Used by a small but growing number of facilities, RTLS technology is gaining acceptance as hospitals seek to locate equipment and wandering patients, troubleshoot operational bottlenecks, monitor critical temperatures and track surgical supplies.

Hospitals are being challenged like never before to contain costs and improve results. Tracking hospital assets within complex environments where people and equipment are in constant motion is vital to these efforts. In response, more facilities are using real-time locating systems (RTLS), an evolving technology that helps track key assets and improve workflow, safety and security.

A daunting task

Knowing where everyone and everything is located at any time is a daunting task, notes Debby Ramundo, R.N., senior technology consultant-IT architecture for Sparling, Seattle. RTLS tools create a context-aware environment, providing knowledge of where equipment and people are located. So far, the most common use has been asset management — tracking and monitoring equipment such as infusion pumps, wheelchairs and surgical equipment.

RTLS technology uses a platform — tags and readers — to identify and track the location of objects and people. For example, a tag is placed on a patient's wrist band or an IV pump. Then, the reader picks up the signal, identifies the location and inputs the information into a database. Thus, a nurse who needs an IV pump can go to a computer to see the location of the nearest available pump.

"Hospitals have realized significant savings by monitoring their equipment in this way," Ramundo says. "Pumps and wheelchairs can end up in unusual locations where they can't be found. These problems lead to underutilization of equipment, prompting the hospital to buy more than is needed. By using RTLS technology, hospitals can decrease the amount of equipment purchased or rented."

Jason Fradin, vice president of marketing and communications for Stanley Healthcare Solutions (, Noblesville, Ind., agrees. Hospitals carry an array of expensive items. The ability to manage this inventory can save millions of dollars a year. "Radio-frequency identification (RFID)-enabled storage allows hospitals to automatically track supplies as they are removed, to see where and how items are being used and thus optimize par levels," he explains.

By eliminating shrinkage and reducing equipment rental expenses, RTLS deployment usually has a return on investment of less than one year, says Tuomo Rutanen, senior vice president, worldwide marketing and business development for Ekahau Inc. (, Reston, Va.

"The typical 300-bed hos­pital without RTLS loses $200,000 to $300,000 [worth] of wheelchairs, infusion pumps and other items each year," he notes. "To add insult to injury, mandated preventive maintenance and other requirements are difficult to meet if you cannot locate the equipment. In addition, hospitals incur rental expenses for things they already have but cannot find and put to use."

On the air

RTLS encompasses a number of competing and complementary locating technologies, including ZigBee, Wi-Fi, infrared, ultrasound, ultra-wideband and other radio frequency systems. Each one impacts the suitability of an application in different ways. Just as important, how these basic technologies are implemented has a significant impact on system performance, location accuracy, cost and reliability. Some systems are hybrid. For example, Ekahau uses Wi-Fi for campuswide coverage and infrared to narrow accuracy down to bed level in certain applications.

"RTLS is a complex tech­nology — more complex than some realize," says Barbara Majchrowski, senior project engineer, health devices group, ECRI Institute, Plymouth Meeting, Pa. "Purchase decisions can incorporate numerous technological and process-related factors. These factors include resolution requirements, signaling technologies, end-user software, alerting capabilities and process reengineering, among many others."

Joel Cook, director of health care solutions, AeroScout Inc. (, Redwood City, Calif., says most hospitals already have Wi-Fi networks in place and use those networks for a variety of services, including data and voice. "One advantage of using Wi-Fi for RTLS is that because it is already deployed widely within health care organizations, you can track and manage items anywhere within the organization immediately upon installing tags and software," he says.

While Wi-Fi or radio frequency-based RTLS may be good for equipment tracking, a technology such as ultrasound is required to provide room or subroom accuracy, according to Terry Aasen, president of Sonitor Technologies Inc. (, Bothell, Wash. "If the hospital is going to use RTLS to improve workflow or safety, it is essential that the RTLS technology provide location information that with 100 percent certainty shows [on] which side of the wall, window or curtain a tracked object is located," he says. The industry has learned that Wi-Fi for RTLS requires infrastructure add-ons for access points to attain reasonable performance for equipment tracking, and will require ongoing calibration to sustain accuracy, he says.

Robert Anderson, director of marketing for Radianse (, North Andover, Mass., says Wi-Fi can place a burden on the data infrastructure that is already in place for medical applications. Also, Wi-Fi may experience dead zones due to radio antenna patterns. "A dedicated RTLS infrastructure (e.g., 433 MHz RF) can handle mission-critical RTLS applications beyond simple asset tracking as well as future growth," he says.

The benefits of RTLS

Whatever the specific format each system follows, experts agree that RTLS can benefit hospitals because it increases efficiency, improves regulatory compliance and heightens overall productivity and patient care. Staff spend less time searching for equipment, patient-tracking processes are improved and better utilization of equipment lowers costs.

"The benefits of RTLS often depend on the application," says Majchrowski. "For asset tracking, benefits may arise from a return on investment derived from rental equipment savings or it may simply be the benefit of finding a piece of equipment when you need it. For workflow-based applications, the benefit may come from more efficient work processes or the ability to generate the data necessary for performance-improvement initiatives."

Valerie Fritz, vice president of marketing, RTLS Division, TeleTracking Technologies Inc. (, Pittsburgh, says it's all about getting more from existing capacity while reducing costs. "Optimizing flow is perhaps the most immediate way to improve operating margin and control increased demand for access," she says.

"A complex set of processes must be in place to ensure that hospitals can quickly place patients in the appropriate bed, with the right staff and the right equipment needed for their care," Fritz adds. "When RTLS location data is integrated into the right software solution, the value in driving capacity and cost containment is astounding."

Success in asset management has led companies to develop expanded RTLS capabilities. Today's systems are being positioned as enterprise visibility and real-time awareness solutions, which can map, monitor and measure objects and people. These capabilities include monitoring the temperature of hospital freezers, sending alerts for scheduled equipment maintenance and displaying current bed occupancy.

In the past, many hospitals had to discard blood or tissue samples if a refrigeration unit fell outside required compliance temperature ranges. The temperature typically was checked and recorded manually every hour by a staff member. If the unit became un­plugged or failed, it might have taken 60 minutes before anyone realized there was a problem.

"By using RTLS, we can check temperature automatically (without human intervention) every 10 seconds and record that data," says Anderson. "If a threshold is above or below a set condition, staff are instantly alerted to take corrective action."

One of the newest applications of RTLS technology lies in monitoring staff hand washing. "Sensors can be utilized to determine if a nurse entering a patient's room has used the soap dispenser to wash her hands before approaching the patient," says Ramundo. "If she has forgotten to wash her hands, the system can signal a reminder."

Other patient safety applications also are being explored by hospitals. RTLS tags can be configured to monitor the location and status of different categories of patients, including infants, psychiatric and geriatric. The badges can trigger an alert if a patient enters a restricted area or attempts to leave the facility. "These systems typically rely on active RFID, because it offers excellent choke-point control and a small tag, which is important when dealing with infants," says Fradin.

Another innovative concept is RFID-tagged consumables such as sponges and other tools that are used during surgery, says David Russell, vice president of operations for epcSolutions Inc. (, Great Falls, Va. "Surgical sponges are now available with RFID tags. After surgery, the team can make a sweep of the area, thus locating any that are submerged or covered, and making sure that none of these tools is unintentionally left inside the patient after surgery."

Implementation levels

Despite all these benefits, ex­perts agree that the percentage of hospitals that use RTLS is less than 20 percent, but that percentage is rapidly increasing.

Any size hospital can use the technology. Because the solutions are scalable, they can be applied to virtually any facility, and small hospitals face the same challenges as large ones.

Anderson sees three levels of RTLS implementation: sites that are evaluating the technology for future use; sites that have adopted RTLS in one department (e.g., perioperative sur­gical services) or for a single application (e.g., asset management); and sites that have deployed RTLS hospitalwide in several departments, which represents the smallest percentage. "Over time, hospitals will migrate from Categories 1 and 2 to full deployment in multiple areas of their facilities," he says.

When designing and installing an RTLS solution, facility managers should consider existing and future needs. Thorough planning and training also are important. "It is common for hospitals to deploy our asset-tracking and management solution, and then find that other departments want to add our temperature monitoring or patient- and staff-safety solutions," says Cook. "Hospitals need a solution that is scalable, robust and enterprisewide."

According to Rutanen, proper planning is the most important element for successful RTLS implementation. Other considerations are building condition and infrastructure or network capabilities. "If deployment is going to be in an older building, the end user may want to stay away from systems that require a new, dedicated, non-Wi-Fi wireless network," he advises.

A well-thought tagging strategy also is crucial, especially in large facilities, according to Aasen. "There needs to be full buy-in from stakeholders and users," he says. "Everyone has to understand the potential of RTLS and be properly trained. Most customers find new-use cases after initial RTLS applications have been deployed. This underlies the importance of acquiring a technology that easily and cost effectively can adapt to growing and changing hospital needs."

Fradin says the complete benefits of RTLS only materialize if the system is aligned with and fully supports clinical workflow, and if staff members at all levels of the organization understand the technology and how to use it. "In evaluating the right solution, it is important that the hospital choose the right partner for this major undertaking — one that understands the clinical environment as well as the technology," Fradin says.

"Understanding the latitude and longitude of each intersection is imperative to precisely mapping the facility and knowing where things are, but labeling the assets themselves is the most burdensome activity," Russell notes. "If you don't know where it is, you have to start by hunting down everything you want to track to make sure it's tagged."

A strategic tool

Taking a peek into the future, Matt Perkins, chief technology officer, Awarepoint (www.aware­, San Diego, says the trend in RTLS applications is moving toward automated workflow systems with way points, similar to how airline pilots map out their flight plans. Simply put, when facilities can identify the bottlenecks, they can implement an automated workflow system to remove those congestion points.

Rutanen sees large hospital groups using RTLS as a strategic tool to help manage their facilities — designing tie-ins into the big picture. "Hospital groups can rebalance things across different properties," he says. "For example, Hospital A needs pumps that Hospitals B and C have in storage; let's repurpose those and deploy them across the enterprise. In this way, they can leverage the technology groupwide and improve economies across an entire group of hospitals."

Neal Lorenzi is a freelance writer based in Mundelein, Ill.

Sidebar - For more information

For further details on the real-time locating systems featured in this month's "Marketplace" article, readers can contact the following vendors:

AeroScout Inc.


Ekahau Inc.

epcSolutions Inc.


Sonitor Technologies Inc.

Stanley Healthcare Solutions

TeleTracking Technologies Inc.