The healthcare industry has experienced drastic changes in the past few years. Nursing and other staff shortages, combined with an aging population and continually rising life-expectancy rates, have pushed the demand for caregivers well past the supply available. As a result, hospitals are learning to supplement their staff with newer technology systems in an attempt to better leverage their staffing levels and accomplish “more with less.” These systems help minimize the time and staff previously required for both healthcare and ancillary hospital functions and, thereby, help to greatly improve efficiencies and allow hospital staff greater flexibility and freedom in performing their duties.

Before discussing these systems, let's take a brief look at the recent past to understand the evolution of the systems revolution within the healthcare industry. As recently as five to ten years ago, systems design was given (at best) a brief thought during the design process. Traditionally, the lead electrical designer would understand the needs for everyday, basic communications equipment within the building (e.g., a telephone system, paging system, and nurse-call system). To prepare for the installation of this equipment, the electrical designer would provide a basic raceway system consisting of empty junction boxes and conduits to be included in the construction process. After construction, the hospital would hire outside vendors to install these systems. The vendors of the various systems had no input as to where their equipment would be located; they simply were asked to make it work with the minimal infrastructure provided during construction.

Today, these basic communications systems are only a small part of the systems designs for hospitals. Newer systems are now used to assist staff with tasks as varied as controlling access to sensitive areas, monitoring and trending patients' vital signs, recording and storing medical records, and protecting infants in nurseries. Additionally, all patient data and records can be transmitted instantly throughout the hospital-or around the world-to allow staff to seamlessly communicate and enhance their ability to diagnose, treat, and monitor patients.

As a result of this proliferation of systems within the hospital, more extensive planning has become crucial to allow for their proper installation. Even more challenging, these systems constantly change and evolve as technology advances. This means that planning must provide flexibility to allow for the quick progress of technology. In other words, the low-voltage systems designer must understand the systems needed for a hospital today while keeping an eye toward the future. These challenges have been confronted by the newest member of the healthcare design team-the low-voltage systems designer.

Early in the design process, the low-voltage systems designer must work with the architect to ensure that the hospital's space planning allows for the integration of low-voltage systems throughout the hospital. These systems include sensitive electronic equipment that must be installed in dedicated communication rooms, with special consideration given to temperature control and other variables. The low-voltage designer must work with electrical and mechanical designers to make sure the proper power and cooling are provided to maintain this sensitive electronic and computerized equipment. Also, several low-voltage systems (such as infant protection, access control, fire alarm systems, etc.) affect the architect's life-safety egress and hardware planning and must be carefully coordinated with the hospital's life-safety plans.

Next, the low-voltage systems designer must provide construction drawings and specifications to define the proper equipment hardware and the amount and type of cabling required, to optimize network and equipment configurations, and to provide guidelines for the installation process. But before the low-voltage systems designer can tackle these issues, he must first be familiar with local, state, and federal codes (including building, electrical, fire, and life-safety codes), industry standards, health regulations, and equipment requirements. Without this knowledge— both of systems applications and specific regulations-improper systems design and installation can occur, becoming a severe liability for the owner.

For example, the state of South Carolina requires all nurse-call wiring to be protected by metal conduit-a regulation not found in national codes and standards. If a low-voltage systems designer were unaware of this requirement, the installation of the nurse-call system would not pass the state's construction review process, leading to delay and extra costs for reworking the installation later.

To further complicate matters, the low-voltage systems designer must provide his or her design while keeping track of one more crucial design element-the budget. A savvy and resourceful designer must constantly balance the systems design with the real-life need to provide a job at a cost that the owner can afford and must understand ways to economically design these systems. The designer must also communicate projected costs to the owner early in the design process to ensure that they don't surpass the owner's means.

One example of a cost-saving measure designers can take is to integrate a physician's dictation system into a modern digital telephone system. This approach capitalizes on the economy of using existing telephone wiring for the dictation system while maximizing its convenience. Furthermore, with the help of voice-recognition software, doctors can have their messages transcribed, e-mailed, and even faxed simply by hitting a few keys on a telephone. But all of this is achievable only through thoughtfully structured cabling design and careful planning.

This same economy of design is true for nursing communications systems. Integrated voice and nurse-call systems allow for calls from patient beds to be transferred immediately to the attending nurse's portable phone or text pager through a lattice of wireless access points that can also be used for data transmission. Streamlining the amount of equipment needed to achieve both tasks, which can be accomplished through careful design, is both financially and aesthetically pleasing because it minimizes the cost of equipment and maximizes the use of floor space.

A low-voltage systems designer must remain involved throughout construction to monitor the proper installation of all these systems. Once they have been designed to meet the owner's needs and budget and the installation has been completed, two questions remain: Do these systems provide the functions promised, and will they enhance staff efficiencies? Therefore, after installation, the designer should help test the systems to make sure they function as designed. He or she also should work with the owner to help train the hospital's staff on the use of this new technology. The best systems in the world can't help a facility if the staff is uncomfortable with or unable to use them.

Choosing a low-voltage systems designer should be a careful decision, but it can be done on the same basis that other traditional design-team members-such as architects, engineers, and interior designers-are selected. You should:

  • Look for those companies and individuals with previous design experience. Make sure that their experience is of a similar scope to your project's.

  • Talk with prospective low-voltage systems designers up front to make sure they understand your objectives and share your values and concerns.

  • Make sure the company or individual is dedicated to ensuring a successful project and will remain involved past the design process-throughout construction, and even afterward to test these systems and train the staff on their use.

In conclusion, the evolution of healthcare and the new concerns of maximizing available staff and using cutting-edge technology have led to an explosion in the use of low-voltage systems in today's hospitals. Looking toward the future, this trend will only continue to advance as newer technologies allow greater flexibility and convenience to enhance the practice of healthcare. HD

Grant A. Ramsay is Director of Special Building Systems at GRG Consulting Engineers, Maitland, Florida.