Can You Hear Me Now?

Oct. 1, 2007

An Idaho-based medical center deploys an adaptive repeater solution to enhance in-facility cellular coverage.

Although St. Luke’s Wood River Medical Center has long employed advanced technology and services, more recently, our medical and administrative staff faced an escalating communications roadblock: cellular communications were significantly impeded throughout the building. While outdoor coverage provided a reasonable three to four bars of signal strength for most carriers, coverage in key areas of the building was in some cases non-existent. This was partly because the building itself is constructed from poured concrete, brick and steel, accompanied by thick interior walls and coated glass windows, as is the case with most hospitals and large institutional buildings.

An Idaho-based medical center deploys an adaptive repeater solution to enhance in-facility cellular coverage.

Although St. Luke’s Wood River Medical Center has long employed advanced technology and services, more recently, our medical and administrative staff faced an escalating communications roadblock: cellular communications were significantly impeded throughout the building. While outdoor coverage provided a reasonable three to four bars of signal strength for most carriers, coverage in key areas of the building was in some cases non-existent. This was partly because the building itself is constructed from poured concrete, brick and steel, accompanied by thick interior walls and coated glass windows, as is the case with most hospitals and large institutional buildings.

These building materials, while providing solidity to the structure, also absorb energy from radio signals as they pass through. In addition, the hospital is geographically located in a valley, with a mountain creating a natural barrier on one side of the building. The strong outside wireless signal quickly disappeared on the inside of the hospital. This meant that in critical areas of the hospital, physicians were unreachable via their main communication devices—their cell phones. Given that patient care is so often time sensitive, the fact that the doctors were unable to efficiently connect back to, or receive calls from, their own offices via cell phone became a growing concern.

The aesthetics of the building were a critical consideration for us as well, because the original hospital designers took special care to ensure the facility would complement the surrounding terrain.

The very devices they had invested in to stay connected and reachable—anytime, anywhere—were proving ineffective. With voice service so severely impacted, any data services on a physician’s mobile device, such as wireless e-mail or Web access, also became unusable. Moreover, since St. Luke’s is guided by a volunteer community board, the doctors who volunteer their time to sit on our board of directors were facing even more time without wireless connectivity during their additional hours in the facility. The poor cellular coverage inside the hospital also meant that any emergency response teams working in the Valley area were unable to use their cell phones as a means of communication when onsite at our facility.

The telecommunications redundancy plan for the hospital also was being impacted by the poor wireless coverage, since hospital cell phones were to be used in the event of an emergency as a vital link to hospital administration. No signal meant no cellular back-up to the landline connections, and no coordinated communication in a disaster response scenario. It soon became evident that a solution was required to ensure reliable cell phone connectivity and accessibility for both physicians and any personnel needing to communicate wirelessly within the hospital.

Initial Considerations
Idaho-based St. Luke’s Healthcare System is comprised of four award-winning, not-for-profit hospitals in the Sun Valley area, including Wood River Medical Center in Ketchum. Opened in November 2000 to serve the healthcare needs of residents of greater Blaine County, St. Luke’s Wood River is a $32 million, state-of-the-art facility with more than 280 employees and medical staff serving more than 2,500 patients in the past year. Our hospital’s services include a 24-hour ED, inpatient and outpatient surgery, diagnostics, maternity services, physical and occupational therapy, mammography, ICU and Med/Surg units.

The poor cellular coverage inside the hospital also meant that any emergency response teams working in the Valley area were unable to use their cell phones as a means of communication when onsite at our facility.

Prior to moving forward on finding a solution to enhance indoor cellular coverage, the hospital board requested that internal hospital guidelines be drawn for cell phone use at St. Luke’s Wood River Medical Center. This was done to set out procedures for proper etiquette, keeping in mind consideration for patients. Additionally, we wanted to have the hospital’s safety officer research and test equipment to ensure that wireless devices would not cause interference with medical equipment in the facility. After due diligence on this front, our IT team began the search for a prospective vendor.

We had some initial basic requirements for any solution to our wireless issues. For example, Verizon Wireless was the predominant carrier in the area for mobile phone service, and for the internal backup cell phones for the hospital, so the product had to support this code division multiple access service. The aesthetics of the building were a critical consideration for us as well, because the original hospital designers took special care to ensure the facility would complement the surrounding terrain. With the hospital’s exterior and interior reflecting the beauty of the Sun Valley area, unsightly antennas outside or inside the building would mar this original design.

Strong Candidate
We wanted a vendor who could support and facilitate an end-to-end solution that went from the site assessment, planning, and installation to post-installation reporting. During my initial Web research on a solution to cellular coverage problems, I had read about Spotwave Wireless in-building products. After reviewing product information, background materials and white papers on how the company’s adaptive repeater products differ from conventional in-building bidirectional amplifiers, I contacted Spotwave directly to determine which product would be an appropriate fit for us.

We were also in touch with Verizon Wireless regarding their recommendations for enhancing signal within the facility. They provided insight into the importance of having a carrier-approved solution, since many products on the market would not protect the wireless network against interference or oscillation. The vendor provided us with details on their SpotCell 2500Xe product line, a fully integrated repeater system to support both cellular and PCS bands for Verizon’s dual-band network. After providing some budgetary quotes for covering the main areas of the hospital, Spotwave put us in touch with their Washington-based integration partner, Leaf Communications, to provide a full proposal for planning, product, and installation and maintenance services.

In January 2007, the Leaf team conducted a site survey to draw up the plan and proposal to provide enhanced coverage in the key areas that needed signal improvement. The proposal outlined a solution that could provision coverage for these areas at 18 cents per square foot. More complex distributed antenna systems, while also carrier-approved, would have to go through a lengthy engineering process and would typically cost $1.50 per square foot, blanketing the entire hospital instead of priority areas. Once all the information was in hand and reviewed by our hospital board, the proposal was accepted and the project moved forward quickly.

Deployment
 Leaf conducted a site walk and radio frequency measurements, which showed pronounced signal impairment in all of the important areas of the hospital, including on both east and west sides of the primary and secondary medical center buildings. The basement level of the hospital’s main building, which houses our IT department, maintenance group, facilities management group and housekeeping, is approximately 95,000 square feet and had no signal at all. Three repeater (50,000 square foot) systems were installed to cover a difficult layout that included several hallways, boiler and furnace rooms and laundry areas.

On the east end of the hospital, main floor signal levels ranged from -99 dBm to -105 dBm—the equivalent of zero to one bar of signal strength. On the west side of this floor, signal levels were at zero. The main floor required coverage for 107,000 square feet, including the cafeteria, many directors’ offices, surgery, administration, the ED and other small groups. Two repeater systems (also 50,000 square foot models) were used to provision coverage to this broad area. The 101,000 square foot second floor of the hospital’s main building, which supports minor emergency services, the birthing unit, administration and surgery, had similar signal impairments.

For more information about
in-building wireless products
from
Spotwave Wireless Inc.

At the east end of the floor, signal levels fluctuated between zero bars and one bar (-91 dBm to -101 dBm). On the west end of the facility, signal levels were at zero. As with the first floor, two repeater systems were deployed to cover this area. A secondary building of the hospital, which houses Physical Therapy, Dental, X-ray, doctors’ offices and communications closets, also needed a signal boost. The first and second levels of this building are each 40,000 square feet and had signal strength ranging from zero to three bars near windows on the east, to zero bars on the west. Only one repeater system (50,000 square foot model) on each floor was required to provision coverage to this building.

All told, three technicians from Leaf were used to complete the deployment, which also required a total of 3,252 feet of RG 11 quad-shielded 75 ohm coaxial cable to connect SpotCell Donor and Coverage antennas. To maintain aesthetics, non-penetrating mounts were used for rooftop installation of Donor antennas that communicate with the Verizon Wireless network. Indoor coverage units were inconspicuously located throughout the facility to blend in with the existing décor. The integration team worked closely with our maintenance group to establish vertical and horizontal cable runs to support the systems.

Cellular connectivity was completely restored within our hospital, allowing critical personnel to work more productively and effectively. Physicians are able to receive and make calls whenever required, assured of a critical tether back to their offices.

A grounding system was installed using a standard bus bar, isolators and mounting brackets on top of the roof. Two vertical masses were run to support each system. Guide wire and cable conduit also were installed to support horizontal runs from systems to building entry, which required some core drilling through each floor. To ensure cellular backup to our landline phone system, power inserters were installed in each communications closet on each floor, with emergency power backup so that cellular coverage would remain constant in the event of power failure.

Immediate Results
Once the systems were activated, the results were immediate and consistent. In the main building basement, coverage went from zero to one bar to four to five bars (-67 dBm to -77 dBm). The main building first and second floors were boosted to four and five bars (-59 dBm to -75 dBm) throughout, from a non-existent or one-bar signal. The secondary building also had four to five bars of coverage after the repeaters were deployed, where previously there had been only one or two.

Cellular connectivity was completely restored within our hospital, allowing critical personnel to work more productively and effectively. Physicians are able to receive and make calls whenever required, assured of a critical tether back to their offices instead of the associated time and cost of having to revert to a landline after a missed call. Emergency response staff that are required onsite at the hospital are able to use their cell phones to communicate back to their peers throughout Sun Valley.

A fully redundant cellular communications system is now in place as an emergency backup to our landline system. From quote acceptance to post-installation testing, the deployment was completed in less than four weeks. We executed a maintenance contract with Leaf and Spotwave and are using the successful deployment of enhanced cellular coverage at the Wood River Medical Center as a model for planning coverage improvements at the three other hospitals within St. Luke’s Health System.

 Angie Moser is project manager for information technology at St. Luke’s Wood River Medical Center in Ketchum, Idaho. Contact her at [email protected].

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