Resources for OR Design & Construction

When the unexpected happens during surgery, a life can be on the line. Communication systems must be judged for their speed, ease of use, and effectiveness. Cost, while a consideration, probably should not be the deciding factor, although the costs of these systems don’t differ widely enough to affect the viability of the project, particularly in construction of new facilities. Here is a look at communications technology for ORs, which is growing increasingly sophisticated.

This relatively simple system, when activated from the OR, turns on a flashing dome signal light above the door to the room. An audible and visual signal must also be provided in other locations throughout the department to notify staff of the need for assistance.

• Comparatively low in cost and easy to install.
• Easy to use. Requires only the push of a button to activate and requires a minimum of interaction on the part of the surgeon or other OR personnel.
• Precludes the possibility of a busy signal, as might happen with a phone system.

• Allows no direct voice communication. Staff will not know the nature of the call, only that they must respond immediately.

Usually found in critical care areas and sometimes in general care areas. Typically, this is a simple push-button system that sends a signal to the PBX switchboard. When somebody hits a code pushbutton, the annunciator panel shows where it originated, prompting the PBX operator to go on the public address system to direct the code team to the appropriate location with the appropriate gear.

Many OR departments choose not to install a Code Blue system because they already have the staff and equipment needed to respond to a cardiac arrest.

• Useful for rapid reporting of the extreme emergency represented by a cardiac arrest.

• Focus is narrow. The system is of no use in the many other possible emergencies where there is a sudden urgent need to communicate.

One of the most recent innovations in hospital communications, cell phones have been used primarily to enhance a nurse call system, allowing hospital staff and patients to reach nurses at all times.

• Two-way mobile communication. With portable cell phones, the carrier can be reached no matter where he or she may be.

• Currently, the system requires a hand-held phone, which would be cumbersome in a sterile environment.
• Allows intrusive phone calls. As a general rule, hospitals are seeking to limit or eliminate intrusions such as pages. This is particularly true in the OR.
• More costly than alternatives, though wireless cell-phone technology holds promise as science and applications develop.

Everyone who remembers intercom systems from grade school knows this is hardly new technology. Modern multi-channel, decentralized systems, however, hold promise for improving communications in the OR setting.

These new systems comprise a head-end rack located in a central com room in the OR department, with remote units throughout the OR. An "all page" option can be selected from any unit, allowing the speaker to be heard instantly in every area of the OR. Group page options are available; all ORs can be one group, and all support rooms could be another group. A discrete conversation can also be held with someone in just one other room. The system also allows simultaneous two-way communication with four to eight independent conversations at one time, depending on the number of channels installed. This instant two-way dialog allows for immediate requests to the appropriate areas, with immediate confirmation and response.

• The quickest and surest way to secure qualified assistance during surgery and postop care.
• Essentially a hands-free system. In the OR, the intercom station would be a flush-mounted wall unit with push-button activation. After the appropriate buttons have been pushed, multi-party conversations can be held while both hands are free.
• Can replace the need for a staff emergency alarm system, as required by the Hospital and Healthcare Facility Guidelines from the American Institute of Architects. (The proposed system must be reviewed with the authority having jurisdiction to clarify that it will meet the intent of guidelines.)

Joe Sather can be reached at 402/399-1152 or jsather@hdrinc.com