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5 Ways Going Digital Makes Hospitals Smarter

By Gordon Wright, Executive Editor

February 1, 2005

Building Design and Construction

Digital systems have become a fundamental component of healthcare design and construction, providing remarkable benefits to patients and hospital operators — and posing new challenges for Building Teams.

"Digital technology impacts every piece of hospital design today," says Ken Kaiser, a principal with Chicago's Proteus Group.

Healthcare planners are still specifying coaxial backbones of twisted pair telephone cable and fiber optic cable for their projects "only because we don't know when and where wireless systems will have enough bandwidth to carry digital imaging," says Kaiser. "We can do pretty much everything else with wireless today."

The issue, he says, is how to build the best infrastructure for today's needs without precluding future options. For example, when wireless becomes the prevailing type of system, there will still be a need for repeaters and nodes to accommodate dead spots within a healthcare facility.

As digital technology continues to advance, the overall goal will be to eliminate multiple systems and accommodate various uses on a single network. One of the most far-reaching results of this process would be to minimize the potential for interference between cell phones and medical devices. "Once you do that, you can do all sorts of wireless communications within a hospital," Kaiser says.

He notes that interference problems caused by early cell phone technology have largely been resolved, although most hospitals continue to ban their use.

With this background in mind, let's take a look at how digital technology is benefiting hospitals — and patient care.

1. Creating a unified communications system for the hospital.

Efforts are under way to eliminate some of the confusion surrounding wireless communication devices. The need to provide designated frequencies for medical telemetry transmitters, such as those for monitoring ambulatory patients, has gained importance with the advent of digital television broadcasting.

Prior to 1998, these telemetry devices were considered "secondary users" of frequencies that are now also used to broadcast digital television signals. As a result, the Federal Communications Commission designated three Wireless Medical Telemetry Service bands as protected frequencies, and has requested that all medical telemetry transmitters be registered with the American Society for Healthcare Engineers. About 1,100 of the nation's 6,000 or so hospitals have registered, according to John Collins, ASHE director of engineering and compliance.

Meanwhile, the Institute of Electrical and Electronics Engineers is leading an effort to encourage medical device manufacturers to standardize the frequencies at which various types of equipment operate. This would make it easier for healthcare facilities to determine potential interference problems.

2. Offering greater convenience for patients and their families.

The trend toward virtually wireless communications, particularly for new facilities, is having benefits for patients and their families, says John Andrews, project manager for A/E firm Leo A Daly on the Alegent Health Lakeside Hospital in Omaha. "It's a cost issue, but there's no question that it is going in that direction."

Emergency-room patients checking into Alegent Lakeside, which opened last August, are taken directly to a treatment room, where staff members using wireless personal digital assistants obtain registration information at bedside. This is a departure from the usual practice of completing the registration process before treatment.

In what might be regarded more as an amenity than a convenience, Todd Hanson, a principal with Portsmouth, N.H.-based architect JSA Inc., cites the use of computers in outpatient settings, such as cancer care centers, where patients make repeated visits for radiation therapy and may be accompanied by a spouse or friend. JSA, which derives more than half of its fees from healthcare projects, is designing family lounges with multiple computer stations where accompanying individuals can access the Internet or watch educational programs to better understand the particulars of a disease. "This is a better experience for them than to just sit bedside for two to three hours during infusion therapy," he says.

3. Reducing medication dispensing errors.

According to the 2000 report of the Institute of Medicine, "To Err Is Human: Building a Safer Health System," medication-related errors occur frequently in hospitals. One study conducted at two teaching hospitals found that about two out of every 100 admissions experienced a preventable adverse drug event, resulting in average increased hospital costs of $4,700 per admission, or about $2.8 million annually for a 700-bed teaching hospital.

If these findings can be extrapolated to the entire U.S. hospital system, the increased cost of preventable adverse drug events affecting hospital inpatients is about $2 billion for the nation as a whole.

In an attempt to reduce errors in what has been described as "America's second biggest drug problem," digital electronic systems are being used to insure that the right patient gets the right medication, in the proper dosage, at the correct time. These systems incorporate protocols that require nurses first to scan the patient's identification wristband and the bar code on prescription containers, then input their individual nurse code and the patient's code before the medication can be dispensed.

4. Better use and placement of high-tech equipment.

As high-tech equipment becomes almost the backbone component of healthcare facilities, its optimum location takes on added importance. Hospital space planning is typically organized along departmental lines — surgical, radiological, and so on. As a result, departmental boundaries are often created.

This is not the case at Banner Estrella Medical Center in Phoenix, which opened last month. Banner Estrella, designed by Seattle-based NBBJ, utilizes an "Interventional Services Suite" concept in which boundaries between traditionally autonomous services disappears, according to NBBJ partner Richard Dallam.

For example, angiography and cardiac catheterization laboratories were configured to serve as "image-guided procedure rooms" and are designed for fully invasive surgical procedures. By sharing facilities, this form of organization minimizes equipment duplication, facilitates the sharing and cross-training of staff, and makes room scheduling more efficient.

John Pangrazio, NBBJ partner, says that this design philosophy, which he also sees emerging in the planning of other healthcare facilities, helps to "break down the fiefdoms of individual departments." Procedures that involve surgery or catheterization have traditionally been performed in different departments. Now the facilities for either type of treatment have been assembled in a single suite.

This concept also imposes a discipline on hospital planning. "As planners, we endorse it, because it provides no excuse for duplication," Pangrazio says.

5. Making life easier for the medical staff.

Digital controls are also helping to keep Lakeside's surgical staff happier by keeping operating room temperatures at desired levels. Clyde Moore, the project's chief mechanical engineer, says that surgeons have been asking to have the temperature in the OR at 63 degrees, compared to ASHRAE and AIA standards in the range of 68–72 degrees.

He says this may be due to the use of gowns made from man-made fibers, which don't "breathe" like cotton-based gowns. Or because surgeons are doubling up on gowns to protect themselves from contracting AIDS. In any case, they want it cooler while operating.

How digital systems aid hospital design

Create a unified hospital communications system.
Offer greater convenience to patients.
Reduce medication dispensing errors.
Promote better use and placement of high-tech equipment.
Make conditions cozier for the medical staff.

Hospital plans to 'spin away' its power problems

Electric power interruptions are all too familiar a problem at Salem (Ohio) Community Hospital. Most of the dozen or so outages that occur every year stem from problems associated with the local electric utility, but sometimes even a squirrel making contact with a transformer or a vehicle knocking down a utility pole can bring the system down, according to Tom Griggs, director of the hospital's plant operation.

Power interruptions have had a devastating effect on the hospital. Surgical procedures have been cut short at critical moments. A thousand desktop PCs can go blank. All the control system panels have to be reset. A two-second power blip can knock out a three-phase compressor or condensing unit.

To end the aggravation and expense (not to mention liability risk) caused by these interruptions, Salem Hospital is installing a system based on rotary flywheel technology in its new 76,000-sf energy plant, scheduled for completion by the fall of 2006.

The system uses the kinetic energy of three 800 kW, 6,000-pound flywheels, driven by electricity, that constantly spin at 3300 rpm. In the event of a power outage, the flywheel system will provide 2.4 mW of uninterrupted power to the entire hospital, with the exception of the building's chillers, for approximately 19 seconds. (The National Electrical Code requires emergency generators to be on line within 10 seconds of a power outage.) The system is also designed to provide "clean" power that is free of damaging spikes and surges, according to V. Mitchell Lyles, director of engineering for the hospital's Cleveland-based architect, Westlake Reed Leskosky.

Robert Smolinski, WRL's manager of electrical engineering, says that hospitals typically upgrade central plants when they add a revenue-generating facility, such as an operating room. But Salem Hospital officials decided to go ahead with the upgrade even without an offsetting income stream. Smolinsky says this probably encouraged hospital officials to evaluate the costs and benefits of the flywheel system even more rigorously than they usually would.

The technology comes from Germany's RWE Piller GmbH and was first used in the U.S. in the late 1990s at industrial facilities and data centers, says company spokesman Mick McDaniel. The first installation at a U.S. hospital took place three years ago.

The flywheel system has an expected life of 20 years, compared to about 12 years for the typical battery system used in most hospitals, says Brad Deaton of Engineering Dynamics, a Cincinnati firm that was involved with the project.

How contractors are battling infection during hospital construction

Every year, about 90,000 patients in U.S. hospitals contract nosocomial infections — they get sick (or sicker) from something they caught in the hospital. Two or three thousand of them die as a result.

Building Teams are helping to attack this problem by taking steps to control the spread of infection sources during construction of new facilities or additions, or during renovation of existing hospitals.

BD&C talked to two experts from Skanska USA Building Inc., the No. 2 contractor in the U.S. ($4.48 billion in 2003), headquartered in Parsippany, N.J. Andrew Quirk, VP for national healthcare, in Atlanta, and Chris Gilbert, senior project manager, in Philadelphia, offered this advice:

Develop a plan and "work it." "All the parties have to get involved right off the bat, so infection control doesn't get left behind," says Quirk. It's especially important to make sure subcontractors meet your standards, he says. "Plan, plan, plan, then implement."
Skanska uses "infection control risk assessment" in planning all hospital work. "ICRA" became a key component of the AIA's Guidelines for Design and Construction of Hospital and Health Care Facilities in 2001. It was developed by two pioneering health specialists, Judene Bartley, a VP at Epidemiology Consulting Services, Beverly Hills, Mich., and Andrew J. Streifel, of the University of Minnesota Department of Environmental Health & Safety.
Skanska has incorporated the AIA's ICRA guidelines into its proprietary hospital construction manual. "We're finding more and more architects are inviting us to their offices in the design phase to ask us about ICRA and how to phase the project to deal with infection control," says Gilbert.
Set a baseline. Bring in an HVAC balancing contractor, and measure the airflow devices in every space you're going to work in. "You may need to change a filter, or have to shut down the air supply in certain sections, or you may have to add fans," says Gilbert. The baseline tells you what you're going to need. Then, if your crew accidentally uncovers mold or some other source of infection (and they will), it will stay there.
Beware the spread of fungus. Patients with open wounds are the most vulnerable to infection, and the biggest threat to them is from aspergillus, a "filamentous, cosmopolitan, and ubiquitous fungus" found in soil, plant debris, and indoor air, according to Internet mold authority Doctorfungus. To control it on warm, dry days, says Gilbert, you may have to water the site. "We also try to get blacktop down as fast as possible" so trucks don't stir up soil, he says.
Check out the neighborhood. "Step outside, and see if your project could impact an adjacent activity, such as a surgical center," says Gilbert. This precaution is crucially important when the adjacent use is an oncology facility, because many cancer patients are severely immunocompromised.
Enlist help from the hospital. "We go to the owner and ask for someone to be identified to work with us on infection control — the facilities director, a nurse or nurse practitioner, even a doctor," says Quirk. "We had an M.D. on a recent project, and he was a great ally on infection control."
Conduct daily inspections. "Walk the job every day with a representative from the hospital," says Gilbert. Are the fans running? Are barriers sealed? Are door controls working? Your written checklists leave a paper trail for the closeout of the project, and the hospital can even use them for subsequent reviews by regulatory agencies.
Look into new products for infection control. Several manufacturers offer mold-resistant antimicrobial drywall products, and there are new and improved HEPA-filtered fans on the market, says Gilbert. He and Quirk like a product called ZipWall (800-718-2255; www.zipwall.com), a sticky tape with its own zipper that allows a construction crew to build a barrier wall that can be zipped open when necessary.

What does infection control during construction cost? "Probably $5–8 a square foot, depending on the job," says Quirk. A reasonable price, if it saves lives.

Register today for "Healthcare Goes Green" webcast

Learn how the healthcare industry, with the help of skilled designers and contractors, is making "green" a priority during BD&C's latest webcast, "Healthcare Goes Green," Thursday, February 24 at 1p.m. CST. Register today at www.bdcmag.com

Lessons from digital imaging pioneers

Four years ago, well in advance of many other hospital systems, Advocate Christ Medical Center in Oak Lawn, Ill., made a bold commitment to the digital world with the completion of its Imaging Center.

When planning for the project began, little operational experience about the facility implications of digital imaging existed. "A number of places were experimenting with digital imaging, but nobody had made a complete transformation," says Michael Doiel, project principal with Omaha-based A/E HDR. The hospital nevertheless decided to proceed with HDR's first project designed specifically to incorporate total digital imaging capability.

To serve outpatient clients, Christ Medical Center wanted a facility that could compete with stand-alone imaging centers, starting with the front door. "It's hard to get a dedicated front door for a radiology department, with its heavy equipment loads," Doiel says. These facilities are typically buried into the facility. But the hospital wanted to provide the convenience of direct accessibility for outpatients, so HDR designed the facility with a three-story atrium with full-height glazing.

The hospital went on line with digital imaging nine months before it moved into its new facility, to ease the transition to a new technology. It performs 260,000 imaging procedures a year, compared to 80,000–100,000 a year for a typical community hospital in the Chicago area.

Digital imaging has real-time advantages compared to a film-based process, says Paul Brye, a facility programmer with HDR. With film-based imaging, turnaround time was "hours, up to a day," he says. Now, it is "in minutes, up to a couple of hours." Within seconds of being archived, a digital image becomes "ubiquitously available," he says. Stored images can be called up on the screen, precluding the need to request them from a file room.

Another benefit, especially to anxious patients, is that radiologists can determine within minutes of a scan whether the initial images are satisfactory, or need to be retaken. With a film-based system, the patient might be required as wait up to an hour to learn whether a retake will be necessary. And if a copy of the image is needed, it can be copied onto a compact disc.

Another societal benefit is that digital imaging eliminates the need to periodically dispose of the toxic chemical by-products generated during film development.

Film-based imaging has not been completely banished, however. Michael Lehman, a principal with architect Taylor, Newport Beach, Calif., says most of the firm's clients keep an "active archive" for seven years.

Storing film that is more than seven years old is difficult due to space limitations. Some hospitals store electronic records at remote locations to circumvent problems that might result from fire or earthquake damage to the main facility. When a patient has new digital files but the doctor is also relying on a film-based archive, Taylor clients opt for a dual system rather than scanning old images into a digital format, Lehman says.