Robots improve safety, efficiency at Thai hospital

Despite a hefty price tag, the hospital views robots as essential in helping reducing human errors

A Thai hospital famous for medical tourism and celebrated for its use of new technologies is turning to robotics to become more efficient and improve patient safety.

The idea isn't to create a nursing staff of Honda Asimo humanoid robots; rather, it's to automate some of the hospital jobs performed by humans where mistakes can be fatal.

"Robotics helps immensely in eliminating errors," said Chang Foo, chief technology officer at Bumrungrad International Hospital in Bangkok. "We have a large emphasis on technology and we evaluate where errors occur, and it's mostly human error," he said.

It's a universal problem in health care. A landmark study by the Institute of Medicine called "To Err Is Human" found that as many as 98,000 people died each year in the U.S. due to mistakes such as giving patients the wrong medicine.

Perhaps scarier than the fatal errors is that the study is a decade old, and that a follow-up published four years ago in the Journal of the American Medical Association found that progress on the issues raised had been "frustratingly slow."

Bumrungrad has already seen how robots can benefit hospitals. Staff are so enthusiastic about robots from a company called Swisslog Holdings that you might mistake them for a Swisslog sales team.

The hospital uses several Swisslog systems, including at least three robots. These are not androids like C3PO or R2D2, but more like box-shaped automated machines with conveyor belts, storage racks and robotic arms that move around pills and laboratory test samples such as blood and urine.

Two of the robots, PillPicker and BoxPicker, have boosted safety significantly at the hospital, Foo says.

PillPicker sorts pills and dosages into individual plastic bags and affixes them with barcodes that say what's inside each one before placing them in a storage area. When a prescription arrives to be filled, BoxPicker sifts through the rows of medicines to pick out the ones it needs with its robotic arm, then binds them together in a package with a new barcode tag stating which patient the medicine is for.

The hospital uses a Swisslog pneumatic tube system, like those used to shuttle documents around some office buildings or at drive-through bank tellers, to send the medicine packs to the patient's floor.

The barcodes are an essential part of the system. They say exactly what the pill is, who it's going to, what time it should be administered and the dosage required. Prior to administering the medicine, a nurse uses a barcode reader at the patient's bedside to ensure it is going to the right patient.

"You would really have to have almost malicious intent to give the wrong medicine to the wrong patient at the wrong time," said Pat Downing, a senior director at Microsoft who has worked with Bumrungrad for several years on related technology projects.

The system is a huge improvement over the traditional method of putting pills in paper cups on a tray and then handing them to patients, which leaves a lot of room for human error.

Other vendors selling pharmacy robots include ScriptPro, Taylist, Omnicell and Pearson Medical Technologies. The main hurdle hospitals are likely to face in deploying such a system is financial: the robots can cost more than US$1 million each.

Bumrungrad is a private hospital that caters mainly to tourists, so it has more money to spend than some of its peers in the region. Thai hospitals also have lower costs, such as for labor, than hospitals in some other countries.

In fact, viewed from a purely financial perspective the robotics system doesn't make sense for Bumrungrad. "It will take decades to get a return on that investment," Foo said.

The low cost of labor means the hospital could easily hire a larger staff to verify medications at each step in the delivery process -- a method it used before it bought the robots. But the hospital decided the investment was worth it because of the lives it may save.

"Where we can eliminate human error as much as possible, we want to," said Foo.

A lot of the technology purchases at Bumrungrad will now be focused on automation and robotics, he added. The hospital is looking at buying more robots for packaging up medications and, potentially, for use in surgery, he said.

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