Clinical-Grade Locating™ (or Clinical-Grade RTLS™)
An advanced real-time location system designed for healthcare applications.
Clinical-Grade Locating requirements:

  1. Location Accuracy
  2. Location Update Speed (Battery Life)
  3. Reliability
  4. Clinical Systems Integration
  5. Installation and Maintenance

Clinical-Grade Locating Assets
1. Location Accuracy: Certainty-based location* accuracy with the capability of segmenting the work space into clinically meaningful zones (or areas). For clinical workflow, zones are typically patient rooms, patient bays, nursing stations, hallway segments, and other areas meaningful to provide care to patients. Mobile zones such as wheelchairs and stretchers are also opportunities to define a patient care area. Accuracy is thus defined as the ability to know with certainty that an asset is in a defined zone. If there is significance to know where the asset is within a zone, then the zone should be divided into smaller zones.

Defining accuracy as the presence or absence of an asset within a defined zone provides a binary input suitable for digital system. This is in contrast to Equipment Grade Locating™ where the zone is not as well defined and the location information is provided in the from of a “probabilistic estimate”.

The Clinical-Grade RTLS system should support transitional accuracy. For example, automating most clinical workflow applications requires bay-level location certainty, or room-level certainty. Any transitional uncertainty at doorway thresholds or within open bays/curtained areas is not be acceptable. The Clinical-Grade RTLS system should also provide the means to create the required zone in a practical “geometry.” For open or curtained off bays in a PACU, Clinical-Grade Locating system would create zones segmenting each bed area  a linear, rectangular perimeter, as shown in Figure 1 below.

Clinical-Grade Locating
Figure 1
Clinical-Grade Locating
Certainty-based, transitional accuracy at the bed/bay-level (linear/rectangular segmentation)
Not Clinical-Grade Locating
Figure 2
Non Clinical-Grade Locating
Usage of Low Frequency RF is not sufficient for transitional accuracy.
There is uncertainty (white space) between beds and bays

2. Location Update Speed (Battery Life): Deliver location updates at a rate greater than the clinical workflow requires. For many workflow applications, such as Nurse Call locating or bed management, five (5) seconds or less is recommended. It is important to note that the location updates refer to the certainty-based data not estimation based. This is because each estimate-based data update is used to improve the probabilistic accuracy of the previous update and not providing a definitive location.

Battery life is inversely proportional to the location update speed. It is important to consider update rate in conjunction with battery life. A practical battery replacement rate could be greater than one year, for example. If the batteries on the tags require changing too often, it may become a burden on the personnel leading to periods of time the tags are not used. As a rule, the less normal workflow is impacted or altered simply to maintain the technology, the greater the chance of it being accepted. Rechargeable batteries are another good example of a significant workflow alteration and a low likelihood of long-term adoption.

3. Reliability: Achieve a very high (99.9% for example) uptime of all tags and infrastructure through the use an enterprise-class device management system.

Infrastructure. All components of the infrastructure, whether the network backbone or the secondary zone defining devices, must be able to be observed remotely over the network. For battery operated devices, the battery level and operational performance status should be observable remotely with altering means in case of an interruption in operation.

Tags. The RTLS should be able to observe the battery status of the tags with at minimum a few months lead time prior to depletion. This is critical since when the battery completely depletes without notice, the asset that the tag is attached to is no longer tracked and the replacement of the battery is much more difficult.

4. Clinical System Integration: Capable of streaming location data to clinical healthcare applications (for example Nurse Call System, EMR systems and Bed Management Applications). This is important because it allows the facility to use the infrastructure for many clinical applications addressing many of the workflow necessary for patient care. Sharing of data amongst these applications increases efficiencies for a variety of necessary processes.

5. Installation and Maintenance: Wire-free installation in patient rooms to avoid patient disruption and prevent any unnecessary infection risks associated with opening ceilings and walls. Ability to maintain the infrastructure in a practical and cost effective, non-disruptive manner.

Software Updates. Not only should the location defining components have means to be updated in case of bugs or necessary enhancements, but also the tags themselves should have this ability as well. Given the importance to minimize patient disruption, this process should be accomplished in a wireless manner and preferably remotely.

The below graphic helps to summarize the visibility and performance that a Clinical-Grade Locating solution must have:
Clinical-Grade Locating

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