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Convergence for critical care

MetroHealth converges voice and data over wireless IP, delivering better care for more patients — without increasing staff size.

During emergency heart surgery at MetroHealth System's new Critical Care Pavilion, a patient's vital signs go haywire. The anesthesiologist needs expert advice, and fast. He hits a button on a wireless phone strapped to his waist and is instantly connected to the department chief, who simultaneously conferences in other anesthesiologists. After this quick verbal consult - during which he never leaves the patient's side - the anesthesiologist makes a small adjustment, the patient stabilizes and the operation is a success.

Life-saving real-time collaborative scenarios such as this have become commonplace at MetroHealth System since the Cleveland healthcare group opened its CCP in June 2004. Near the established medical center, the CCP features an emergency department and 17 surgical suites tied together via a state-of-the-art wireless data and VoIP system.

With the CCP's opening, MetroHealth doubled its space and tripled the number of monitored beds. Staff size, however, did not change. This meant that simply extending the medical center's Gigabit Ethernet backbone to the CCP wasn't going to be adequate, says Vince Miller, vice president and CIO at MetroHealth.

"We knew communications was going to be a big issue," he says. "We thought [VoIP] might be the answer." Besides VoIP, wireless made better business sense than giving the on-the-go emergency department and surgical staffs stationary connections to the hard-wired corporate network serving the facility.

So MetroHealth combined the two technologies to create a converged wireless network that has improved operations and patient care while serving about 70,000 critical care patients a year. As a result, MetroHealth - the only Level 1 trauma center serving the region - earns recognition as a 2005 Enterprise All-Star.

Eliminating the runaround

MetroHealth hasn't exactly been conventional with its wireless VoIP setup. For example, it doesn't use Cisco's CallManager IP PBX software, even though it does rely on the Cisco Catalyst 4507 switch at its core and 44 Cisco AP1210 access points. Instead, IT used its Nortel 1000 PBX as the base of its IP system, says Joan McFaul, director of IT infrastructure. "If we had gone all-Cisco, we would have had to put in two telecommunications systems. This way, we . . . retained our traditional telecom" infrastructure while implementing wireless VoIP, she says.

For placing VoIP calls, McFaul's six-member IT team selected SpectraLink's 2211 wireless phones. Spectralink Voice Protocol (SVP) server software, loaded on the Catalyst 4507, ensures that the CCP's 802.11b wireless LAN can support voice and data. The hospital, in turn, can implement new applications that leverage both, she says.

MetroHealth’s All-Star project leaders Vince Miller and Joan McFaul.

As an example, McFaul describes how MetroHealth's emergency department nurses use the wireless VoIP network. When emergency department nurses come on duty, they log themselves and their wireless phones and headsets in to the nurse call system by swiping bar codes on their badges and the devices. After they key in their patient assignments, the call system database uses middleware from a company called Emergin to map the phones to the nurses' assigned patients and to the cardiac monitors and call buttons in the exam rooms. The nurses not only receive voice calls via the wireless network, but also data alerts from the monitoring devices.

If a patient's vital signs go beyond a preset threshold, for example, a cardiac monitor would issue an alert that the nurse receives via the wireless phone. When any monitor registers a code-blue emergency, all staffers are immediately notified via their wireless phones.

A substantial productivity increase results. "A nurse can receive an alert from the physical monitor or a patient call request and respond to the patient through the nurse call button," Miller says. "The nurse knows from the phone display the source of the request or alert and can speak with the patient directly."

This saves time, especially in critical situations, McFaul adds. "If a patient calls and says he's bleeding, you need to respond immediately. But maybe the patient just needs a blanket. Either way, you know how to respond, without having to go to the room first to figure out what the situation is," she says. The upshot is that the emergency department staff can handle more patients and monitor more beds, while keeping staffing levels the same, she says.

The wireless VoIP network also makes paging more efficient, Miller says. Previously, emergency department nurses would use desk or wall phones to page doctors and then to receive the return calls. The nurses had to wait near the phones from which they issued the pages, or risk missing the return calls. With the new system, return calls come directly to the wireless phones strapped to the nurses' waists. "Nurses can reach a doctor and have questions answered no matter where they are on the floor," he says. This is a big improvement, especially when lives hang in the balance, and critical care decisions need to be made in seconds.

The system cost MetroHealth $170,000. Already the productivity improvements and overall ROI are measurable, Miller says. For example, the group no longer needs to devote five staffers to watching patient monitors. There alone the annual savings is $200,000.

"But the real key is the productivity. It has allowed us to see a greater number of patients with the same size staff," Miller says. "Overall, the physicians, the anesthesiologists, the nurses - and especially the patients - are all extremely happy with it."

Cummings is a freelance writer in North Andover, Mass. She can be reached at

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