Friday
February 7, 2003
Automated guided vehicles (AGVs) have been around for 25 years as a labor-free alternative to help hospitals run their department operations more efficiently and profitably. According to their proponents, AGVs are capable of safely, accurately and speedily transporting supplies, meals, trash, pharmaceuticals, linens and other bulk items up to 1,000 to 1,500 pounds through a hospital environment.
Auxiliary equipment can also be integrated into the systems, such as surgical cart lifts/elevators, cart washers, trash dumpers, retort sterilizers and automatic doors.
Up until now, AGVs have been more widespread in manufacturing than in health care. And, while the number of hospitals using AGVs is still very small--there's an estimated range of 10 to 20 installations in the U.S. health care industry, according to FMC Technologies, Chalfont, Pa.--more hospitals are taking a look at AGVs as they commit to modernizing their existing transport systems.
Mark Longacre, marketing manager for FMC, says AGV growth has been slow in health care for several reasons.
For one thing, he says, managed care issues and lack of funding have hindered growth. AGVs have had to compete for hospital funding versus purchase of other equipment and expansions, and there is a natural tendency for administrators to look to increasing revenues before reducing costs. Purchasing additional equipment and expanding the facility give the hospital a means to increase revenues,while AGVs are for reducing operating costs. However, proponents say, that trend might be reversing itself as hospitals are beginning to invest in robotic systems that can boost productivity and improve patient care in the face of employee shortages.
Another reason for slow AGV utilization in health care facilities has been the expense of making infrastructure alterations. AGV systems can be used with service elevators, but dedicated service elevators are preferred, which makes application more complex for existing facilities. AGVs are most practical for long, 10-foot-wide (or more) main corridors in spread-out facilities, and impractical for small hospitals. However, advocates believe the growth in health care construction activity is making some of these drawbacks moot as well.
In any case, AGV technology has really soared of late. Older systems were guided by wires embedded in the floor, and any changes to the facility or areas serviced would require major floor modifications that were time-consuming, costly and disruptive. Now, AGVs are increasingly laser guided, following a computer-generated virtual path. The path can be changed without requiring changes to the building. Only the software needs to be modified. Laser guidance is also more accurate and reliable than wire-guided systems, vendors say.
Similarly, wireless radio frequency (RF) communication has also been replacing communication systems using a wire embedded in the floor. A good communication system is critical because the host control system must be in constant communication with each vehicle so that it can give commands to provide the most efficient operation. The wireless RF system provides top-quality communication and is not susceptible to interference and "blank spots" that were sometimes evident in wire communication systems.
Another advantage of the wireless RF system is that it can be used to communicate additional data. Some health care facilities already have an RF system of access point used to transmit patient and other data to wireless devices (laptops, PDAs, etc.). The automated transport system can use this existing RF communication system to convey important messages to hospital staff as well as serve the communications link between vehicles and the host computer.
The host control systems often now use standard PC hardware and the Windows 2000 operating system, replacing older host systems based on less-common computer hardware and software. This makes the systems much easier to use and operators require less training than before. Programs are menu driven with help online. The operating systems are also very stable, although "hot back-ups" are still offered to allow the systems to automatically switch to a redundant second host computer should the first system fault.
The two major AGV players in the health care industry are FMC Technologies Automated Systems and Swisslog North America of Denver.
FMC's newest AGV, the ATLIS 3000, was designed to provide a cost-effective material transport system for the health care industry with a quick return on investment. "AGVs are disciplined to get the right materials to the right place at the right time," Longacre says. "They can decrease a hospital's labor shortages, improve efficiency and secure damage-free handling."
The ATLIS 3000 features laser triangulation in navigation, a process that allows the vehicle to operate with optimum accuracy. All of the hardware and software of the vehicle control system has been run for hundreds of thousands of hours in the most extreme environments, the manufacturer says.
"Above all, we wanted to create a system that would be safe for the staff who would use it," Longacre says. "It also had to be extremely reliable because there is no backup labor pool to call on if the system is not operational." The Ohio State University Medical Center will be the first health facility to use the ATLIS 3000 system. They have contracted for 46 ATLIS 3000 AGVs to be installed in 2003.
FMC offers both a flat- or tower-type vehicle, but the tower vehicle has ergonomic advantages over the flat vehicle. Operator controls are at a comfortable operating position, and warning lights are at a position where they can be seen. Maintenance is easier with components positioned in areas that allow servicing. The ATLIS vehicle is outfitted with a stainless-steel external skin and is available with sealed controls for washdown applications.
New support software allows the system to be easily customized. A "panel builder" feature allows quick changes in operator control panel touchscreens, and a "layout wizard" allows quick changes of the guide path so that new areas can be serviced and existing areas can be supported in the future.
The "setup wizard" interfaces the system with pagers and e-mails so that it can automatically generate messages under certain conditions. A report generator provides standard professional reports. The host computer interfaces with elevators, doors and cart washers. FMC has so far supplied six ATLIS AGV systems and 100 vehicles to health care customers.
Greenville (S.C.) Memorial Hospital currently has 21 FMC AGVs and is in the process of expanding the system. The hospital maintains 1,000 beds at its main campus, seven satellite stations, and a staff of 7,000 employees.
An early adopter of the technology, Ken Bailey, supervisor of AGVs at Greenville, has been using them since 1972. Back then, the hospital built a mezzanine level just to accommodate the vehicles. About 10 years ago, when the 1970s-era vehicles needed to be replaced, he started using FMC's ATLIS.
In the fall, the main campus will acquire a new wing with 88 new beds. At that time, Bailey will acquire five more ATLIS AGVs. He has added three additional elevators to the hospital, programmed to interface with the AGVs and cart washers.
AGVs run horizontally between the ground floor and the mezzanine level so when materials are transported to the upper floors they ascend the elevator, "drop" the materials and then return to their point of origin. The public doesn't see the AGVs, nor do the doctors, nurses or patients.
The hospital uses AGVs to transport food and dirty trays, and they are programmed to complete this task within 15 minutes. They also transport OR supplies and surgical instruments, linen, trash and general supplies.
"Thanks to the AGVs, we have avoided hiring 65 employees to move material. The addition of five more vehicles makes it unnecessary to hire additional FTEs," Bailey says. Assuming the total average cost for each FTE ranges from $30,000 to $50,000 (including wages, benefits, labor taxes and miscellaneous employee-related expenses), Greenville has so far saved a total of $19.5 million to $32.5 million over the life of the AGV system.
"My department handles AGV maintenance in-house," says Bailey. "We use FMC for expansions because we lack the manpower and computer expertise to make these changes on our own. AGV maintenance requires one person for every 10 cars, so we maintain a crew of nine individuals, which includes electronics tech people to keep the cars running and monitor technicians to man the computer system," he says.
"The nine employees also work on the tube system, sterilizer, medical gas system, public address system, auto code system, security camera and access control system, as well as repairing surgical tables, the television system and general electronics," Bailey adds.
The ATLIS model at Greenville runs on wires embedded in the floor. Bailey comments: "The new laser-navigated AGV offers a wireless technology which is more user friendly and flexible than our model, and probably requires less maintenance. However, for the time being, we plan to get 20 years use out of our existing vehicles."
In April 2002, Swisslog North America introduced the Transcar LTC2 AGV system, specifically designed for the health care environment.
"The LTC2 is a low-profile, bi-directional vehicle with virtual path, laser contour following guidance to provide faster, more regular deliveries to floors and minimize potential for injuries," says Kim Garoutte, systems engineer at Swisslog. This advanced technology utilizes existing right-of-ways and requires no wall targets, embedded wires or other costly building modifications. Virtual path maps are stored at the system control center and downloaded to each vehicle.
LTC2's NiCd batteries require only 30 minutes of recharging time per shift. The system control center operates on the Windows 2000 operating system with remote modem access and online help for maintenance. Communications between the control center and AGVs are achieved through a wireless RF communication system.
The LTC2 offers a low-profile lifting ability facilitating movement of carts to minimize cross-contamination. It transports meals/soiled trays; linen; trash; supplies and surgical cases; and bulk pharmaceuticals between centralized operations and patient floors.
The first installation of a 16-vehicle Transcar LTC2 system in North America is under contract with Houston's Memorial Hermann Southwest Hospital, scheduled for completion in May. Pete McGraw, director of clinical engineering, has a successful track record with AGVs. He's also used a 1970's-era system for 25 years, but needs to replace it since parts are hard to come by. He began researching AGVs over a year ago and was impressed by the versatility of the LTC2.
McGraw says: "Once it's installed, we'll use it to transport linens, waste materials and food trays. Ultimately, we hope to end hand delivery of supplies and use the LTC2 to transport surgical and central supplies, taking on all labor-intensive assignments at the hospital."
While employee shortages and increased health care construction activity are giving health facilities operations personnel a new reason to look at AGVs, their ultimate success or failure will hinge on their performance in the field, where all innovations are ultimately judged.
Deb Lehman is a freelance writer based in Fanwood, N.J.
This article 1st appeared in the February 2003 issue of Health Facilities Magazine.