By Alexis Carlyon, MJ Medical Consultant
Technology and its total integration within the hospital environment was at the forefront of the briefing for the new St Olav’s hospital in Trondheim. Almost sixteen years on from its inception, has the vision been realised and has it delivered the fully immersed integration it aimed for?
In April 2013, along with other students from the Planning Buildings for Health MSc course at Medical Architecture Research Unit (MARU), I visited Norway as part of a comparative health estates study trip. We visited a variety of facilities ranging from the older community hospital at Levanger, parts of which dated back to 1917, and the more recent St Olav’s University Hospital in the centre of Trondheim. St Olav’s has undergone extensive redevelopment with phased opening of new buildings since 2004 and has been hailed as Europe’s most “integrated” hospital. So what is a fully integrated hospital and what can we learn from this approach?
Technology in Use
The concept for the St Olav’s hospital was to have a truly patient centred facility that would embrace modern technology for the next generation. Clinical specialities are housed in individual centres, however the staff and services move to the patient, rather than patients moving departments. This concept was underpinned by the notion of full integration of technology and ICT systems. From automatic staff uniform dispensing, IP based nurse call systems, automatic guided vehicles, an automated pharmacy and a single interconnecting data network linked to all medical and non-medical technology within the hospital to name but a few examples, it would certainly appear that the vision has been achieved with many industry reports suggesting that the hospital is the most modern hospital in Europe with unrivalled integration of ICT in a healthcare environment (Fevre, 2006).
The Masterplan for St Olav’s is in the style of city blocks, spread over 223,000m2, across 10 buildings, 6 of which are the main hospital ‘helsehus’ (houses) linked by sky bridges and underground service tunnels. The blocks each follow a similar stacking arrangement. The standardisation of design at this scale lends itself to the integration of technology, as well as orientation for patients, staff and visitors.
The Norwegian University of Science and Technology (NTNU) is completely integrated within each of the buildings as demonstrated in the diagram above and accounts for 25% of the total development. This collocation of diagnostics, treatment and research spaces puts clinicians, students and researchers together and should yield both research and treatment benefits.
This is supported by the ICT system being fully integrated with applications and solutions over a single IP network. The use of this technology could be seen working across the hospital. From the patient self check in systems, that is widely used across the UK, to the more technical integrated theatres. There are 43 theatres across the hospital; six of them are Operating Rooms of the Future (FOR). These operating rooms of the future make full use of the integrated networks, with the AV-ICT Structures enabled to support live and interactive communications in High Definition (HD). These unique spaces are also known within the hospital as ‘laboratories’ and they have been designed specifically for the development testing and implementation of new technologies and treatments within a number of sub-speciallities. St Olav’s and NTNU have been established as a leading research centres for many years, one of their more recent developments is the use of 3D ultrasound to aid minimally invasive neurology and vascular surgeries.
The IP network has been future proofed to support developments in technology as well as any expansion in the buildings. PACS, the filmless radiology application that allows you to access radiology images requires a heavy uninterrupted access of bandwidth of upto 4Gbps. The system designed for St Olav’s uses 10gbps. This will support images being accessed anywhere on site, even on wireless devices. (Cisco,2005)
The patient call system is also supported by the IP network, rather than a traditional system, where a patient call bell sounds at the staff base, the call is routed to the geographically closest person, allowing greater time to be spent with patients. At the start of a shift patients were assigned to team members, the patient call would be routed to them on their IP phone, if they were not available it would automatically send a message to the next nearest staff member. The lack of call lights outside of rooms was noticeable during our visit, as was the absence of the large patient call panels behind the staff bases. The clinical colleagues within our study group were noticeably concerned by this; however the nurses we spoke to said the system in their opinion was a vast improvement, saved time and allowed more time to nurse.
The IP phone system was also used across the hospital, we saw this demonstrated by the logistics team, who were able to assign porters based on their location on the campus, rather than the porter returning to base after each task.
The use of integrated ICT systems was not limited to medical technologies;
St Olav’s uses SwissLogs Automated Guided Vehicles (AGV) to transport goods around the hospital, the AGV’s work wirelessly and are able to sound warnings as they approach people. We observed one of the AGV’s ‘call’ for the lift over the wireless network, a patient entered the lift, not noticing the AGV with transport cart waiting, although quickly exited as the AGV approached. On sensing someone in the lift the AGV retracted and waited for the next lift. Trials for moving patients with the AGV were implemented, however this was deemed a step too far and the feedback from patients and staff was negative. With patients finding the experience of being moved by robots adding to the stressful situation of being in hospital, this was quickly reinstated as the porter’s role.
In comparison with the high tech automated systems in use, the staff across the hospital used a slightly less ‘high tech’ yet innovative solution for transporting themselves and goods around the campus, opting for scooters!
St Olav’s has around 8,500 staff and medical students and uses in excess of 130,000 uniforms, scrubs and gowns per year. The challenge faced was how to ensure uniforms were available to all staff in the right size at the right time. The solution again makes use of the hospitals integrated ICT systems. With RFID tags used to access the uniform dispensing systems via each member of staffs ID card and allowing the member of staff to access the right uniform in the correct size. Once finished with the uniform in any of the dedicated laundry bins around the hospital. An RFID tag attached to the uniform then logs its return and laundry processing. The intelligent garment storage system then reads the tags as they are placed into the storage system and register when they are removed keeping a real time inventory. As levels fall below a certain criteria replenishment orders are automatically generated.
Throughout the hospital the controlled drugs were stored in automated dispensing systems. To access the system staff had to use their ID card which would register who accessed the drugs providing a valuable audit trail, as well as removing role of key holder. This system logs who access the drugs, saving time as authorised staff have the correct permission and do not need to find the ‘designated key holder’ to access drugs for patients. In addition to the localised automated drug storage cabinets at the point of care in treatment rooms, the same technology applied to prep rooms for drugs being prepared and booked to patients prior to the ward rounds. The systems at ward level are supported by the Pillpick automated pharmacy robot system. This system can prepare drugs for the ward replenishment, outpatient pharmacies and the preparation of single dosses’ and distribution via the pneumatic tube station automatically to the ward. In an emergency this can be completed within 15 minutes of the order being placed.
The levels of integration of technologies in St Olav’s were clearly briefed from the outset and implemented, making it a beacon for other developments across Europe. The vision has been realised and the benefits we witnessed demonstrated a tangible return on the investment. In this case the investment was one of faith as much as capital and it was clear for this project to be a success, it needed strong leadership and unwavering faith in the long term goal. In conclusion, whilst it was hard to gather any information on teething problems or negative lessons from St Olav’s, there is much that could be learnt for hospitals throughout the UK. By deploying a strategic approach to the integration of technology generally and utilisation of the innovative systems, patient care and efficiency in care delivery could translate into real savings, particularly when considered against the backdrop of an NHS which is faced with finding year on year savings. Perhaps this is a real time demonstration of spending to save?
Author, Alexis Carlyon – In my role as a Health and Equipment Planner at a Medical Consultancy MJ Medical, I have been involved in a wide range of healthcare projects across the UK and Middle East over the last ten years. Undertaking the Planning Buildings for Health MSc at MARU has enhanced and consolidated the knowledge I have gained working in the sector as well as gaining a valuable insight into the research and development at MARU and experiences of fellow students.