Radio-frequency identification (RFID) is the use of radio frequency electromagnetic fields to transfer data. It is a wireless non-contact method and is commonly used for the purposes of automatically identifying and tracking tags attached to objects. These tags usually contain electronically stored information.
At Tan Tock Seng Hospital (TTSH) in Singapore, this RFID method has been used in its SmartSense system, and used to record vital signs of patients, monitor their body temperatures and track their locations. This innovative system has won the hospital one of the first seven HIMSS-Elsevier Digital Healthcare Awards in the inaugural ceremony in 2013. Rachel Lim speaks to Mr Yong Keng Kwang, the Director of Nursing of TTSH, to more fully understand the system and the benefits it has brought to the hospital, its patients and its staff.
APBN: Please describe the SmartSense system and how it works.
Mr Yong: TTSH SmartSense system provides real time RFID patient location tracking, non-invasive continuous body temperature monitoring and recording of patients' vital signs.
The system is also integrated with TTSH's Electronic Medical Records system providing latest vital signs data and charts online to enable timely treatment and collaborate on treatment options.
An RFID tag attached to the patient's lower body provides location and temperature data. A tablet, with Medical Device Interface software, is connected to a vital signs monitor, extracts and uploads data wirelessly to an electronic chart. SmartSense's automatic data recording and charting increases patient safety by minimizing human errors. It also saves nurses time for direct patient care, improving care quality and nurses' productivity. Non-invasive continuous capturing of temperature also ensures patients have uninterrupted rest.
RFID location tracking allows for timely location of patients to administer treatment and better monitoring of patients who has risk of wandering off the wards.
APBN: What were the reasons that led to the implementation of this system?
Mr Yong:There were 2 main reasons:
- To leverage on RFID technology to track and optimize patient flow, and turnover.
- It allows frontline nurses and doctors to be notified of patient's change in temperature in real-time, hence enabling appropriate treatment/ response to be carried out in a more timely manner.
APBN: How have the hospital, the staff and patients benefited from this new system?
Mr Yong: The SmartSense system has many different benefits.
- Improves patient care and safety, higher staff productivity
- It reduces nurses' time spent taking temperatures, recording vital signs data and charting trends.
- It eliminates errors from transcribing vital signs readings into patient notes and manually plotting trends, thus improving patient safety.
- The RFID patient location tracking improves patient care as nurses can locate patient easily to provide timely administration of medication and treatment. It also allows nurses to have more time for direct patient care.
- It reduces staff time in handling paper notes or locating lost patient charts.
- The non-invasive continuous capturing of temperature also ensures patients have uninterrupted rest.
- Improves Bed Management
- Improved bed turnaround and utilisation - When a patient is discharged, housekeeping is notified in real time, and the bed is cleaned within 30 minutes.
- Facilitates Pandemic management
- During pandemics, contact with patients is minimized with automated temperature recording.
- Historical data on the patient's movement facilitates speedy contact tracing, quarantine and pandemic management. SmartSense also opens the opportunity for an alarm system for quarantine through location tracking.
APBN: What were some of the challenges in implementing this system? Were there problems for the staff in learning and adapting to it?
Mr Yong: Some of the challenges were:
- The lowering of temperature during bathing
- Displacement of the tags if not secured well
- Missing readings when patient goes out of RFID readers' range
- RFID tag possibly being removed by patient (typically those with cognitive deficits)
- Determining the RFID receivers' coverage
- Battery life and durability of sensor tags
These actions were taken to overcome the challenges:
- Site surveys were done to obtain best coverage and performance of RFID technology, with consideration of patient movement patterns.
- Training was provided to nurses on troubleshooting when temperature errors were observed.
- RFID tags are changed regularly when battery goes low.
APBN: Have there been additional costs to the patients after the implementation of this system?
Mr Yong:There is no additional cost to be shouldered by the patient post implementation of the SmartSense technology.
APBN: Have there been any additional costs on the patients?
Mr Yong: As we are still in the pilot phase (funded by MOH) there is no additional cost to the patient.
About the Interviewee
Yong Keng Kwang is the Director of Nursing Service at Tan Tock Seng Hospital. His qualifications include Bachelor of Nursing (Honours), Certificate in District Nursing from the UK and a Masters in Business Administration.
Keng Kwang started his career as a clinical nurse at 1200-bedded Tan Tock Seng Hospital, Singapore, in 1996. He moved to Nursing Administration as a Senior Staff Nurse in 1998 to work on Division-wide nursing projects. He was subsequently promoted to Assistant Director, Nursing in 2002 after 4 years, and recently to Director, Nursing in October 2011.
In his years in Nursing Administration, he worked on multiple projects as well as in different portfolios relating to strategic planning, manpower development, clinical operations, but most primarily, quality management. He has helped to set up the quality framework within the Nursing Division, and has also played key roles in leading the Nursing Division in the Hospital's quests for ISO, SQC (Singapore Quality Class) & JCI accreditations. All this while, he plays a key role in assisting the Director of Nursing to plan and drive nursing transformation efforts.
But nursing quality management is not embedded in clinical quality alone – quality in terms of service and operational consistency is also paramount. Hence, beside his administrative responsibilities within the Nursing Division, he also serves as an Improvement Facilitator in TTSH's Kaizen Office (since January 2008), member of the TTSH MyCare Taskforce, and member of TTSH Clinical Practice Improvement Program Faculty. He has been facilitating Lean initiatives/ quality improvement projects across different departments (within the hospital), and one of his key projects includes the General Surgery Short Stay Ward.
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