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.
