Study Confirms RTLS Improves Hospital Contact Tracking, but High Initial Cost
A Singapore research team has shown in a simulation that a real-time location system (RTLS) can identify almost three times as many contacts as conventional methods - in 96.2% less time and with 97.6% fewer staff. Although the initial cost is high, RTLS shows great potential for efficient contact tracing in the event of an outbreak. However, the study emphasises that further improvements are needed before RTLS can fully replace conventional methods.
- Anja Van Bocxlaer, Managing Director
A prospective case study conducted by Guan Yee Ng of Duke-NUS Medical School and Biauw Chi Ong of the Medical Board at Sengkang General Hospital (SKH) has evaluated the effectiveness of real-time location system (RTLS) technology in contact tracing. The study, conducted at Sengkang General Hospital in Singapore, was part of a national simulation exercise to prepare for emerging infectious disease (EID) outbreaks.
The results compare RTLS with traditional electronic medical record (EMR) methods and highlight the benefits of this innovative approach.
Large-Scale Simulation Conducted in a Tertiary Hospital in Singapore
The study took place at SKH, a 1,000-bed public hospital with 4,000 staff members. A total of 1,000 hospital employees participated by wearing RTLS-enabled staff tags. The simulation replicated a Middle East respiratory coronavirus (MERS-CoV) outbreak, tracking the movements of an index patient through the emergency department, operating theatre, and inpatient ward.
The goal was to assess the speed, manpower requirements, and costs associated with RTLS-based and EMR-based contact tracing.
RTLS Identifies More Contacts in Less Time Compared to EMR
The results showed that RTLS identified nearly three times as many contacts as EMR while significantly reducing the time and manpower needed. RTLS identified 226 unique contacts, while EMR detected only 82 when considering tagged staff and patients. The system achieved a 96.2 percent reduction in the time required for contact tracing, a 97.6 percent reduction in manpower, and a 97.5 percent reduction in total labour hours.
RTLS required just one staff member and 0.9 hours to complete the process, whereas EMR involved 42 staff members and took 23.7 hours. The system also detected a higher number of healthcare workers and patients who had been in contact with the index case, providing a more comprehensive overview of potential exposures. In the emergency department, RTLS recorded 870 percent more unique staff contacts than EMR.
High Initial Investment Could Limit RTLS Adoption in Hospitals
Although RTLS demonstrated clear advantages in efficiency and accuracy, the study also highlighted the system’s high cost. The hospital invested $653,594 in RTLS equipment over three years, while no additional costs were required for the EMR method. While RTLS reduced per-episode manpower costs to $62, compared to $2,125 for EMR, the study estimated that at least 317 contact tracing episodes over three years would be needed to offset the initial investment.
RTLS Shows Potential to Become the Future Standard for Contact Tracing
Despite the high initial costs, the study suggests that RTLS has the potential to become a standard tool for hospital contact tracing. The technology demonstrated better sensitivity and specificity than conventional EMR-based methods, allowing for faster identification of contacts and potential exposures.
However, widespread implementation may require further cost reductions, system refinements, and increased compliance with staff tag usage. While RTLS is not yet ready to fully replace existing methods, it represents a promising step toward more efficient and accurate contact tracing in healthcare settings.
Equipment
The RTLS used for contact tracing in the Sengkang General Hospital in Singapore was based on the SmartSense* Solutions infrastructure and SmartSense RTLS platform provided by Cadi Scientific. Staff tags and patient tags were used. The staff tags were additionally equipped with an antenna that captured tag interactions within a 2m radius of itself.
Tag signals were received by the campus-wide network of wireless ceiling receivers and exciters. In this study, 1000 of the 4000 staff members wore staff tags. The 1000 employees selected included physicians and nurses working in high-risk areas such as the emergency room and inpatient wards. The rest of the staff, including other physicians, nurses, allied health professionals, support staff, and students, did not wear staff tags. All patients wore patient tags from registration to discharge.
The RTLS platform tracked two forms of contact: (1) tag-to-tag based and (2) location based. A tag-to-tag based contact was registered when any tags (staff or patient) were detected within a 2-m radius of a staff tag for at least 1 minute. A location-based contact was registered when any tags were detected within the same location for at least 1 minute. Tags were located using WiFi triangulation and chokepoint tracking.
* Cadi Scientific's SmartSense RTLS is designed for demanding healthcare environments. It is manufactured in Singapore and leverages the hospital's WiFi or RFID infrastructure.
More information: study on BMJ Open, medical journal
