news/2020/03/19/hospitals-coronavirus-funding-138383

5. Centers for Medicare & Medicaid Services (CMS). (2020). CMS Issues Recommendations to Re-Open Health Care Systems in Areas with Low Incidence of COVID-19. Issued April 19. Retrieved from https://www.cms.gov/newsroom/press-releases/cms-issues-recommendations-re-open-health-care-systems-areas-low-incidence-covid-19

6. Centers for Medicare & Medicaid Services (CMS). (2020). Recommendations for Re-Opening Facilities to Provide Non-emergency Non-COVID-19 Healthcare: Phase I. Retrieved from https://www.cms.gov/files/document/covid-flexibility-reopen-essential-non-covid-services.pdf

7. American College of Surgeons (ACS), (2020). Joint Statement: Roadmap for Resuming Elective Surgery after COVID-19 Pandemic. Issued April 17. Retrieved from https://www.facs.org/covid-19/clinical-guidance/roadmap-elective-surgery

©2020 Prompt.Health - an Infinite Leap company. All original content in this publication is copyright material belonging to Infinite Leap. Any re-use or reproduction without the expressed, written consent of the copyright owner is strictly prohibited.

HOW TO CREATE A COVID-SAFE SURGICAL CENTER BY LEVERAGING REAL-TIME TECHNOLOGIES

Reports, including room occupancy trends, provide insights for process improvements

Quickly view patients and staff who have come into contact with a contagious individual

ABOUT THE AUTHORMary Jagim, MSN, RN, CEN, FAENChief Nursing Officer at Infinite Leap

Mary Jagim has over 30 years of experience in emergency nursing, healthcare leadership, public policy, and healthcare consulting. She served as president of the Emergency Nurses Association in 2001 and was a member of the IOM Study on the Future of Emergency Care in the US Health System. In her current position, Mary serves as the Chief Nursing Officer at Infinite Leap, the premier healthcare consulting group and solutions provider for real-time technologies. Mary is one of the leading experts in the implementation and use of real-time location in healthcare. With her practical expertise in emergency preparedness, she assists healthcare systems with leveraging technology to provide a safer environment for patients and staff.

ABOUT PROMPT.HEALTHPrompt.Health, an Infinite Leap company, provides easy and affordable real-time technology solutions that make a big impact on patient experience and safety, increased capacity and access, and improved staff satisfaction.

• Visitor ManagementIf visitors are allowed to accompany patients, keeping track of visitors and identifying one visitor per patient can be a challenge. The same workflow tools that support patient flow can assist with visitor management. As an example, WorkflowRT for Surgery Centers allows staff to identify a patient’s designated visitor and communicate with them. The figure below illustrates tools for visitor management.

• Automated Messages and Custom MessagingAs patients advance through the phases of the surgical experience, from check-in to pre-op to surgery and then on to recovery, the movement of their badge generates automated updates to families or any recipients the patient has identified. Custom messages may also be sent at any time. This messaging tool keeps families informed while easing the level of effort by staff. A sample of automated messages for a surgical site is shown below.

BACKGROUND The Centers for Medicare and Medicaid Services (CMS) recommended on March 18, 2020 to delay all elective surgeries, and non-essential medical, surgical, and dental procedures, during the COVID-19 pandemic. Due to this recommendation ambulatory surgery centers that only perform elective procedures have for the most part been closed. Hospitals were instructed to triage non-elective cases and prioritize those deemed necessary or urgent.1 Delaying the elective surgeries has resulted in up to an 80% decline in surgical cases.2,3,4

The delay of elective procedures was meant to prevent the spread of COVID-19, preserve critical equipment, and ensure adequate hospital beds and healthcare worker resources. But the impact has also resulted in a delay of care for patients, a disruption in employment for many staff and providers, and a significant drop in surgical service’s revenue. Since elective surgical services contribute significantly to a hospital’s bottom line, the loss of revenue is having a major impact on the financial status of hospitals and surgery centers.

On April 19, 2020, CMS issued recommendations on re-opening health care systems in areas with a low incidence rate of COVID-19.5 The guidance provides direction on the considerations a facility needs to take prior to resuming elective surgical cases.6

Resuming elective surgical cases while protecting patients and staff from possible exposures is a multifaceted challenge. In a joint statement published by the American College of Surgeons, American Society of Anesthesiologists, Association of PeriOperative Registered Nurses, and the American Hospital Association, numerous considerations and recommendations are listed for surgery centers.7 Many of these considerations are related to the scheduling of cases and the processes around the patient experience that impact contact points with other individuals.

They include the following:• Patient messaging and communication to

provide clear instructions for patients prior to arrival onsite

• Patient arrival process at facility• Social distancing requirements in waiting

and care areas• Visitor restrictions• Limiting number of personnel in contact

with patients along with potential patient-staff contact points

• Response procedure for a COVID-19 positive patient or staff

• Scheduling consideration for the prolonged duration of operating room turnover time due to additional environmental cleaning requirements

• Strategy for operating extended hours and weekends to allow for more case capacity

DISCUSSIONAs communities begin to re-open, hospitals and surgery centers will be slowly re-opening their schedules. Extended weekday and weekend hours may be needed to address the backlog of delayed cases while maintaining appropriate spacing of cases to accommodate the extended room turnover times. There will be new challenges as they implement the processes necessary to maintain patient and staff safety. Facilities will be undertaking the difficult task of optimizing patient access and flow through the OR while limiting risks for patient and staff exposures.

Necessary priorities will include:• Patient communication• Maintaining social distancing of 6 feet apart• Eliminating waiting lines for check-in• Reducing or eliminating patient time spent in

waiting rooms• Visitor restriction and communication• Minimizing person to person contact before,

during, and after surgery• Organized and efficient room turnover process

with comprehensive cleaning protocols• Efficiently performing thorough contact tracing

to identify patients and staff in the practice at risk in the event of any exposures

• Optimize number of cases while maintaining safe environment for patients

Surgery centers must develop plans and processes now to prepare to fully reopen while providing a safe space for patients and staff. Healthcare facilities can choose to leverage technology solutions to address the challenges of

running operations in the “new normal”. However, with the economic impact on healthcare, funds for solutions will be limited. There are affordable technology solutions that have the ability to provide solutions to several of the new challenges facing surgery centers.

SOLUTIONTHE POWER OF REAL-TIME LOCATION SYSTEMSIn order to reduce risk of exposure, knowing the location, time spent in each location, and person to person contact between patients and staff will be extremely important. Real-time location systems (RTLS) offer a solution for surgery centers that provides this data in a meaningful way to support flow and throughput processes. Specifically, RTLS tools are able to provide insight into processes aimed at facilitating the patient arrival process, enhancing communications, improving staff workflow and patient throughput, and reducing the risk of infections.

Traditionally, RTLS solutions tend to be cost prohibitive and time-consuming to implement. That is no longer the case with the introduction of a new generation of RTLS solutions that are affordable and easy to install. The following are examples of ways RTLS can support surgery centers in meeting their critical goals around access and safety.

STREAMLINED PATIENT ARRIVAL AND CHECK-IN PROCESSPriority one to ensuring patient and staff safety is coordinating the patient's arrival in a manner that reduces their time spent waiting near

others. Facilities will want to begin communication with the patient prior to their arrival on campus. Waiting lines to check in should be avoided. Communications, preferably through text messaging, should direct the patient to the exact location of check-in, where they pick up an RTLS badge. Once checked in, patients should be directed straight to pre-op. By using the real-time location, clinical staff in Pre-Op and the OR are immediately aware of the patient's arrival and location so that patients proceed through the phases of care in the shortest amount of time with the least amount of person to person contact.

USE OF RTLS DATA TO IMPROVE STAFF WORKFLOW AND PATIENT THROUGHPUTAs surgery centers begin opening up, they will be focused on accommodating the most number of cases possible, while limiting a patient’s time and points of contact in the facility. The standard

priorities around ontime case starts and room turnover will require heightened operational focus. By leveraging RTLS, the time a patient arrives in the OR suite and the time it takes to turn over the room are automatically captured.

When patients have RTLS badges, staff are always able to quickly know where a patient is located, what phase of care they are in, and how long they have been in any particular patient phase. This is done automatically and can also flow into an electronic health record. Furthermore, with staff wearing RTLS badges, the location of surgical team members is also known, which improves overall visibility and aids in reducing delays starting surgical cases.

As an example, in the figure below, the onsite patient list from WorkflowRT for Surgery Centers allows clinicians to see at a glance the real-time location of all patients, how long they have been

in the current phase of care, and the staff who are in the room with them. Other views provide them at-a-glance information to know which OR or prep/holding rooms are occupied and which are available. Clinicians are also able to clearly identify how long the patient has been alone, potentially waiting on a staff member or service such as discharge. By using RTLS tools, real-time views are able to highlight the key pieces of information clinicians need to efficiently advance the patient to the next phase of care. All of the data is updated automatically based on the movement of the RTLS badges.

Wall displays, such as the one below, can also be used to cue staff regarding patient status and delays in care. The wall displays provide an even more efficient option for staff to quickly look up and know the location and status of patients and/or staff.

IMPACTING ROOM TURNOVER TIMES OR room turnover is going to be a critical part of the process. Room turnover is generally accepted as one of the key processes where efficiency is critical because it drives the start of the next case and is closely tied to surgical case capacity. With RTLS, the exact movement time of the patient out of the OR suite can drive a notification to the turnover team to begin cleaning. RTLS can even help “watch the clock” to indicate the time of

turnover. With the requirement for more complex and thorough room sanitizing, assuring optimal efficiency of the turnover process will be critical. To impact the room turnover process appropriately, it must be known which areas of the room turnover need the focus—information the RTLS data will provide.

REPORTSRTLS has the ability to automatically capture (without requiring manual input from staff) data related to location, time, and duration of patients and staff. By leveraging key metrics, surgery centers are able to identify surgical delays and modify processes to gain improvements. The figures below from WorkflowRT for Surgery Centers provide an example of trend data for patient flow and room occupancy that could be used to optimize surgical capacity.

CONTACT TRACINGAccurate and efficient contact tracing will be a required part of resuming surgical caseloads. With the assistance of an automatically-generated contact tracing report which leverages data collected by RTLS, surgical centers can speed up the process of taking the necessary steps to minimize the spread of the disease. The contact tracing report enables the surgery center to promptly notify patients and staff about potential exposure so follow-up.

VISITORS AND FAMILYVisitor management and communications will be critical in the post-COVID era. Visitor restrictions may be in place at some sites, meaning patients may only be allowed one person to accompany them, or they may be required to come alone. Communication will be of utmost importance to give patients and families peace of mind by knowing they will be receiving ongoing updates throughout the surgical visit. RTLS can enable a number of tools to support communication. As an example, WorkflowRT for Surgery Centers offers the following features:

9

• Family View BoardIf families are able to be inside the facility, a family view board, as seen in the following example, can be displayed in the waiting area providing visual updates on the patient's progress.

REFERENCES1. Centers for Medicare & Medicaid Services (CMS).

(2020). CMS Releases Recommendations on Adult Elective Surgeries, Non-Essential Medical, Surgical, and Dental Procedures During COVID-19 Response. Retrieved from https://www.cms.gov/newsroom/press-releases/cms-releases-recommendations-adult-elective-surgeries-non-essential-medical-surgical-and-dental

2. Mehrotra. A et al. (2020). “What Impact Has COVID-19 Had on Outpatient Visits?,” Commonwealth Fund, Apr. 23, 2020. Retrieved from https://doi.org/10.26099/ds9e-jm36

3. Respaut, R, Spaulding, R. (2020). U.S. Hospitals Halt Lucrative Procedures Amid Coronavirus, Job Cuts Follow. Reuters, March 23, 2020. Retrieved from https://www.reuters.com/article/us-health-coronavirus-usa-hospitals/u-s-hospitals-halt-lucrative-procedures-amid-coronavirus-crisis-job-cuts-follow-idUSKBN21I388

4. Luthi,S et al. (2020). Hospitals Bid for $100 Billion in Next Coronavirus Package. Politico, March 19, 2020. https://www.politico.com/news/2020/03/19/hospitals-coronavirus-funding-138383

5. Centers for Medicare & Medicaid Services (CMS). (2020). CMS Issues Recommendations to Re-Open Health Care Systems in Areas with Low Incidence of COVID-19. Issued April 19. Retrieved from https://www.cms.gov/newsroom/press-releases/cms-issues-recommendations-re-open-health-care-systems-areas-low-incidence-covid-19

6. Centers for Medicare & Medicaid Services (CMS). (2020). Recommendations for Re-Opening Facilities to Provide Non-emergency Non-COVID-19 Healthcare: Phase I. Retrieved from https://www.cms.gov/files/document/covid-flexibility-reopen-essential-non-covid-services.pdf

7. American College of Surgeons (ACS), (2020). Joint Statement: Roadmap for Resuming Elective Surgery after COVID-19 Pandemic. Issued April 17. Retrieved from https://www.facs.org/covid-19/clinical-guidance/roadmap-elective-surgery

©2020 Prompt.Health - an Infinite Leap company. All original content in this publication is copyright material belonging to Infinite Leap. Any re-use or reproduction without the expressed, written consent of the copyright owner is strictly prohibited.

HOW TO CREATE A COVID-SAFE SURGICAL CENTER BY LEVERAGING REAL-TIME TECHNOLOGIES

Automated updates on patient status via text messaging

ABOUT THE AUTHORMary Jagim, MSN, RN, CEN, FAENChief Nursing Officer at Infinite Leap

Mary Jagim has over 30 years of experience in emergency nursing, healthcare leadership, public policy, and healthcare consulting. She served as president of the Emergency Nurses Association in 2001 and was a member of the IOM Study on the Future of Emergency Care in the US Health System. In her current position, Mary serves as the Chief Nursing Officer at Infinite Leap, the premier healthcare consulting group and solutions provider for real-time technologies. Mary is one of the leading experts in the implementation and use of real-time location in healthcare. With her practical expertise in emergency preparedness, she assists healthcare systems with leveraging technology to provide a safer environment for patients and staff.

ABOUT PROMPT.HEALTHPrompt.Health, an Infinite Leap company, provides easy and affordable real-time technology solutions that make a big impact on patient experience and safety, increased capacity and access, and improved staff satisfaction.

• Visitor ManagementIf visitors are allowed to accompany patients, keeping track of visitors and identifying one visitor per patient can be a challenge. The same workflow tools that support patient flow can assist with visitor management. As an example, WorkflowRT for Surgery Centers allows staff to identify a patient’s designated visitor and communicate with them. The figure below illustrates tools for visitor management.

• Automated Messages and Custom MessagingAs patients advance through the phases of the surgical experience, from check-in to pre-op to surgery and then on to recovery, the movement of their badge generates automated updates to families or any recipients the patient has identified. Custom messages may also be sent at any time. This messaging tool keeps families informed while easing the level of effort by staff. A sample of automated messages for a surgical site is shown below.

BACKGROUND The Centers for Medicare and Medicaid Services (CMS) recommended on March 18, 2020 to delay all elective surgeries, and non-essential medical, surgical, and dental procedures, during the COVID-19 pandemic. Due to this recommendation ambulatory surgery centers that only perform elective procedures have for the most part been closed. Hospitals were instructed to triage non-elective cases and prioritize those deemed necessary or urgent.1 Delaying the elective surgeries has resulted in up to an 80% decline in surgical cases.2,3,4

The delay of elective procedures was meant to prevent the spread of COVID-19, preserve critical equipment, and ensure adequate hospital beds and healthcare worker resources. But the impact has also resulted in a delay of care for patients, a disruption in employment for many staff and providers, and a significant drop in surgical service’s revenue. Since elective surgical services contribute significantly to a hospital’s bottom line, the loss of revenue is having a major impact on the financial status of hospitals and surgery centers.

On April 19, 2020, CMS issued recommendations on re-opening health care systems in areas with a low incidence rate of COVID-19.5 The guidance provides direction on the considerations a facility needs to take prior to resuming elective surgical cases.6

Resuming elective surgical cases while protecting patients and staff from possible exposures is a multifaceted challenge. In a joint statement published by the American College of Surgeons, American Society of Anesthesiologists, Association of PeriOperative Registered Nurses, and the American Hospital Association, numerous considerations and recommendations are listed for surgery centers.7 Many of these considerations are related to the scheduling of cases and the processes around the patient experience that impact contact points with other individuals.

They include the following:• Patient messaging and communication to

provide clear instructions for patients prior to arrival onsite

• Patient arrival process at facility• Social distancing requirements in waiting

and care areas• Visitor restrictions• Limiting number of personnel in contact

with patients along with potential patient-staff contact points

• Response procedure for a COVID-19 positive patient or staff

• Scheduling consideration for the prolonged duration of operating room turnover time due to additional environmental cleaning requirements

• Strategy for operating extended hours and weekends to allow for more case capacity

DISCUSSIONAs communities begin to re-open, hospitals and surgery centers will be slowly re-opening their schedules. Extended weekday and weekend hours may be needed to address the backlog of delayed cases while maintaining appropriate spacing of cases to accommodate the extended room turnover times. There will be new challenges as they implement the processes necessary to maintain patient and staff safety. Facilities will be undertaking the difficult task of optimizing patient access and flow through the OR while limiting risks for patient and staff exposures.

Necessary priorities will include:• Patient communication• Maintaining social distancing of 6 feet apart• Eliminating waiting lines for check-in• Reducing or eliminating patient time spent in

waiting rooms• Visitor restriction and communication• Minimizing person to person contact before,

during, and after surgery• Organized and efficient room turnover process

with comprehensive cleaning protocols• Efficiently performing thorough contact tracing

to identify patients and staff in the practice at risk in the event of any exposures

• Optimize number of cases while maintaining safe environment for patients

Surgery centers must develop plans and processes now to prepare to fully reopen while providing a safe space for patients and staff. Healthcare facilities can choose to leverage technology solutions to address the challenges of

running operations in the “new normal”. However, with the economic impact on healthcare, funds for solutions will be limited. There are affordable technology solutions that have the ability to provide solutions to several of the new challenges facing surgery centers.

SOLUTIONTHE POWER OF REAL-TIME LOCATION SYSTEMSIn order to reduce risk of exposure, knowing the location, time spent in each location, and person to person contact between patients and staff will be extremely important. Real-time location systems (RTLS) offer a solution for surgery centers that provides this data in a meaningful way to support flow and throughput processes. Specifically, RTLS tools are able to provide insight into processes aimed at facilitating the patient arrival process, enhancing communications, improving staff workflow and patient throughput, and reducing the risk of infections.

Traditionally, RTLS solutions tend to be cost prohibitive and time-consuming to implement. That is no longer the case with the introduction of a new generation of RTLS solutions that are affordable and easy to install. The following are examples of ways RTLS can support surgery centers in meeting their critical goals around access and safety.

STREAMLINED PATIENT ARRIVAL AND CHECK-IN PROCESSPriority one to ensuring patient and staff safety is coordinating the patient's arrival in a manner that reduces their time spent waiting near

others. Facilities will want to begin communication with the patient prior to their arrival on campus. Waiting lines to check in should be avoided. Communications, preferably through text messaging, should direct the patient to the exact location of check-in, where they pick up an RTLS badge. Once checked in, patients should be directed straight to pre-op. By using the real-time location, clinical staff in Pre-Op and the OR are immediately aware of the patient's arrival and location so that patients proceed through the phases of care in the shortest amount of time with the least amount of person to person contact.

USE OF RTLS DATA TO IMPROVE STAFF WORKFLOW AND PATIENT THROUGHPUTAs surgery centers begin opening up, they will be focused on accommodating the most number of cases possible, while limiting a patient’s time and points of contact in the facility. The standard

priorities around ontime case starts and room turnover will require heightened operational focus. By leveraging RTLS, the time a patient arrives in the OR suite and the time it takes to turn over the room are automatically captured.

When patients have RTLS badges, staff are always able to quickly know where a patient is located, what phase of care they are in, and how long they have been in any particular patient phase. This is done automatically and can also flow into an electronic health record. Furthermore, with staff wearing RTLS badges, the location of surgical team members is also known, which improves overall visibility and aids in reducing delays starting surgical cases.

As an example, in the figure below, the onsite patient list from WorkflowRT for Surgery Centers allows clinicians to see at a glance the real-time location of all patients, how long they have been

in the current phase of care, and the staff who are in the room with them. Other views provide them at-a-glance information to know which OR or prep/holding rooms are occupied and which are available. Clinicians are also able to clearly identify how long the patient has been alone, potentially waiting on a staff member or service such as discharge. By using RTLS tools, real-time views are able to highlight the key pieces of information clinicians need to efficiently advance the patient to the next phase of care. All of the data is updated automatically based on the movement of the RTLS badges.

Wall displays, such as the one below, can also be used to cue staff regarding patient status and delays in care. The wall displays provide an even more efficient option for staff to quickly look up and know the location and status of patients and/or staff.

IMPACTING ROOM TURNOVER TIMES OR room turnover is going to be a critical part of the process. Room turnover is generally accepted as one of the key processes where efficiency is critical because it drives the start of the next case and is closely tied to surgical case capacity. With RTLS, the exact movement time of the patient out of the OR suite can drive a notification to the turnover team to begin cleaning. RTLS can even help “watch the clock” to indicate the time of

turnover. With the requirement for more complex and thorough room sanitizing, assuring optimal efficiency of the turnover process will be critical. To impact the room turnover process appropriately, it must be known which areas of the room turnover need the focus—information the RTLS data will provide.

REPORTSRTLS has the ability to automatically capture (without requiring manual input from staff) data related to location, time, and duration of patients and staff. By leveraging key metrics, surgery centers are able to identify surgical delays and modify processes to gain improvements. The figures below from WorkflowRT for Surgery Centers provide an example of trend data for patient flow and room occupancy that could be used to optimize surgical capacity.

CONTACT TRACINGAccurate and efficient contact tracing will be a required part of resuming surgical caseloads. With the assistance of an automatically-generated contact tracing report which leverages data collected by RTLS, surgical centers can speed up the process of taking the necessary steps to minimize the spread of the disease. The contact tracing report enables the surgery center to promptly notify patients and staff about potential exposure so follow-up.

VISITORS AND FAMILYVisitor management and communications will be critical in the post-COVID era. Visitor restrictions may be in place at some sites, meaning patients may only be allowed one person to accompany them, or they may be required to come alone. Communication will be of utmost importance to give patients and families peace of mind by knowing they will be receiving ongoing updates throughout the surgical visit. RTLS can enable a number of tools to support communication. As an example, WorkflowRT for Surgery Centers offers the following features:

• Family View BoardIf families are able to be inside the facility, a family view board, as seen in the following example, can be displayed in the waiting area providing visual updates on the patient's progress.

REFERENCES1. Centers for Medicare & Medicaid Services (CMS).

(2020). CMS Releases Recommendations on Adult Elective Surgeries, Non-Essential Medical, Surgical, and Dental Procedures During COVID-19 Response. Retrieved from https://www.cms.gov/newsroom/press-releases/cms-releases-recommendations-adult-elective-surgeries-non-essential-medical-surgical-and-dental

2. Mehrotra. A et al. (2020). “What Impact Has COVID-19 Had on Outpatient Visits?,” Commonwealth Fund, Apr. 23, 2020. Retrieved from https://doi.org/10.26099/ds9e-jm36

3. Respaut, R, Spaulding, R. (2020). U.S. Hospitals Halt Lucrative Procedures Amid Coronavirus, Job Cuts Follow. Reuters, March 23, 2020. Retrieved from https://www.reuters.com/article/us-health-coronavirus-usa-hospitals/u-s-hospitals-halt-lucrative-procedures-amid-coronavirus-crisis-job-cuts-follow-idUSKBN21I388

4. Luthi,S et al. (2020). Hospitals Bid for $100 Billion in Next Coronavirus Package. Politico, March 19, 2020. https://www.politico.com/news/2020/03/19/hospitals-coronavirus-funding-138383

5. Centers for Medicare & Medicaid Services (CMS). (2020). CMS Issues Recommendations to Re-Open Health Care Systems in Areas with Low Incidence of COVID-19. Issued April 19. Retrieved from https://www.cms.gov/newsroom/press-releases/cms-issues-recommendations-re-open-health-care-systems-areas-low-incidence-covid-19

6. Centers for Medicare & Medicaid Services (CMS). (2020). Recommendations for Re-Opening Facilities to Provide Non-emergency Non-COVID-19 Healthcare: Phase I. Retrieved from https://www.cms.gov/files/document/covid-flexibility-reopen-essential-non-covid-services.pdf

7. American College of Surgeons (ACS), (2020). Joint Statement: Roadmap for Resuming Elective Surgery after COVID-19 Pandemic. Issued April 17. Retrieved from https://www.facs.org/covid-19/clinical-guidance/roadmap-elective-surgery

©2020 Prompt.Health - an Infinite Leap company. All original content in this publication is copyright material belonging to Infinite Leap. Any re-use or reproduction without the expressed, written consent of the copyright owner is strictly prohibited.

10

HOW TO CREATE A COVID-SAFE SURGICAL CENTER BY LEVERAGING REAL-TIME TECHNOLOGIES

Quick & easy way for access control staff to identify the designated visitor(s) for each patient

Visual display for family waiting rooms showing patients' progress

ABOUT THE AUTHORMary Jagim, MSN, RN, CEN, FAENChief Nursing Officer at Infinite Leap

Mary Jagim has over 30 years of experience in emergency nursing, healthcare leadership, public policy, and healthcare consulting. She served as president of the Emergency Nurses Association in 2001 and was a member of the IOM Study on the Future of Emergency Care in the US Health System. In her current position, Mary serves as the Chief Nursing Officer at Infinite Leap, the premier healthcare consulting group and solutions provider for real-time technologies. Mary is one of the leading experts in the implementation and use of real-time location in healthcare. With her practical expertise in emergency preparedness, she assists healthcare systems with leveraging technology to provide a safer environment for patients and staff.

ABOUT PROMPT.HEALTHPrompt.Health, an Infinite Leap company, provides easy and affordable real-time technology solutions that make a big impact on patient experience and safety, increased capacity and access, and improved staff satisfaction.

• Visitor ManagementIf visitors are allowed to accompany patients, keeping track of visitors and identifying one visitor per patient can be a challenge. The same workflow tools that support patient flow can assist with visitor management. As an example, WorkflowRT for Surgery Centers allows staff to identify a patient’s designated visitor and communicate with them. The figure below illustrates tools for visitor management.

• Automated Messages and Custom MessagingAs patients advance through the phases of the surgical experience, from check-in to pre-op to surgery and then on to recovery, the movement of their badge generates automated updates to families or any recipients the patient has identified. Custom messages may also be sent at any time. This messaging tool keeps families informed while easing the level of effort by staff. A sample of automated messages for a surgical site is shown below.

PH-WSS-WP-CO-05/20-01

11

BACKGROUND The Centers for Medicare and Medicaid Services (CMS) recommended on March 18, 2020 to delay all elective surgeries, and non-essential medical, surgical, and dental procedures, during the COVID-19 pandemic. Due to this recommendation ambulatory surgery centers that only perform elective procedures have for the most part been closed. Hospitals were instructed to triage non-elective cases and prioritize those deemed necessary or urgent.1 Delaying the elective surgeries has resulted in up to an 80% decline in surgical cases.2,3,4

The delay of elective procedures was meant to prevent the spread of COVID-19, preserve critical equipment, and ensure adequate hospital beds and healthcare worker resources. But the impact has also resulted in a delay of care for patients, a disruption in employment for many staff and providers, and a significant drop in surgical service’s revenue. Since elective surgical services contribute significantly to a hospital’s bottom line, the loss of revenue is having a major impact on the financial status of hospitals and surgery centers.

On April 19, 2020, CMS issued recommendations on re-opening health care systems in areas with a low incidence rate of COVID-19.5 The guidance provides direction on the considerations a facility needs to take prior to resuming elective surgical cases.6

Resuming elective surgical cases while protecting patients and staff from possible exposures is a multifaceted challenge. In a joint statement published by the American College of Surgeons, American Society of Anesthesiologists, Association of PeriOperative Registered Nurses, and the American Hospital Association, numerous considerations and recommendations are listed for surgery centers.7 Many of these considerations are related to the scheduling of cases and the processes around the patient experience that impact contact points with other individuals.

They include the following:• Patient messaging and communication to

provide clear instructions for patients prior to arrival onsite

• Patient arrival process at facility• Social distancing requirements in waiting

and care areas• Visitor restrictions• Limiting number of personnel in contact

with patients along with potential patient-staff contact points

• Response procedure for a COVID-19 positive patient or staff

• Scheduling consideration for the prolonged duration of operating room turnover time due to additional environmental cleaning requirements

• Strategy for operating extended hours and weekends to allow for more case capacity

DISCUSSIONAs communities begin to re-open, hospitals and surgery centers will be slowly re-opening their schedules. Extended weekday and weekend hours may be needed to address the backlog of delayed cases while maintaining appropriate spacing of cases to accommodate the extended room turnover times. There will be new challenges as they implement the processes necessary to maintain patient and staff safety. Facilities will be undertaking the difficult task of optimizing patient access and flow through the OR while limiting risks for patient and staff exposures.

Necessary priorities will include:• Patient communication• Maintaining social distancing of 6 feet apart• Eliminating waiting lines for check-in• Reducing or eliminating patient time spent in

waiting rooms• Visitor restriction and communication• Minimizing person to person contact before,

during, and after surgery• Organized and efficient room turnover process

with comprehensive cleaning protocols• Efficiently performing thorough contact tracing

to identify patients and staff in the practice at risk in the event of any exposures

• Optimize number of cases while maintaining safe environment for patients

Surgery centers must develop plans and processes now to prepare to fully reopen while providing a safe space for patients and staff. Healthcare facilities can choose to leverage technology solutions to address the challenges of

running operations in the “new normal”. However, with the economic impact on healthcare, funds for solutions will be limited. There are affordable technology solutions that have the ability to provide solutions to several of the new challenges facing surgery centers.

SOLUTIONTHE POWER OF REAL-TIME LOCATION SYSTEMSIn order to reduce risk of exposure, knowing the location, time spent in each location, and person to person contact between patients and staff will be extremely important. Real-time location systems (RTLS) offer a solution for surgery centers that provides this data in a meaningful way to support flow and throughput processes. Specifically, RTLS tools are able to provide insight into processes aimed at facilitating the patient arrival process, enhancing communications, improving staff workflow and patient throughput, and reducing the risk of infections.

Traditionally, RTLS solutions tend to be cost prohibitive and time-consuming to implement. That is no longer the case with the introduction of a new generation of RTLS solutions that are affordable and easy to install. The following are examples of ways RTLS can support surgery centers in meeting their critical goals around access and safety.

STREAMLINED PATIENT ARRIVAL AND CHECK-IN PROCESSPriority one to ensuring patient and staff safety is coordinating the patient's arrival in a manner that reduces their time spent waiting near

others. Facilities will want to begin communication with the patient prior to their arrival on campus. Waiting lines to check in should be avoided. Communications, preferably through text messaging, should direct the patient to the exact location of check-in, where they pick up an RTLS badge. Once checked in, patients should be directed straight to pre-op. By using the real-time location, clinical staff in Pre-Op and the OR are immediately aware of the patient's arrival and location so that patients proceed through the phases of care in the shortest amount of time with the least amount of person to person contact.

USE OF RTLS DATA TO IMPROVE STAFF WORKFLOW AND PATIENT THROUGHPUTAs surgery centers begin opening up, they will be focused on accommodating the most number of cases possible, while limiting a patient’s time and points of contact in the facility. The standard

priorities around ontime case starts and room turnover will require heightened operational focus. By leveraging RTLS, the time a patient arrives in the OR suite and the time it takes to turn over the room are automatically captured.

When patients have RTLS badges, staff are always able to quickly know where a patient is located, what phase of care they are in, and how long they have been in any particular patient phase. This is done automatically and can also flow into an electronic health record. Furthermore, with staff wearing RTLS badges, the location of surgical team members is also known, which improves overall visibility and aids in reducing delays starting surgical cases.

As an example, in the figure below, the onsite patient list from WorkflowRT for Surgery Centers allows clinicians to see at a glance the real-time location of all patients, how long they have been

in the current phase of care, and the staff who are in the room with them. Other views provide them at-a-glance information to know which OR or prep/holding rooms are occupied and which are available. Clinicians are also able to clearly identify how long the patient has been alone, potentially waiting on a staff member or service such as discharge. By using RTLS tools, real-time views are able to highlight the key pieces of information clinicians need to efficiently advance the patient to the next phase of care. All of the data is updated automatically based on the movement of the RTLS badges.

Wall displays, such as the one below, can also be used to cue staff regarding patient status and delays in care. The wall displays provide an even more efficient option for staff to quickly look up and know the location and status of patients and/or staff.

IMPACTING ROOM TURNOVER TIMES OR room turnover is going to be a critical part of the process. Room turnover is generally accepted as one of the key processes where efficiency is critical because it drives the start of the next case and is closely tied to surgical case capacity. With RTLS, the exact movement time of the patient out of the OR suite can drive a notification to the turnover team to begin cleaning. RTLS can even help “watch the clock” to indicate the time of

turnover. With the requirement for more complex and thorough room sanitizing, assuring optimal efficiency of the turnover process will be critical. To impact the room turnover process appropriately, it must be known which areas of the room turnover need the focus—information the RTLS data will provide.

REPORTSRTLS has the ability to automatically capture (without requiring manual input from staff) data related to location, time, and duration of patients and staff. By leveraging key metrics, surgery centers are able to identify surgical delays and modify processes to gain improvements. The figures below from WorkflowRT for Surgery Centers provide an example of trend data for patient flow and room occupancy that could be used to optimize surgical capacity.

CONTACT TRACINGAccurate and efficient contact tracing will be a required part of resuming surgical caseloads. With the assistance of an automatically-generated contact tracing report which leverages data collected by RTLS, surgical centers can speed up the process of taking the necessary steps to minimize the spread of the disease. The contact tracing report enables the surgery center to promptly notify patients and staff about potential exposure so follow-up.

VISITORS AND FAMILYVisitor management and communications will be critical in the post-COVID era. Visitor restrictions may be in place at some sites, meaning patients may only be allowed one person to accompany them, or they may be required to come alone. Communication will be of utmost importance to give patients and families peace of mind by knowing they will be receiving ongoing updates throughout the surgical visit. RTLS can enable a number of tools to support communication. As an example, WorkflowRT for Surgery Centers offers the following features:

• Family View BoardIf families are able to be inside the facility, a family view board, as seen in the following example, can be displayed in the waiting area providing visual updates on the patient's progress.

REFERENCES1. Centers for Medicare & Medicaid Services (CMS).

(2020). CMS Releases Recommendations on Adult Elective Surgeries, Non-Essential Medical, Surgical, and Dental Procedures During COVID-19 Response. Retrieved from https://www.cms.gov/newsroom/press-releases/cms-releases-recommendations-adult-elective-surgeries-non-essential-medical-surgical-and-dental

2. Mehrotra. A et al. (2020). “What Impact Has COVID-19 Had on Outpatient Visits?,” Commonwealth Fund, Apr. 23, 2020. Retrieved from https://doi.org/10.26099/ds9e-jm36

3. Respaut, R, Spaulding, R. (2020). U.S. Hospitals Halt Lucrative Procedures Amid Coronavirus, Job Cuts Follow. Reuters, March 23, 2020. Retrieved from https://www.reuters.com/article/us-health-coronavirus-usa-hospitals/u-s-hospitals-halt-lucrative-procedures-amid-coronavirus-crisis-job-cuts-follow-idUSKBN21I388

4. Luthi,S et al. (2020). Hospitals Bid for $100 Billion in Next Coronavirus Package. Politico, March 19, 2020. https://www.politico.com/news/2020/03/19/hospitals-coronavirus-funding-138383

5. Centers for Medicare & Medicaid Services (CMS). (2020). CMS Issues Recommendations to Re-Open Health Care Systems in Areas with Low Incidence of COVID-19. Issued April 19. Retrieved from https://www.cms.gov/newsroom/press-releases/cms-issues-recommendations-re-open-health-care-systems-areas-low-incidence-covid-19

6. Centers for Medicare & Medicaid Services (CMS). (2020). Recommendations for Re-Opening Facilities to Provide Non-emergency Non-COVID-19 Healthcare: Phase I. Retrieved from https://www.cms.gov/files/document/covid-flexibility-reopen-essential-non-covid-services.pdf

7. American College of Surgeons (ACS), (2020). Joint Statement: Roadmap for Resuming Elective Surgery after COVID-19 Pandemic. Issued April 17. Retrieved from https://www.facs.org/covid-19/clinical-guidance/roadmap-elective-surgery

©2020 Prompt.Health - an Infinite Leap company. All original content in this publication is copyright material belonging to Infinite Leap. Any re-use or reproduction without the expressed, written consent of the copyright owner is strictly prohibited.

ABOUT THE AUTHORMary Jagim, MSN, RN, CEN, FAENChief Nursing Officer at Infinite Leap

Mary Jagim has over 30 years of experience in emergency nursing, healthcare leadership, public policy, and healthcare consulting. She served as president of the Emergency Nurses Association in 2001 and was a member of the IOM Study on the Future of Emergency Care in the US Health System. In her current position, Mary serves as the Chief Nursing Officer at Infinite Leap, the premier healthcare consulting group and solutions provider for real-time technologies. Mary is one of the leading experts in the implementation and use of real-time location in healthcare. With her practical expertise in emergency preparedness, she assists healthcare systems with leveraging technology to provide a safer environment for patients and staff.

ABOUT PROMPT.HEALTHPrompt.Health, an Infinite Leap company, provides easy and affordable real-time technology solutions that make a big impact on patient experience and safety, increased capacity and access, and improved staff satisfaction.

1-833-776-6781

�info@prompt.health

�www.prompt.health

PH-WSS-WP-CO-05/20-01

• Visitor ManagementIf visitors are allowed to accompany patients, keeping track of visitors and identifying one visitor per patient can be a challenge. The same workflow tools that support patient flow can assist with visitor management. As an example, WorkflowRT for Surgery Centers allows staff to identify a patient’s designated visitor and communicate with them. The figure below illustrates tools for visitor management.

• Automated Messages and Custom MessagingAs patients advance through the phases of the surgical experience, from check-in to pre-op to surgery and then on to recovery, the movement of their badge generates automated updates to families or any recipients the patient has identified. Custom messages may also be sent at any time. This messaging tool keeps families informed while easing the level of effort by staff. A sample of automated messages for a surgical site is shown below.