Approaches and Solutions to Hospital Emergency Department Overcrowding Including Failure Mode and Effect Analysis as a Risk Assessment Technique of Real-time Locating System

Emergency Departments (ED) are highly dynamic environments comprising complex multi-dimensional patient-care processes. In recent decades, there has been increased pressure to improve ED services, while taking into account various aspects such as clinical quality, operational efficiency, and cost performance. Overcrowding has become a major barrier to receiving a proper and timely emergency care in many acute hospitals throughout the world. Patients often face long waiting times to be seen and treated. Those who require admission may even wait longer. The scope of this research is to focus on ED factors that lead to overcrowding and their management. Technology is being cited as one of the management tools, specifically the utilization of Radio Frequency Identification (RFID) for tracking patients as their journey progresses through an ED. Like any technology, RFID has potential and pitfalls. The author chose to use Failure Mode and Effect Analysis (FMEA) as a tool to explore the possible failures of RFID technology as it is utilized in one of the ED in Riyadh Military Hospital (RMH). This particular ED has been used as a case study to explore those failures and, with the use of FMEA, propose a set of recommendations to address those failures and improve the design and implementation of RFID. The experience of RMH-ED was explored through interviews and a survey in which 100 participants took part. The survey touched upon various aspects of this experience. This was due to the various roles of the surveyed staff who were involved with this technology. These roles ranged from front line clinical staff to administrative staff, management staff and technical support staff. Data analysis showed convincing evidence of the positive impact RFID had on managing ED overcrowding. However, and as expected, there are some pitfalls and failures that FMEA helped identifying and suggested potential solutions to them. RFID is a small link in the chain of other technological innovations and solutions. It is by no means capable of solving the problems associated with ED overcrowding by itself. Most of the search carried out by the author identified large variation in approaches to dealing with the issue of ED overcrowding. Those ranged from applying more human resources to altering the pathways of managing patients journey through healthcare system to applying more intermediate layers of management to ease the pressure of the Emergency departments. Other approaches included some aspects of technology such as development of early warning systems that have not been widely adopted and remained as isolated efforts

Technology Acceptance, Acceptabilty and Appropriation in Professionnal Bureaucracies : The Case of RFID for Improving Mobile Assets Management in Hospitals

RÉSUMÉ : Les hôpitaux, même ceux de petite taille, peuvent gérer sur une base quotidienne plusieurs milliers d’actifs fixes et mobiles. Les actifs mobiles sont très diversifiés et incluent des pompes à infusion, du matériel chirurgical, des électrocardiogrammes, des machines portables à rayons X, des défibrillateurs, etc. Ces actifs circulent en permanence entre les différents services et les divers départements. Pratiquement tous les patients dépendent d'un ou plusieurs actifs mobiles lors de leur hospitalisation. Ces actifs sont également indispensables à la prestation des soins de santé et le personnel clinique consacre une partie importante de leur temps pour chercher ces actifs lorsque requis. L'incapacité de retrouver ces actifs en cas d’urgence peut mettre la vie des patients en danger. La technologie RFID (Radio Frequency Identification) a le potentiel de retracer et d’effectuer le suivi, et ce, de façon unique et transparente, les actifs mobiles et, par conséquent, d’en améliorer leur gestion dans les hôpitaux. Comparé à d’autres secteurs d’activité, le secteur de la santé adopte RFID à un rythme beaucoup plus lent, ce qui se traduit par un nombre limité d'études empiriques portant sur l’implantation de RFID dans ce secteur. Cette thèse se propose donc de contribuer à ce vide empirique par une analyse en profondeur d’une implantation réelle de RFID. Cette implantation vise à améliorer la gestion d'un type d’actifs mobiles, nommément les pompes à infusion dans un hôpital. Les données empiriques ont été recueillies pendant une période de 25 mois, de la phase de préfaisabilité jusqu’à la phase de post-implantation. Huit organisations (incluant l'hôpital qui est le principal site d'observation) et 35 participants ont été impliqués. Les résultats de la recherche peuvent être résumés comme suit. À la question, pourquoi RFID est implanté? La réduction des inefficacités existantes liées à la gestion des actifs mobiles en est la principale raison. De plus, la familiarité avec les technologies de l’information au sein de l'hôpital, la compatibilité de l’infrastructure existante (l'hôpital est presque 100% Wi-Fi) et l'expérience des partenaires technologiques sont des facteurs positifs reliés à l’implantation RFID. Comment l’implantation RFID est-elle effectuée? Les résultats montrent que le processus d’implantation est fortement itératif : les participants reviennent en effet sur les phases précédentes et modifient les décisions approuvées antérieurement. L'amélioration continue des services de soins est sans aucun doute la préoccupation principale exprimée par tous les participants de l'hôpital. Toutefois, les attentes et les exigences diffèrent entre les différents groupes de participants. Les résultats démontrent un clivage entre les points de vue de l’administration et ceux du côté clinique. Des divergences sont notées entre les infirmières et les médecins, et, entre les techniciens de l'hôpital (responsables des TIC, ingénieurs biomédicaux, et spécialistes de la maintenance) et les administrateurs. Les enjeux les plus importants ne sont pas technologiques, mais sont principalement organisationnels, ce qui semble découler de la présence de points de vue divergents. Est-ce que la RFID améliore la gestion des actifs mobiles? Les résultats suggèrent que les avantages identifiés et évalués lors l’implantation de RFID appartiennent aux catégories suivantes: amélioration de la visibilité des actifs, augmentation de l'efficacité opérationnelle, réduction de certains coûts et émergence de processus intelligents. Ce dernier point apparait comme particulièrement important. Les processus intelligents misent principalement sur les capacités d'auto-identification et de sensibilité au contexte (context-awareness) de RFID, sur le changement automatique de statuts, et sur la mise à jour automatique des applications d’hôpital (par exemple, WMS). Les résultats démontrent également que les processus intelligents améliorent la planification et la prise de décision. Est-ce que les caractéristiques intrinsèques des organisations dans lesquelles la technologie RFID est envisagée posent des contraintes à son implantation? Les hôpitaux, qualifiés de bureaucraties professionnelles, constituent un ensemble unique de contraintes dont on doit tenir compte lors d’une implantation RFID. En particulier, l'inertie, la complexité et la rigidité organisationnelles ne sont pas favorables à des changements à grande échelle dans l’hôpital et affectent la façon dont RFID est implanté. En outre, l'existence d'une structure à double pouvoir et les pièges liés à une culture forte (culture entrapment)ont un impact profond sur l'importance des avantages découlant de RFID. Est-ce que l’acceptation de la technologie, son acceptabilité et son appropriation représentent des concepts clés pour comprendre l’implantation de la RFID? Ces trois concepts ont été explorés lors de cette recherche et ont conduit à deux observations principales. Tout d'abord, on peut affirmer que si la technologie est acceptée, acceptable et appropriée, elle est utilisée, de façon partielle ou plus large. Par extension, l'acceptation, l'acceptabilité et l'appropriation pourraient être importantes non seulement pour expliquer l'ampleur de l'utilisation d'une technologie (utilisation partielle par rapport à la pleine utilisation), mais aussi pour expliquer les raisons pour lesquelles une technologie a été initialement adoptée, puis ensuite rejetée. Deuxièmement, les résultats empiriques ne confirment pas un ordre chronologique entre ces trois concepts. Par exemple, l'appropriation ne suit pas l'acceptation, même au début de l’implantation. Au contraire, l'acceptation, l'acceptabilité et l'appropriation coexistent à tout moment pendant le processus d’implantation. Cependant, l’ordre chronologique joue quand même un rôle puisque les niveaux d'acceptation, l'acceptabilité et l'appropriation varient au fil du temps. En outre, ces trois concepts sont sensibles à la fois à la technologie (dans ce cas, RFID) et au contexte dans lequel cette technologie est utilisée (l'hôpital), qui continuent de leur côté à changer au fil du temps. La thèse se termine en examinant les limites de la recherche, en proposant quelques pistes de recherche. Les contributions de cette thèse peuvent être pertinentes pour les chercheurs, les décideurs du secteur de la santé, les administrateurs d'hôpitaux, et les spécialistes et consultants en TI.----------ABSTRACT : Hospitals, even small ones, handle on a daily basis several thousands of mobile and fixed assets. Mobile assets are very diverse, ranging from infusion pumps, surgical equipment, electrocardiograms, portable x-ray machines, defibrillators to wheelchairs and rotate constantly between different medical wards. Since virtually every patient depends on one or more mobile assets during his or her hospital stay, they are also indispensable in healthcare delivery. Clinical staff spends a significant share of their working time searching for these essential, but commonly misplaced assets. Locating mobile assets is not only a time consuming activity, but the inability to find them when needed is remarkably costly, and possibly life threatening. RFID (Radio Frequency Identification) holds the potential to uniquely and seamlessly track and trace mobile assets and, thus, to improve mobile asset management in hospitals. Compared to other sectors, healthcare organizations adopt RFID at a much slower pace and only a limited number of empirical studies address RFID adoption and implementation in the context of healthcare. This thesis intends to contribute the research arena by analysing a real-life RFID implementation in order improve the management activities of one type of mobile assets, namely infusion pumps in hospital settings. The research focuses on a real-life RFID implementation in one European hospital. Empirical data was collected for a 25 month period from the pre-feasibility stage to post-implementation stage from eight organizations (including the hospital as the main observation site) and from thirty-five participants. Research results can be summarized as follows. To the question why RFID is implemented? The most straightforward answer is to reduce the existing inefficiencies related to mobile assets management. Technological preparedness and readiness drive RFID implementation: This includes familiarity with IT innovations within the hospital, compatibility with existing IT infrastructure (the hospital is almost 100% Wi-Fi enabled), and experience of technological partners with RFID implementation in various sectors. How RFID implementation is carried out? The answer seems to be through a highly iterative five stage process where participants revisited and modified previously agreed steps. The continuous improvement of care services was without a doubt the superseding concern expressed by all participants from the hospital. However, expectations and requirements differ among different groups of participants. The empirical evidence demonstrates not only a cleavage between the administrative and clinical perspectives, but also within the clinical perspective. Divergences run deep within each perspective (for instance, nurses vs. doctors) and between the technologists in the hospital (ICT managers, biomedical engineers, and maintenance specialists) and the administrators. The most significant issues related to such implementation are not technological but are mainly organizational, as they seem to arise from the presence of diverging perspectives. Does RFID really improve mobile assets management? Results suggest that the benefits identified and evaluated during the real life RFID implementation belong to the following broad categories: improving assets visibility, promoting operational efficiency, reducing costs and facilitating the emergence of intelligent processes. Intelligent processes are mainly derived from the RFID capabilities for auto-identification and context-awareness, process automatic status change, and automatic update in hospital’s enterprise applications (i.e. WMS). Results further demonstrate that intelligent processes improve planning and decision-making. Do the intrinsic characteristics of organizations play a role in RFID implementation? The very characteristics of hospitals, qualified as complex professional bureaucracies, constitute a unique set of constraints to be taken into account for RFID implementation. In particular, organizational inertia, complexity and inflexibility are not conductive to hospital-wide changes and affect how RFID is implemented. Moreover, the existence of a dual power structure and a tendency to culture entrapment may have a profound impact on the importance of the benefits derived from RFID. Do technology acceptance, acceptability and appropriation represent key concepts that should be considered to understand the implementation of RFID? These three concepts were explored in the research. This leads to two main observations. First, it could be stated that if technology is accepted, acceptable and appropriated, then it is fully used. By extension, acceptance, acceptability and appropriation could be significant not only in explaining the extent of use of a technology (partial use vs. full use), but also the reasons why a technology was initially adopted and then discarded. Second, empirical results reject the presence of a chronological order between the three concepts. For instance, appropriation does not follow acceptance, even initially. Rather, acceptance, acceptability and appropriation coexist at any time during the implementation process. However, chronology still matters since the levels of acceptance, acceptability and appropriation vary over time. Furthermore, these three concepts are sensitive to both the technology (in this case RFID) and to the context where it is use (the hospital), which are also changing over time. The thesis examines research limitations, proposes some research avenues and outlines contributions that may be relevant for researchers, healthcare policy makers, hospital administrators, IT specialists and IT consultants

Design and Implementation of System Components for Radio Frequency Based Asset Tracking Devices to Enhance Location Based Services. Study of angle of arrival techniques, effects of mutual coupling, design of an angle of arrival algorithm, design of a novel miniature reconfigurable antenna optimised for wireless communication systems

The angle of arrival estimation of multiple sources plays a vital role in the field of array signal processing as MIMO systems can be employed at both the transmitter and the receiver end and the system capacity, reliability and throughput can be significantly increased by using array signal processing. Almost all applications require accurate direction of arrival (DOA) estimation to localize the sources of the signals. Another important parameter of localization systems is the array geometry and sensor design which can be application specific and is used to estimate the DOA. In this work, various array geometries and arrival estimation algorithms are studied and then a new scheme for multiple source estimation is proposed and evaluated based on the performance of subspace and non-subspace decomposition methods. The proposed scheme has shown to outperform the conventional Multiple Signal Classification (MUSIC) estimation and Bartlett estimation techniques. The new scheme has a better performance advantage at low and high signal to noise ratio values (SNRs). The research work also studies different array geometries for both single and multiple incident sources and proposes a geometry which is cost effective and efficient for 3, 4, and 5 antenna array elements. This research also considers the shape of the ground plane and its effects on the angle of arrival estimation and in addition it shows how the mutual couplings between the elements effect the overall estimation and how this error can be minimised by using a decoupling matrix. At the end, a novel miniaturised multi element reconfigurable antenna to represent the receiver base station is designed and tested. The antenna radiation patterns in the azimuth angle are almost omni-directional with linear polarisation. The antenna geometry is uniplanar printed logspiral with striplines feeding network and biased components to improve the impedance bandwidth. The antenna provides the benefit of small size, and re-configurability and is very well suited for the asset tracking applications

RFID: Prospects for Europe: Item-level Tagging and Public Transportation

This report, which is part of the COMPLETE series of studies, investigates the current and future competitiveness of the European industry in RFID applications in general and in two specific cases: item-level tagging and public transportation. It analyses its constituent technologies, drivers and barriers to growth, actual and potential markets and economic impacts, the industrial position and innovative capabilities, and it concludes with policy implicationsJRC.DDG.J.4-Information Societ

4th International Symposium on Ambient Intelligence (ISAmI 2013)

Ambient Intelligence (AmI) is a recent paradigm emerging from Artificial Intelligence (AI), where computers are used as proactive tools assisting people with their day-to-day activities, making everyone’s life more comfortable. Another main concern of AmI originates from the human computer interaction domain and focuses on offering ways to interact with systems in a more natural way by means user friendly interfaces. This field is evolving quickly as can be witnessed by the emerging natural language and gesture based types of interaction. The inclusion of computational power and communication technologies in everyday objects is growing and their embedding into our environments should be as invisible as possible. In order for AmI to be successful, human interaction with computing power and embedded systems in the surroundings should be smooth and happen without people actually noticing it. The only awareness people should have arises from AmI: more safety, comfort and wellbeing, emerging in a natural and inherent way. ISAmI is the International Symposium on Ambient Intelligence and aiming to bring together researchers from various disciplines that constitute the scientific field of Ambient Intelligence to present and discuss the latest results, new ideas, projects and lessons learned, namely in terms of software and applications, and aims to bring together researchers from various disciplines that are interested in all aspects of this area

Selected Papers from the 5th International Electronic Conference on Sensors and Applications

This Special Issue comprises selected papers from the proceedings of the 5th International Electronic Conference on Sensors and Applications, held on 15–30 November 2018, on sciforum.net, an online platform for hosting scholarly e-conferences and discussion groups. In this 5th edition of the electronic conference, contributors were invited to provide papers and presentations from the field of sensors and applications at large, resulting in a wide variety of excellent submissions and topic areas. Papers which attracted the most interest on the web or that provided a particularly innovative contribution were selected for publication in this collection. These peer-reviewed papers are published with the aim of rapid and wide dissemination of research results, developments, and applications. We hope this conference series will grow rapidly in the future and become recognized as a new way and venue by which to (electronically) present new developments related to the field of sensors and their applications

Supply chain visibility and sustainable competitive advantage: An integrated model

Lack of visibility of the assets in a product supply chain compromises attempts to optimise supply chain management. Increasing the visibility of these assets presents a relatively unexplored frontier in operations and supply where organisations can create competitive advantage through the opportunities asset visibility offer. This research aims at investigating the key capabilities of asset visibility specifically those associated with returnable transport assets that travel across supply chains carrying material and products e.g. cages, boxes, trays, trolleys and pallet bins. In addition, how these capabilities may influence supply chain visibility and firm performance in a way that might lead to sustainable competitive advantage is examined. To achieve these objectives, the research develops a two-stage model that is theoretically grounded in the extended resource-based view. Philosophically, the research adopts a critical realist approach using abductive logic. Methodologically, a sequential exploratory strategy for data collection is implemented. A qualitative, indepth site-based case study supported by field expert interviews was conducted as a pilot study. The pilot study findings refined the initial conceptual model derived from literature and informed the next stage of the research. The quantitative phase focused on refining the factors constituting asset visibility capabilities and then testing the relationship between these capabilities and supply chain visibility, performance and sustainable competitive advantage. Key findings are that asset visibility capabilities are shaped through three key capabilities: (1) an asset management capability formed by both core technological aspects related to tracking and tracing technology, and non-technological ones focusing on logistic-related capability; (2) a complementary technological capability comprising of IT infrastructure for supply chain integration; and (3) a complementary nontechnological capability represented through three sub-capabilities: (a) supply chain process integration; (b) focal firm-3PL relational orientation; and (c) internal firm integration. The research findings prove a positive relationship between asset visibility capabilities and supply chain visibility. In addition, a positive relationship between these capabilities and sustainable competitive advantage through the mediated effect of supply chain visibility and firm performance, is confirmed.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Realistic chipless RFID: identification and localization

Für die weitere Massenverbreitung von RFID Systemen ist ein günstiges und genaues Verfahren zur Objektlokalisierung und –verfolgung zwingend erforderlich. Chiplose RFID Systeme erlauben im Gegensatz zu herkömmlichen chipbehafteten RFID Systemen den Einsatz von einfachen, druckbaren RFID Tags, eine Möglichkeit zum Einstieg in die Ära von extrem billigen RFID Tags. Diese Dissertation konzentriert sich auf die Lösung von drei Herausforderungen bei der Erkennung von chiplosen RFID Tags innerhalb geschlossener Räume. Der erste in der vorliegenden Arbeit diskutierte Aspekt beschäftigt sich mit Methoden zum Eliminieren des Störechos der Umgebung (clutter removal techniques). Im chiplosen RFID System ist das Umgebungsstörecho definiert durch das von der Umgebung reflektierte Signal, das nicht mit dem RFID Tag interagiert. Die Stärke dieses Signals ist in jedem Fall größer als die des vom RFID Tag zurückgestrahlten (backscattered) Signals, was die Signaturerkennung des RFID Tags unmöglich macht. Zur Lösung dieses Problems schlage ich zwei Algorithmen vor. Der erste ist die Leerraum-Kalibrierung (empty room calibration). Bei diesem Algorithmus werden die Messungen mit RFID Tag von denen ohne RFID Tags abgezogen. Der zweite Algorithmus basiert auf dem Rake-Receiver unter Nutzung einer Zufallsfolge (PN sequence), er erfordert keine zusätzliche Kalibrierung. Der zweite Aspekt betrifft die Notch Erkennung und Identifikation, ein sehr wichtiger Bereich des chiplosen RFID Systems. Er ist dafür verantwortlich, die Notchs in Bits umzuwandeln. Für eine effektive Detektion werden Windowing (Fenster) Verfahren vorgeschlagen, wobei jedes Fenster einen oder auch keinen Notch beinhalten kann. Insgesamt drei neue Verfahren zur Notch Erkennung wurden implementiert. Als erstes ein Matched Filter (MF), in dem der einkommende Notch mit einem Referenz Notch verglichen wird. Das zweite Verfahren basiert auf einer gefensterten Singulärwertzerlegung, damit kann sowohl der Notch erkannt werden, als auch seine Bandbreite bestimmt werden. Als drittes Verfahren wird das dynamische Frequency Warping vorgestellt. Diese Technik nutzt nichtlineare um die Notche unddie Frequenzverschiebungen, die an den Notches auftreten, zu erkennen. Als dritter Aspekt wird die Lokalisierung der RFID Tags in dieser Dissertation diskutiert. Dazu werden zwei Algorithmen erklärt und implementiert. Der erste Algorithmus beruht auf der Triangulation durch drei getrennte RFID Lesegeräte, während sich der zweite die Position des RFID Tags aus der Signalstärke und dem Winkel des vom RFID Tag kommenden Signals berechnet. Alle genannten Algorithmen und Verfahren wurden in einer realen Innenraum Testumgebung mit RFID Tags und einer Software Defined Radio (SDR) Plattform vermessen, um die Zuverlässigkeit der Algorithmen unter normalen Bedingungen zu überprüfen.For mass deployment of RFID systems, cheap and accurate item level identification and tracking are profoundly needed. Fortunately, unlike conventional chip-based RFID, chipless RFID systems offers low-cost printable tags holding a better chance to enter the era of penny-cost tags. This dissertation concentrated on solving three challenges in the detection of the chipless tag inside an indoor environment. The first aspect discussed in the thesis are the chipless RFID clutter removal techniques. In chipless RFID the environmental clutter response is defined as the signal reflected from the environment, that does not interact with the tag. This signal has higher power than the backscattered signal from the tag, rendering the tag signature undetectable. Two algorithms to overcome this problem was used, the first is empty room calibration. The first algorithm is based on subtracting the measurement with the tag from the one without. The second algorithm is Rake receiver using PN sequence; this algorithm requires no pre-measurement calibration. The second aspect is notch detection and identification which is a critical part of the chipless system. This part is responsible for converting the notches into bits. For effective detection, a windowing operation is proposed, where each window may contain a notch or not. Three novel techniques are implemented to detect the notch. The first is matched filter were a reference notch is compared with the incoming signal. The second is window based singular value decomposition, where a constellation is created to detect not only the existence of a notch but also the bandwidth of the notch. The third notch detection technique is dynamic frequency warping. This technique utilizes non-linear warping to detect the notch and the frequency shifts that occurs on the notch. The third aspect discussed in the thesis is tag localization. In this aspect, two algorithms are implemented and explained. The first is trilateration which requires three different readers. The second localization algorithm exploits received signal strength and angle of arrival to detect the location of the tag accurately. All the algorithms were tested using a real testbed to validate the reliability of the techniques. The measurements were done using fabricated tags in an indoor environment using Software Defines Radio (SDR)