Mount Sinai Hospital Gets Wireless Treatment

Nobody enjoys having to stay in hospital – lots of time to kill, questionable food and a lot of waiting. But one hospital in Toronto recently put a wireless solution in place, giving its patients less time to wait and its staff a better means of communication.

Mount Sinai Hospital wanted to reduce the response time for patients. It needed to update its patient call bell system, which patients use to call on nurses when they require attention. The system was about 20 years old, and was not a very integrated system, according to a hospital spokesperson.

“Patients were waiting too long for their calls to be responded to,” explained Dana Ormston, senior project manager, Informatics program, at Mount Sinai. “Nurses could not hear the audio of the old system, so patients would sometimes have to wait.”

According to research done by the hospital, patients would have to wait an average of seven minutes for a call to be responded to.

“Some got responded to within 30 seconds, but others waited a long time. So with the wireless (system), the primary nurse that is attached to – that is programmed to – be connected to the patient’s call-bell, now that nurse will have the tool to respond immediately.”

The system that was implemented was Avaya Inc.’s Definity Wireless Business System, which furnishes more than 300 hospital staff members with wireless handsets, enabling them to communicate no matter where they are within the hospital. The system allows for the potential of up to 1,500 handsets should the hospital require it, according to Ron Gordon, director of product marketing at Avaya in Markham, Ont.

The previous nurse call system that was in place required the nurses to walk back to the main desk in order to speak with a patient who had called. With this new system, a patient’s call is automatically routed through to the nurse’s handset.

The implementation process required Avaya to integrate with the hospital’s existing call system, as well as its existing phone system, Gordon said. Each one of those systems had to be able to communicate with the other.

The challenge for Avaya was being able to provide communication no matter where a staff member was. While at the start of a shift, 10 to 15 nurses might congregate around a station, within a few minutes they will be spread out throughout the halls and in various rooms, Gordon said.

“We had to have the ability that, from an antenna perspective, you could have multiple speech paths, so multiple doorways, for them to get into the system,” he said.

Essentially it is dial tone that allows users to get into the system and receive a call from the nurse call system, Gordon explained. It had to be ensured that there were enough speech paths so that if a patient was in dire need and tried to communicate via the call bell, that he or she would not get a busy signal.

There had to be enough speech paths so that calls could go through without any sort of blockage, Gordon explained.

“From an implementation standpoint, our system works so that you’ve got 12 speech paths per wireless fixed base, which would normally run about three antennas – which is what we did with [the hospital],” he said. “And those speech paths are then allocated on a need basis. So although you have the antennas spread out, if there is one antenna that has a demand for more speech paths in the morning and then another one has a requirement for them in the afternoon, it will move the speech paths as they are required or as they are needed.”

Avaya went into the hospital with some testing equipment to gauge the strengths of the signals, enabling the system to have total coverage throughout the 18-floor hospital.

“And the nice thing is that we’d get bleed from one floor to the next, so what you’d do is you would stagger [the antennas] so that if you had one area that was covered specifically from the floor you are on, you might get one of the extreme corners covered by the floor above or below. And we’ve certainly made a lot of use of that because some of the areas, you couldn’t get an antenna into the area you actually needed it. You might cover that one from the floor above because you’ve got better access on that floor,” Gordon said.

The initial implementation took about two weeks, according to Ormston. During that time the design was created and mapped out, and an on-line pilot test was conducted for mobile workers within the hospital. Based on the results of that testing period, antennas and base stations were moved and added.

The one issue that Ormston said is still outstanding is that the handsets go into sleep mode when entering the elevators, resulting in no coverage.

“If you’re running to a cardiac arrest or an emergency, you don’t want to have that going into sleep mode. So we’re now just putting in – and Avaya is putting in – the equipment at no cost.”

An elevator consultant came up with a design for the hospital, and once the equipment is in, it will allow for total coverage when using the wireless devices.

One of the main concerns for the hospital was whether or not the wireless technology was going to interfere with the biomedical engineering equipment.

“We tested it out and there is no interference whatsoever with pacemakers, or monitors, respirators,” Ormston said, adding that there was also a concern for the staff that would be using the handsets. The hospital conducted extensive research on that as well, and found that there was no indication that the wireless technology would harm users.

“All our team members now do have the wireless – our respiratory therapists, our physicians, our nurses, our service assistants. All the critical team members now are on board. It is a whole different pattern of communication. It is much more efficient.”

With everyone carrying a handset, the critical care team at the hospital is able to respond immediately to emergency situations such as cardiac arrests. Whereas previously a call had to be made to a communications station to have the team paged, the whole team is now alerted immediately in such a case.

“So there, of course, we’re saving really critical time of about three minutes, minimum,” Ormston said.

Gordon pointed out that the system not only allows the staff to provide faster care, but better care as well. For instance: a patient is experiencing discomfort and uses a call bell to alert the nurse, but the nurse is unsure as to what the doctor’s orders are. The nurse is able to conference in the patient’s physician to find out what steps should be taken, and the patient is able to talk to the doctor directly.

Patient reaction to the new system has been minimal, as nothing has changed on their end of the system. It is exactly the same for them as it has always been, Ormston said. But, she added, the hospital environment as a whole has significantly changed.

“The environment is extremely quiet – much quieter – because you don’t have all those call bells ringing,” she explained. “And when you make an environment more peaceful, it seems to me that everyone’s voices are even talking quieter, and people are moving slower, so it is a much more peaceful environment, which I think is really important in this kind of setting for patient healing.”