Knowing that "time is muscle," Riverside Methodist Hospital staff started planning in 2000 to consolidate its fragmented heart and emergency services into a new, six-story, free-standing building so that the new McConnell Heart Hospital at Riverside and emergency department (ED) were only a floor apart. Emergency services took the initiative to find a more effective communications tool, and we went live with it in ED on opening day, Mar. 12, 2004, rolling it out on all clinical floors of the new building four months later.

Riverside Methodist Hospital in Columbus, Ohio is a 1,059-registered bed, not-for-profit, acute care, community hospital with 1,500 physicians and 6,500 employees. Part of the OhioHealth system of 13 member or affiliate hospitals, home health, hospice and outpatient facilities, Riverside is home to the largest open heart program in central Ohio. Our heart services, however, were scattered in the old hospital, and ED services were broken into three units on two floors. In our old ED, we cared for 70,000 patients annually in grossly inadequate 28,000 square feet of space designed to accommodate 45,000 patients a year. We had 32 beds, but only a third of them were private rooms. Twenty of the "rooms" were merely stretchers behind curtains in a "race track" design around the nurses' station.

To communicate, we carried heavy Motorola two-way radios clipped to our scrubs that had batteries that lasted less than one shift. Because of the line of sight through the curtained rooms, clinicians would shout to each other in the hallways. Telephones rang constantly and in the tight quarters, we could hear conversations on about 50 radios. Physicians were on one frequency on the radios, nurses were on another and we couldn't switch frequencies. Therefore, doctors and nurses called unit secretaries or charge nurses to locate each other, waiting on hold or playing telephone tag. We could hear sensitive patient conversations behind the curtained "rooms," when loud overhead speakers, pagers and multiple radio announcements didn't interrupt.

Exploring Options

To find a better way to communicate and to improve the environment of care, the planning committee put together an ED communications budget of $125,000 in 2001, thinking that we'd probably end up with a lighter, upgraded model of the Motorola radios we owned that had a longer battery life. We also explored an option from another vendor, but the devices would have been very expensive, the system required proprietary wiring and we couldn't negotiate a package deal.

We considered cell phones because the operating room bought about eight to 10 of them to communicate among pre-op, the operating room and the post anesthesia care unit. But the phones were expensive--running from $900 to $1,000 a piece--the system required a proprietary antenna system and we had to dial numbers like a regular phone. For the hundreds of point-to-point, task-oriented communications we initiate throughout the day, cell phones are too expensive and two-way radios are too slow.

Cost-effective Solution

We had resigned ourselves to using radios and started discussing with Motorola segregating groups of workers on communications frequencies when we got a call from our information services department about a new product that might fit the bill. The product turned out to be the Vocera communications system--a wireless platform that provides hands-free, voice communication throughout any 802.11b networked building or campus--from Vocera Communications, Cupertino, Calif. The lightweight communications badge clips to our scrubs or hangs on a lanyard and uses simple voice commands to initiate calls to individuals or groups. Like Star Trek, all we do to contact someone is press the talk button, say his or her name and we're put through.

After about 10 minutes reviewing the system's communication capabilities, we knew we had to test it in ED. We conducted a two-week test run in the old ED and surveyed the staff for their feedback. The reaction was very positive, so we decided to go with Vocera. We spent our $125,000 ED communications budget on $25,000 worth of badges (80 to 85 badges at $300 each, enough to equip ED at peak staffing, plus extras to accommodate breakage), a server for $75,000 and $25,000 for licenses and training. The 80 or so badges we ordered included equipping not only peak staffing in ED, but also lab, registration and housekeeping staff. We would love to have one device for everyone in emergency services, but with a headcount in ED alone of 240, that cost would have been too high.

We have two separate wireless networks in ED: a proprietary network for our Welch Allyn monitors and standard 802.11b wireless, which was already being installed in ED to accommodate the wireless laptops for bedside registration and other functions. Since the communication system runs on standard 802.11b wireless, our ED communications budget didn't have to bear the cost of the infrastructure. That cost came out of a separate IS budget.