Case Study: A Hospital on the Bleeding Edge

The trouble with being a wireless pioneer is that sometimes it means you make your move too soon.

Three years ago when Mount Sinai Hospital in Toronto received a huge anonymous grant earmarked for “improving patient care,” it decided to spend the money on overhauling the way patients and staff communicate.

The hospital, an 18-floor, 480-bed facility located in the heart of downtown Toronto, was looking to solve two problems in particular. It wanted to reduce the time it took nurses to respond when a patient pressed their bedside call bell. And it wanted to reduce noise levels on the wards.

When Dana Ormston, a senior project manager in the hospital’s informatics department, researched the scope of the problem, she was shocked to find that the mean time for a nurse to respond to patient calls was seven minutes.

And pages for nurses, doctors and orderlies were continually broadcast over the PA system – including into patient rooms – on average every ten minutes. Hardly a quiet, restful environment for healing.

Mount Sinai found a way to solve both problems by integrating a new nurse call system from Rauland-Borg Corp. ( with the Definity Business Communications System, a 1.9 GHz in-building mobile telephone system from Avaya Inc. (

Now nurses, physicians and other medical staff – over 250 hospital employees in all – carry the slightly-larger-than-cell-phone-size Definity phones, with the ringer set to vibrate when a call comes in.

When a patient presses his bedside buzzer, a page is sent directly to the nurse assigned to him. Nurses program their phones in the morning using a simple touch-screen interface to ensure their patients’ calls come directly to them.

Patients can pick up the standard wireline telephone on their bedside table and talk to the nurse – the wireless and wireline systems are also completely integrated – or speak over the nurse call system.

The network can also be used to page a Code Blue team in the event of a medical emergency. And nurses can contact doctors directly wherever they are in the hospital.

The ground-breaking implementation, completed in September 2000, included 100 base stations. Today the hospital is in the process of putting access points in six elevators so pages will find staff even when they’re moving between floors.

The system was initially not well received because it represented a major departure in working methods, and the nurses in particular were concerned about potential health hazards.

But it has had a tremendous impact, and most users now can’t imagine how they survived without it, Ormston says.

The mean time to respond to a patient call is down to 1.4 minutes. And quiet reigns over patient areas.

“When I go down to the [patient] units now, it feels totally different because it’s so much quieter,” Ormston says. “It’s not so frenetic either. People seem to be talking lower and even moving slower.”

Staff came around to liking the system because they found it saved them time – at least an hour a day, some say. It’s time that used to be spent traipsing back and forth between the nursing station and patient rooms when answering calls or trying to communicate with physicians.

Although Ormston can’t prove it yet, she believes the $1.2-million system will ultimately pay for itself in reduced hospital stays for patients because of the improved staff efficiency.

In the meantime, the Definity system has already achieved its initial objectives of improving patient care and patient satisfaction levels.

So what could possibly be wrong with this picture?

Nothing really. It’s just that the technological worm has turned a few times. Wi-Fi technology has ascended, and the hospital is now beginning to see that 2.4 GHz has some very attractive features – most importantly, that it could be used to integrate voice and data functions on one network.

“At the time we got the 1.9 GHz system, it was basically all that was available – it was the best that was on the market,” says senior systems analyst Ken Carey. “But the 2.4 GHz technology offers so much more.”

It could be used to provide high-speed mobile access to hospital data and for IP-based video conferencing. The hospital already has pilot trials underway to test 2.4 GHz networking. It has wheeled carts with PCs on them that communicate over the hospital’s IP network via 802.11b access points.

It also has a pilot underway to test the viability of physicians carrying wirelessly connected PDAs. They can use the handhelds to get access to electronic patient records and lab results, and to place orders for lab work, imaging and meds.

That pilot is using 10 GHz wireless networking equipment, but Carey says the hospital could very well end up opting to do it over a 2.4-GHz network.

One possible kick against 2.4 GHz is concern about interference with electronic biomedical equipment. But those concerns have almost been put to rest now, Carey says.

“It’s always difficult to pin down those folks or get them to give their 100-percent blessing on anything. But so far they haven’t found any problems [with the 2.4-GHz gear].”

A 2.4-GHz network could even be used for voice. In fact, it will be, possibly as early as this June, Carey says.

Last year, the hospital bought an adjacent office building and is converting it to use for outpatient clinics, research and administrative space. The wired phone system in the new facility will be voice over IP – using technology from Nortel Networks (

Once it’s up and running, the hospital will begin experimenting with integrating a 2.4-GHz-based mobile wireless telephony system also from Nortel.

One of the attractions of 2.4 GHz is that it integrates with wireline IP/Ethernet networks and could reduce the number of different kinds of infrastructure the hospital’s informatics department would have to support.

That said, Mount Sinai certainly isn’t going to abandon its investment in the 1.9-GHz technology any time soon. “I can see the two systems [2.4 and 1.9 GHz] co-existing,” Carey says.

Staff who need mobile access to additional services beyond voice – bar code reading, for example, which requires a data network – will probably move over to a 2.4-GHz-based system for both voice and data.

Carey believes the hospital will move heavily towards the use of bar coding to track and process each step in various kinds of transactions, from ordering to delivering services, tests and medications.

In one extreme scenario, nurses, patients, equipment, medications – even the drawer in which the medications are kept – would be bar coded and swiped during the course of delivering service, and the resulting data sent over a wireless network.

One thing that would not be easy to do right now is integrate a mobile phone system based on voice over 2.4 GHz wireless with a nurse call system. Vendors like Rauland-Borg have not announced intentions to integrate with 802.11-based voice systems.

This is not a huge problem in the new Mount Sinai facility, however, because it will have few, if any, in-patient beds.

But if integration with a nurse call system does become a requirement – and even outpatient clinics have some patient communications needs, Carey notes – there are middleware vendors who claim to be able to do it today.

Did Mount Sinai make its move too soon with the 1.9-GHz-based Definity system in its main building? Should it have waited for 2.4 GHz?

It’s tough to second guess a technology implementation that has so clearly met and even exceeded its objectives. And it would have been tough three years ago to predict the rise of 802.11.


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