The Electrical Worker online
September 2015

IBEW Helps Build Hospital of the Future
in Toronto
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More than 2.6 million people call Toronto home, and every year, lots of them get sick.

If they need to go to a hospital, they have dozens of choices, but like most large North American cities, their hospitals have barely kept up with the furious pace of technological advances and are often run using paper-based systems that would be familiar to a doctor 30 or 40 years ago.

So when the Government of Ontario began planning the consolidation of the three-campus Humber Regional Hospital in 2005, health officials weren't interested in building a state-of-the-art teaching hospital. Far more was needed.

On Oct. 18, doors will open at the new CA$1.7 billion Humber River Regional Hospital, North America's first 100-percent digital hospital, a nearly paperless, interconnected, green and efficient apotheosis of the 21st century hospital, and nearly all of the most complicated, advanced systems were built by members of Toronto Local 353.

"It was one of our most complex data and electrical jobs ever and the scope and size of the job was at some points overwhelming," said Local 353 Business Manager Steven Martin. "There were up to eight tower cranes on 16 slabs and it was right in the middle of the city. We had 500 or more guys on one corner block for a significant amount of time and the partnership ethic across trades was upfront and in your face."

The project also boasted a remarkable safety record: 5 million man-hours without time lost due to injury.

"The general contractor, PCL, had never reached that marker on a project before," said Ted Szwec, Local 353 business representative. "They were very impressed."

A permanent testament to the work done by Local 353 will be marked on the wall honoring hospital sponsors. Martin negotiated a deal with the hospital that if all the electrical work was union, the local would give back a dollar for every hour on the job.

"Next to the foundations, the corporations and the citizens of Ontario, Local 353 will be remembered for donating CA$600,000 to the hospital. We are very proud of what that number represents for the local and our members," Martin said.

The Paperless Hospital

Even the most advanced hospitals in North America are built on overlapping and disconnected systems throwing out hundreds of thousands of pages of paper each year. Highly advanced diagnostic machines go unused while nurses hunt down missing wheelchairs. Patient status is written down with pen and paper, separate from medical histories — also paper files — while test results are on other pieces of paper and prescriptions are written on still other pieces of paper.

Not at Humber.

"The only paper trail in that whole building is the band around the patient's wrist. Everything else goes through antennas or wires," said Dave Lonsdale, project manager for the electrical and data contractor Plan Group and a 35-year member of Local 353.

Paper-based records simply can't keep up with the organizational demands of a 21st century urban hospital.

"When we talked to our staff, the amount of time they spent looking for wheelchairs and stretchers is inordinate," said Humber River Hospital CEO Dr. Reuben Devlin. "You'd think it would be easy in a hospital, but in a busy hospital, at the beginning of the day they're all in one place. At the end of the day, they are all over the place."

Obviously the technology exists to separately solve the piles of paper, the missing wheelchairs, test results sitting in out baskets and getting the right pills to the right patient at the right time. The job at Humber was to solve all the problems at the same time, seamlessly.

It starts with very simple ideas. When a patient is lying in bed, all of the monitoring equipment sends a continuous stream of data to a secure hospital-wide wireless system. The radio frequency ID chip on the patient's wristband, nurse's ID badge, and the sticker on the wheelchair are constantly monitored by the real-time locating system. All tests are ordered from handheld devices carried by hospital staff and transmitted over the extensive Wi-Fi and distributed cellular antenna network.

As soon as a test is run, the results are sent out to the doctors who ordered them, and automatically added to a patient's file, which they can access from bedside tablets that also control the temperature in the room, identify a doctor or nurse when they enter the room and even allow access to movies and video calls with family and friends.

"You really have to see inside the ceilings," Lonsdale said. "The most technically complicated part of the job was making sure all the antennas were able to communicate effectively without interfering with one another."

And the schematics for each floor simply weren't detailed enough to be blindly followed.

"No design is perfect and our guys had to be aware of a lot of variables in every room so that errors were not integrated," Lonsdale said.

There is even a self-guided delivery system more often seen in auto plants than hospitals. The wheeled carts will deliver nearly three-quarters of the hospital's supplies through the facility support corridors that thread throughout the hospital. Unlike older automated delivery systems that could only travel along copper strips embedded in the floor, Humber's robots use the Wi-Fi antennas in the ceiling to triangulate their location, allowing them to ride in the elevators, go around obstacles or call for help if they get stuck.

"All of this had to be 'future-proofed,'" Lonsdale said. "The backbone has 60 percent more fiber than we need today and 60 percent more space on the cable trays running through the building. The racks in the server rooms also have 60 percent additional space to allow new technologies to slot in as they come along."

By putting all files, insurance information, prescriptions, status reports and diagnoses on a single network available instantly to everyone through tablets and other mobile devices, Humber River is reducing patient and staff travel distances 16 percent and building energy consumption 40 percent.

There are simpler ideas as well. In nearly every hospital room in nearly every hospital, a nurse walks past the bathroom before they get to the patient. Not at Humber.

"The washroom is on the far side of the room," Lonsdale said. "Reduces steps."

It's a simple thing that eliminates thousands of wasted minutes every year, Devlin said.

But this seemingly simple idea led to something quite radical. Each of the 653 bathrooms was built entirely offsite in a multi-trade assembly line.

"In 12 years, this is the first time I have seen anything on this scale," Szwec said. "PCL is not bound to us. They could have gone nonunion. I think doing it this way will keep us competitive."

Making a Hospital Digital

Humber is the first, but it won't be the last. According to industry analysts at the Dorenfest Group, North American hospitals will spend $30.5 billion on information technology next year.

The reason is simple. Hospital errors killed between 100,000 and 120,000 people last year in the U.S. and Canada, according to studies by the U.S. National Academy of Sciences Institute of Medicine and the Canadian Institute for Health Information. Just under 10 percent of them were from missed drug-interactions alone.

Evidence shows that even partially digitizing patient information can yield remarkable improvements in patient outcomes. At Hackensack University Medical Center in New Jersey, the digital drug-order system has prevented dozens of potentially dangerous combinations before the prescription is even filled, according to a report in Businessweek magazine. Hospital officials attribute much of the 16 percent reduction in patient mortality to their digital initiatives.

Humber is going much further.

"This will be the benchmark of what a hospital aspires to be," Lonsdale said. "Every hospital built in North America will be compared to it."



Humber River Regional Hospital will be North America's first 100 percent digital hospital when it opens next month.

(Photos courtesy: Plan Group)





Special features of the hospital include autonomous supply delivery carts (above) and hundreds of sensors throughout the building monitoring equipment, staff and patients.

(Photos courtesy: Plan Group)