in December 2005
By Larry Bernath
The ability to integrate
overhead paging technology with other communication systems
in a hospital via the network is a dramatic advancement.
When hospital administrators
plan an upgrade or replacement of their overhead paging
systems or select equipment for a new addition, many are
surprised to discover myriad opportunities for increased
power, flexibility, management and integration. Following
is a discussion of recent advancements in paging technology
and a description of a state-of-the-art hospital communication
Systems that are more than 15 years
old typically have traditional 70-volt technology with central
amplifiers, heavy-gauge cable and speakers with transformers.
Moves and changes over the years cause many speaker lines
to become unbalanced or overloaded, resulting in low volume,
distorted sound or uneven coverage. Amplifier problems are
often the result.
The current technology for hospitals
uses self-amplified speakers connected with standard Cat3/5/6
cable. This architecture is inherently more reliable because
there are no central amplifiers to become unbalanced or
overloaded. Expansion is virtually limitless. Further flexibility
can be achieved by connecting each speaker on a virtual
home run to the Intermediate Distribution Frame (IDF). This
is accomplished by installing three speakers on a wiring
run, with a separate audio path to each speaker (the fourth
pair carries power to the onboard amplifiers). This practice
allows the zone assignment of a speaker to be changed without
lifting a tile or touching the speaker. It is done in just
a few minutes at the cross-connect block in the communication
Another advantage of self-amplified
speakers is the ability to perform critical balancing. Unlike
a 70-volt speaker that has four volume taps on the back,
a self-amplified speaker can be adjusted continuously from
off to full on by adjusting the volume control on the front
of the speaker with a screwdriver. Using white noise and
a sound-level meter, it is quite easy to adjust levels for
optimum intelligibility and evenness of coverage.
Because most speakers in hospitals
are installed in lay-in tile ceilings, the use of speakers
that are the exact size of a 2x2 tile provides two important
advantages: They are easier to install and much easier to
move. Because facility changes in a hospital are a weekly,
if not daily, occurrence, having speakers that are easy
to relocate is an important consideration.
Noise-sensing volume controls are
used in areas of a hospital that are alternately loud and
quiet, such as utility and work areas where equipment is
running from time to time. The difference in ambient sound
in a cafeteria between the quietest and loudest period (lunch
hour, for example) is usually not enough to warrant a noise-sensing
hospital facilities constantly change, having speakers
that are easy to relocate is an important consideration.
Electronic wall displays
are direct in the message they present.
A zone is the smallest discreet
area that can receive a page announcement. Most systems
can page a zone, pre-selected groups of zones or all zones
at the same time (all-call). Some systems can have multiple
programmable group zones and priority override, a feature
that allows a critical message to interrupt a routine message.
Traditionally, hospital paging
systems have one communication path. That is, only one announcement
can be made at a time. This works fine if only a few people
are accessing the system, but the larger the hospital, the
more likely that a single-path system will be inadequate.
Departmental paging can relieve the bottleneck, but a multiple-path
system is the best answer for a large, busy hospital.
Shortcomings of traditional paging
systems and budget restrictions on their upgrade or replacement
have motivated the installation of departmental paging systems
in hospitals. Surgical suites, intensive-care units and
emergency departments frequently generate a high volume
of announcements in their local areas, causing the central
system to be overloaded at peak times. Transferring these
announcements to a local system relieves the hospital-wide
system. Departmental systems frequently incorporate talkback,
a feature that adds the function of an intercom.
Integrating a departmental system
with the main system can be a challenge. Keeping the systems
separate is dangerous because a simultaneous announcement
from each system could make both unintelligible. The much
better way is to integrate the systems, so a critical message
from either system interrupts a routine message from the
other. Advanced page controls can be programmed to do this.
The central control of a paging
system typically comprises several components. The first
component is the page control, a device that connects the
paging system to the telephone system and allows the selection
of zones by dial code. The page control also allows for
a priority message to override a routine message and other
features. Smaller page controls provide a fixed number of
zones and groups; larger ones provide multiple paths and
are expandable to hundreds of zones. Advanced page controls
are software programmable.
Other central control components
include digital messaging units, which store prerecorded
announcements and come in a variety of sizes. Stored announcements
can be activated by pushbutton, dial code or on a time schedule.
Many hospitals store Brahm’s Lullaby and
broadcast it whenever a baby is born.
In a traditional centrally amplified
system, amplifiers are part of the central control. Typically,
there is one amplifier per zone. One shortcoming of this
architecture is that failure of an amplifier results in
the loss of an entire zone. The loss of an amplifier in
a self-amplified system affects only one speaker.
Installing three speakers on a
wiring run allows the zone assignment of a speaker to be
The most dramatic advancement in
overhead paging technology is the ability to integrate it
with other communication systems in a hospital via the network.
Most paging systems are connected to the telephone system,
but it is now possible to integrate telephone and paging
with pocket pagers, two-way radios, cell phones, email,
screen pops, nurse call, electronic wall displays, wireless
keychain devices and practically any other communication
system found in a hospital. It is also possible to access
these systems using existing computers as browser-based
graphical user interfaces.
A browser window can display a
personnel directory, a message directory or a building graphic
for zone selection. Messages are delivered with the click
of a mouse, without the sender having to remember the location
or best way to reach a particular person. The system remembers,
and sends the message according to parameters that can be
changed as frequently as people and preferences change.
Integrating the various systems
in a hospital frequently increases the power of each of
them. When messages are sent only to the most appropriate
areas or devices, messages are more likely to be heard (or
seen) and acted upon. Important messages can be escalated,
or repeated until acknowledged. Delivery, recognition and
response to emergency messages can improve dramatically.
Voice over IP
Hospitals are expanding by adding
specialized health centers and clinics in outlying areas.
Integrating communications among multiple buildings is accomplished
easily using VoIP technology over the network. Facilities
that are hundreds of miles apart can communicate as if they
were right next door.
With today’s technology,
staff located in buildings that are hundreds of miles apart
can communicate instantaneously.
ADA and HIPPA Compliance
The Americans with Disabilities
Act and the Health Insurance Portability and Accountability
Act create new requirements for hospital communications.
Systems that are designed and programmed to comply with
new regulations fare better than those that rely solely
on the training of users in proper protocol.
ADA requires hospitals to communicate
clearly and effectively with hearing-impaired staff, patients
and their families. Particular messages must therefore be
delivered visually as well as audibly. Visual media include
email, digital pagers, PC screen pops and electronic wall
displays. Using text-to-voice translation, an integrated
system can deliver a text message automatically through
visual media and a voice message through audible media at
the same time.
HIPAA regulations are designed
to protect patient privacy. This presents a challenge in
an emergency, when concern for privacy must be balanced
against a patient’s life and health. One solution
is the ability to deliver discrete information (“Code
Blue on Two West”) over public media such as paging
speakers and wall displays, and specific information (“Code
Blue on Two West Room 289) over private media such as pocket
pagers and cell phones. When systems are integrated (as
described earlier), both formats can be delivered immediately,
automatically and simultaneously.
Planning for the Future
It is not just paging anymore.
Flexibility and integration provided by advanced technology
are changing hospital communications completely. The possibilities
are endless, and it is more important than ever to bring
facility, communication and healthcare staff together to
learn, define needs, and establish policies that meet those
needs over the long term. The payoff is improved service,
quicker response time, lower costs and compliance without
A 30-year veteran of the sound communications industry,
Larry Bernath, national sales manager for Valcom Services
LLC, Roanoke VA, has designed systems for hundreds of commercial,
industrial, educational, healthcare and government facilities