Health-Care Experts Offer Candid Advice on Power Reliability
May 1, 2008
Health-care facility managers may have their hands tied when it comes to upgrading equipment in the wake of budget restrictions. But when asked at a national editorial roundtable on emergency power systems for health-care facilities, facility managers dealing with the problem outlined how financial obstacles can be hurdled, while ensuring that power never goes down.
Roundtable moderator Bhavesh Patel, director of Marketing for ASCO Power Technologies, guided discussion of overall protection strategies and philosophies that many health-care facilities follow to ensure reliable power. The discussion also addressed the importance of merging radiology and imaging equipment into emergency power distribution systems.
Roundtable participants included Dawn Willey, facilities manager of Benefis Healthcare; Kevin Deitsch, facilities manager of Saint Joseph hospital; Rick Gilson, senior engineer at KJWW Engineering; Dave Stymiest, senior consultant-Compliance and Facilities Management of Smith Seckman Reid, Inc.; and Scott Kesler, director of Electrical Engineering at OWP/P.
“What factors do you consider in deciding whether to upgrade or replace a power system?” Patel asked. “What are the risks and issues involved?”
Deitsch of Saint Joseph said, “Today, whenever we plan an infrastructure upgrade, we install the highest quality material available because we know we will not see any other upgrades in that area for many years. When I joined Saint Joseph in 1999, the majority of the electrical structure was between 35 and 40-years old
A major issue is balancing the bottom line with a health-care facility’s mission - healing and saving lives. Tech-savvy managers must justify to chief financial officers and other C-suite executives why an emergency power system should be upgraded or replaced, rather than adding revenue-generating diagnostic equipment.
Stymiest of Smith Seckman Reid explained, “If it’s net present value, present worth, integrated rate of return, whatever the metrics are that are used by the CFO, the facility directors need to be conversant in that language and need to be able to argue effectively for their infrastructure needs.
Facility managers need to relate reliable power to revenue-generating equipment when they are in the boardroom. Operating rooms produce X amount of dollars per day, and if one of them is down, it’s going to take X amount of revenue to recover it, since the institution may be operating at two percent of net sales. Also, prorating the cost of upgrading an emergency power system over several years helps spread out the total cost, making the numbers easier for Boards to accept.
Kesler of OWP/P agreed. “Unless you’re dealing with a brand new facility or a substantial expansion, systems are built over a period of time-around 36 to 60 months.”
Willey of Benefis Healthcare then outlined how she would get a premier emergency power system with a limited budget. “We’ll buy a Yugo each year until we can piece together our Cadillac.
“The world today requires health-care facilities to operate all the time. It’s part of our patients’ and physicians’ expectations. That’s why we decided to invest in a new emergency power system over the past five years.”
Facility managers obviously are the ones charged with maintaining power to a hospital’s life safety and critical loads. They ensure emergency equipment operates to standard, they replace aging and outdated equipment and, come hell or high water, they keep power on.
What strategies do they use to achieve that?Some hospitals meet minimum requirements for emergency power as called for by Chapter 8 of NFPA 110. Decision makers feel they cannot justify beefing up their emergency power systems because they may not have experienced major power failures.
Explaining basic code requirements, Gilson of KJWW Engineering said, “Hospitals are required to provide emergency power for life safety, which often is confused with patient safety. A life safety branch of emergency power is for egress purposes, emergency communications, and is the first priority of emergency load pick-up from transfer switches.”
Then again, some hospitals far exceed NFPA guidelines. Willey added, “It doesn’t really matter what the NFPA requires, we are going to far exceed that expectation.”
We also look at the code as just the minimum,” Deitsch said. “We exceed that by 100 percent or better.”
“What’s the benefit of that approach?” Patel asked. Deitsch responded, “The big benefit is we never go down–never.”
While some health-care facilities maintain N+1 or N+2 emergency power systems, others strive for 2N capability. The ability to back up both emergency and utility power with redundant systems makes everyone sleep better at night, especially facility managers and engineering staff.
Benefis Healthcare, for example, employs four generators that keep the power on throughout the entire hospital in the event of a power failure. The life-safety branch is connected to an uninterruptible power system that ensures reliable power flows while the generators are starting. The generators can be paralleled to the utility to enhance power reliability.
Whatever the level of redundancy, the bottom line for many health-care facilities is that revenue-generating equipment, such as MRI and CAT imaging systems, continues to operate when utility power is offline. Saint Joseph is one of those facilities.
“One of our big moves currently, when you’re talking about emergency power and additional backup, is on our large pieces of equipment, the linear accelerators, the CAT scans, the MRIs,” Deitsch said.
By law, life-safety loads must remain a priority for the emergency power systems. However, subsequent loads under the critical branch include radiology and imaging, for example. If backed up properly, these loads would continue to bring a steady stream of revenue into the health-care facility even while the utility power source is offline.
The problem, however, is that emergency power systems can take up to 10 seconds to begin providing power to loads after utility power fails. Patients on life support or in surgery cannot tolerate even a moment’s interruption in power. Also, sensitive electronic equipment, such as MRIs and even computers, would need to be re-started. Important data might be lost. Facility managers back up their life-safety and critical loads with an uninterruptible power system (UPS).
“Since we want redundancy without a single point of failure at those UPSs, we are currently putting small transfer switches in there ahead of the gear and running different feeders from different levels of service off the generators,” Deitsch said.
In a perfect world, a hospital would be completely backed up by a 2N emergency power system. A UPS would immediately take the reigns of providing power once the utility failed. The UPS would then relinquish power to the emergency power system. When utility power fails, the ideal is that none of the hospital staff realizes what’s happening.
When budget allocations allow for modernizing the emergency power system, facility managers plan meticulously according to their philosophies and strategies.
Since these allocations aren’t available every year, facility managers have to ensure that they’re getting the most equipment for their dollar without compromising quality.
“From the hospital standpoint talking about systems, what worked for us was designing what we wanted and then figuring out how to do it over a period of time,” Willey said. “I think where hospitals run into problems is when they pose a solution and say they want all of it now. But if you can do it over a three-to-seven year plan, at least in my experience, you’re going to get it.”
Emergency power systems for health-care facilities can range in age from brand new to almost 40-years old. Replacing systems completely, or upgrading existing systems, requires careful planning and execution. Custom engineered equipment upgrades, for example, usually take up to 28 weeks to complete and save from 30 to 89 percent of the total cost to entirely replace the system.
Keeping emergency power systems technologically up to date is more important than ever since the type and amount of loads have mushroomed. Gilson shared an anecdote that proved the point: “Ten or fifteen years ago, we used to have telephone closets that had two receptacles and a 3.2 kVA load. Today, these communications closets have grown to the extent where the data applications probably are approaching about 20 kVA per closet. So in a 400,000 square-foot facility, there is an extra 400 kVA of additional generator load that we didn’t have to think about 10 or 15 years ago.”
Further additions to the critical-load branch include cooling systems and food service facilities. Cooling has become a hot topic because so much of the hospital’s equipment requires protection from overheating. “They are not mandates at this point,” Stymiest explained. “But I believe JCAHO (Joint Commission on the Accreditation of Healthcare Organizations) has asked facilities to look at, for example, ventilation for more areas, to look at putting more radiology equipment on emergency power, to look at cooling in areas that are not required by present codes.”
Cooling systems and chillers keep a hospital’s patients comfortable and data centers from overheating. Other equipment and departments that best operate under cool conditions are operating and CAT scan rooms. Rooms with a lot of equipment will generate a lot of heat if it’s not properly dissipated.
When a facility’s emergency power capacity doesn’t keep pace with load growth, engineering staff must pick and choose by order of priority which loads receive power during an outage. Such decisions can create considerable angst among hospital staff.
Facility managers may have different philosophies regarding the best emergency power system setup, but roundtable panelists agreed that preventive maintenance and equipment testing under severe circumstances are the keys to mission success and failure avoidance.
“One of the things that I think existing facilities ought to be doing right now is risk assessments for internal failures,” Stymiest said. “Facility managers need to look at the failure of more than just one generator, at distribution system failures further on down the line and have plans in place for dealing with such eventualities.”
One way to minimize failure is to regularly maintain equipment, without disrupting power to loads. Bypass-isolation transfer switches, for example, allow loads to remain connected to power during maintenance.
In an era of doing more with less, facility managers and their consultants still must ensure power reliability for hospitals in the face of relentless load growth and budgeting issues.