Health-care facilities exist to save lives, improve patient health, and reduce pain. Administrators rightly do not consider themselves to be power reliability experts. Yet without emergency power to ensure continuous power to medical equipment, the health-care facility’s life-saving mission can be jeopardized, costs can soar, and the profitability of the facility, on which its continued existence depends, can be threatened.
An editorial roundtable, sponsored by ASCO Power Technologies, discussed the critical role of emergency power in health-care facilities (see also Mission Critical’s Winter edition, p. 32). Roundtable moderator Bhavesh Patel, director of Marketing for ASCO Power Technologies, guided the discussion by facilities professionals and consulting engineers who examined centralized vs. networked delivery of emergency power, its costs, latest trends, and other topics.
The Value PropositionIn the fiercely competitive world of health care, facilities with the latest equipment and best medical staff prosper. In this world, emergency power capability is required, expected, and expensive. Emergency power is both a lifesaver and a marketing tool.
As roundtable participant Jerry Petric, partner, Korda/Nemeth Engineering, Inc., observed, “If there is a catastrophic event or a utility outage, you would more likely visit a hospital that it going to be up and running at 90-100 percent than one that is functioning minimally. This can be a great marketing tool for the facility.”
But the price can be high, and facility owners prefer to spend money on equipment that makes money and profit (e.g., MRIs). Emergency power systems do not, on the surface, contribute to profitability. They aren’t glamorous, and like Homeland Security, their cost can be measured, but not their value, until an event occurs that requires emergency power.
“How high is the cost?” ASCO’s Patel asked. In addition to purchasing and maintaining equipment to meet or exceed national and other codes, it must be frequently upgraded to provide additional protection for sensitive, expensive high-tech medical equipment that’s added to enhance a facilities’ healthcare capabilities.
Kevin Deitsch, manager of Facilities at Saint Joseph Hospital, commented that, “We spent a great deal of time planning a $26 million upgrade of our system, which now encompasses three engine-generators, paralleling gear, transfer switches, a new system-wide electrical backbone, and alternate power sources.” That is a real commitment to safety and doctor/patient satisfaction.
Emergency power also is critical to Dawn Willey, director of Facilities at Benefis Healthcare. “Yes it’s expensive,” she said, “but if you don’t have electricity, that’s even more expensive. Think of everything electronic a hospital runs on: security, radiology, cat scans, and operating rooms. And, that’s just the big stuff.”
Upgrading emergency power systems offers the opportunity to add loads. Petric comments that the National Electrical Code (NEC) does not require air-conditioning equipment to be connected to emergency power. However, facilities are going to need these systems to be operational if there is an extended utility outage.
With hospitals becoming more electronic, more must be protected by emergency power. Hospital systems increasingly overlap electronically. Well-designed emergency power systems adapt to the changing environment.
Patient records are now on the hospital’s IT system, for example. By law, these records must be protected and staff must have immediate access to them. A doctor will take a PDA into a patient’s room and download the file to a surgeon thousands of miles away. Technology advanced health care to new levels, but it must be maintained by electricity-even during a utility power outage.
One panelist suggested going into a new hospital and looking at the data center. Some are given more attention than the patient care centers. It’s like body parts. The data center is the brains of the facility, and without the brain, nothing works. Not much is kept on hard copy today. Everything is maintained digitally, including X-rays. Everything recorded in labs is digital. The backbone is the computer system. Its power must be maintained at the proper level during a utility outage.
Data are becoming so important that at some point the data center may be supplied power on a separate branch. The reason: health-care administrators don’t want a surgical vacuum pump tripping breakers and affecting data centers.
Also helping to justify the cost of upgrades is the memory of hurricane Katrina. In its aftermath, American Society for Healthcare Engineering (ASHE) distributed a Sentinel report recommending a review of operational procedures in the event of mass utility failures. This reinforced the lessons of the great Northeast blackout, when operating rooms in New York and other cities went dark.
Scott Kesler, director of Electrical Engineering at QWP/P, sees two key issues: patient safety and lost revenue. Patient safety is a given requirement, but more than ever, so is lost revenue. Owners need profits, and assuring the availability of expensive revenue-generating equipment approaches safety in importance. Kesler believes that these issues are best addressed through careful planning at the outset of new or upgrade projects.
“Identifying and evaluating existing conditions is critical,” he said. Work through them as part of the design and planning process so the hospital understands the impact on operations. That includes any shutdowns and how they affect the hospital from an operational perspective. Since patients can be billed several thousand dollars for MRIs and other high-tech procedures, upgrade cost estimates must include the “cost” of even short-term interruptions of operations.
Define ValueBest is in the eye of the beholder, and, frankly, what money can buy.
“But, how much is enough?” Patel asked the panelists.
Rick Gilson, senior engineer at KJWW Engineering Consultants, believes that bigger isn’t necessarily better. It’s better to have a higher quantity of smaller automatic transfer switches (ATSs).
He said, “In the health-care environment, a single component failure can result in widespread outages if you put all your eggs in one centralized basket. A majority of clients want smaller ATSs of a uniform size that are easier to maintain, have the same spare parts, and provide flexibility so that if there is a component failure, just a piece of a department or floor and not an entire patient tower is lost.”
He added that the health-care industry provides for the needs of people who can’t take care of themselves. When the normal utility fails there has to be enough generation capacity on the campus to take care of the critical-care population … to sustain life and continue normal hospital operations, not just meet minimum code requirements.
James Brownrigg, vice president of Healthcare and Research Projects at Turner Logistics, LLC, finds that most of the designs for emergency power are conventional.
“I don’t see changes regarding equipment purchases,” he said. “However, UPS requirements have increased so much that there is a UPS for each piece of equipment because hospitals want parallel redundancy.”
That’s when you have one good generator and you have the second and third generators standing by for backup. It’s the same for UPS. If you have one why not have two, just in case? It’s a matter of redundancy: N+1, N+2, N+3. And it’s the old cost/benefit question. How safe is safe enough?
It would be nice to be able to put a cost benefit analysis together for power outages. This requires quantifying reliability. The IEEE Gold Book, which is the “IEEE Recommended Practice for the Design of Reliable Industrial and Commercial Power Systems,” has addressed this issue. It is difficult to conduct a full cost-benefit analysis because a lot of the costs associated with power outages are intangible. It might be more effective to talk about risk because financial people, as a rule, tend to be risk averse.
Rick Gilson explained that the code requires a mixture of power, especially for acute-care areas such as operating rooms, ICUs, and pediatric intensive care units. Recommended is a normal branch and a critical branch. But, Gilson observed, the surgeons, the physicians, and the nursing staff don’t want to have to make decisions as to what piece of equipment they are going to lose in case of a normal utility failure. One way to address these concerns is by providing multiple transfer switches to meet the intent of the code but also provide basically full critical power in each of the patient, operating, and special procedure rooms such as cath labs and all critical-care areas.
The Emergency Power SystemHospitals are unique facilities where uptime is critical. Since owners are often on-site and feeling the pulse of their facilities every day, hospitals tend to test and maintain their emergency power systems with either trained employees or contractors. But Brownrigg finds that outpatient facilities and surgi-centers that are away from the hospital may not maintain equipment to the same high standard.
Patel noted that lack of maintenance is the greatest cause of failure of generator, fuel, and starting systems. These may be the easiest parts to maintain, but they are the most often overlooked.
There are several reasons for lack of maintenance. Servicing equipment can disrupt hospital operations and must be done by trained personnel. Maintenance can be out of sight, out of mind. It competes for the time and attention of the maintenance staff. It costs money - either in increased staff or payments to outside contractors. And it has no marketing value. Hospitals don’t promote the fact that they do maintenance on their emergency generators.
But proper maintenance is a must. When emergency power is suddenly needed, it must respond. Yet, Kesler sees that “in times of staff and budgets cuts, maintenance can be reduced or not happen. Poorly maintained equipment breaks down and must be replaced sooner, and it costs more to maintain.”
The lesson is that day-to-day operational costs can be lowered with an ongoing maintenance program. Fortunately, owners and managers are taking note of this and placing renewed emphasis on ongoing maintenance. It’s the old story: Pay now or pay more later.
At Saint Joseph Hospital, Deitsch has found that following manufacturer specifications for the emergency power systems is the right thing to do. Electrical systems are on a one-, two-, or three-year cycle for maintenance, including emergency power.
Along with maintenance, testing is very important to ensure the emergency power system remains operational. The code requires monthly and annual testing. Petric recommends using closed-transition transfer switches and daytime testing with actual loads to obtain actual readings, rather than at night when loads are minimal. Bypass-isolation transfer switches also are recommended, allowing transfer switches to be maintained without interruption to the loads.
David L. Stymeist, senior consultant - Compliance and Facilities Management at Smith Seckman Reid, Inc., emphasized the importance of system maintenance at all levels, particularly the distribution systems on the load side of the transfer switches because it is so difficult to turn them off.
What's the Future Hold?The roundtable members were asked what they see coming in the future for emergency power systems in health-care facilities. There was general agreement that:
- Technology is changing health-care facilities into high-tech environments with rapidly increasing needs for emergency power to all electrical and electronic equipment.
- The vital role of the data center and patient records to medical operations will result in their emergency power being a separate load under the critical branch.
- With imaging and other high-tech equipment generating important revenue, ensuring continuous power will be viewed as a positive investment, not just a drag on profit.
- There will be increasing recognition by owners and staff of the importance and commitment to maintaining emergency power systems.
- The increasing sophistication of emergency power systems requires additional, ongoing training of maintenance personnel.
- As the ASCO Roundtable members confirmed during the discussion, utility power failures do happen and will continue to happen. It’s not if, but when and how often.
- With health-care facilities transforming from people-intensive to technology-intensive care-the importance of reliable emergency power is increasingly critical for the facilities to assure delivery of life-saving services.