Published in December 2005

Paging Technology for Hospitals
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 system.

Amps, Speakers
     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 closet.
     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 volume control.

	Because 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.

Zones, Paths
     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.

Departmental Paging
     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.

Central Control
     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 changed simply.

Integration
     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 compromise.


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 nationwide.