Critical Power for Healthcare Facilities
CSE: When do you make the decision to either upgrade a power system or rebuild it? What are its risks and issues?
WILLEY: Probably the biggest issue for us, as we started looking at rebuilding our power system—especially emergency power—was cost. In today's world, we must be able to operate all the time. It's part of being competitive. It's part of our patients' and physicians' expectations. That's how we decided to invest in a new emergency power system over the last five years.
DEITSCH: When I arrived at Denver's St. Joseph Hospital in 1999, the electrical system had already been experiencing failures on most of its major components. Most of the electrical infrastructure was between 35 and 40 years old, even with a preventative maintenance program. Our team decided that we needed to review the entire system. We conducted our research and found that refurbishing the existing system would be more expensive than replacing the entire system. So, we focused on how we were going to replace the electrical system without affecting any of the patient loads or any other services. We wanted to make sure we could build for the future, so we incorporated all that into our planning.
CSE: You've hit on a key issue. You're an operating facility and can't just shut everything down, but you need to replace the entire system. How do you deal with a phased schedule? Do you have a dual system running?
BROWNRIGG: There's no question. Almost every institution we work for that is remodeling or renovating continues operating. So it becomes an issue of a very complex phased installation.
In some cases, if the emergency power generation and distribution infrastructure are there, then maybe it's not so difficult. But if you're talking about a facility or equipment that's 35 or 40 years old, there probably wasn't as much flexibility. You literally have to start over. That's what we're talking about—switching over the entire system rather than adding. Many facilities are so old that they're not flexible enough to add sections. You can't drop future sections with future cubicles for feeder breakers, or you can't drop a section and extend the bus.
CSE: What do some of our designers at the table say about this? What do you feel are the major difficulties when you've got something that's 30-plus years old dealing with today's power and system requirements?
PETRIC: We're looking at the overall picture of space, what we can do to minimize outage and inconvenience to the owner, capacity for future growth, and the age and possible reuse of existing equipment. Do we provide a new system or do we add onto the building? Those types of questions are all looked at when you're planning an emergency power expansion.
CSE: What happens, for example, when you have a dual feed coming in from the utility? How many hospitals have that luxury. Or is it a luxury?
STYMIEST: Hospitals should have dual utility feeds. I think that feature is more necessity than luxury these days.
CSE: Where are UPS systems fitting in? I think traditionally, in most hospitals, it's always been smaller UPS in a distributed configuration. A few projects that we've seen are going to a centralized UPS scheme. Is this becoming the norm?
PETRIC: More hospitals are seeing the need for central UPS systems in their facilities. With the 2003 blackout, we had a hospital facility that was very concerned about how a long-term outage would affect them—and that they could continue to function. They wanted to back up their entire critical branch with a UPS system. We ended up designing a battery-free UPS system for their critical branch, as well as providing emergency generator capacity to serve the whole hospital.
STYMIEST: I think one of the issues with centralized systems is the need to pay more attention to the potential for common mode failure, or common point of failure. Distributed systems and components could be more reliable than centralized systems, from the standpoint of internal failures.
WILLEY: The challenge with that, though, is manpower. In hospitals, quite frankly, we continue to grow, but I haven't been able to increase staffing. So when you start dealing with more distributed systems, you can't maintain them as easily or as well as a centralized system. And I understand what you're saying, but that's part of what you've got to weigh when you look at operations and what you grow into.
STYMIEST: I agree. Also, maintenance is key. Someone mentioned that more and more facilities are going with centralized medium-voltage emergency power systems. The maintenance of medium-voltage systems is a much more complicated issue than the maintenance of 480-volt systems, and requires a higher degree of maintenance staff training and preparation.
CHISHOLM: The management systems for your emergency power supply system (EPSS) have got to be improved. Increasing your equipment to the high-tech stage is one thing, but then you must have, in my opinion, an automated management system to control it, because like David [Stymiest] says, there are a lot more issues today than just checking a 480 volt system and checking the oil. Now we've got a few other issues, such as high-tech parallel gear and synching the utilities. As Dawn [Willey] mentioned, she doesn't have an unlimited budget for hiring people and sending them to school to learn those systems. So you have to mix it and match it. The legal profession has forced us to look at super systems. The question is 'Who's going to foot the bill?' Ultimately, the patient's going to foot the bill.
CSE: What about cost? What are the cost comparisons for physical hardware for this kind of piecemeal plan, versus a centralized one?
GILSON: Distributed systems are smaller and less expensive, and it all ties into the master plan of the facility for growth and the level of technology that they're wanting to approach.
CSE: Let's talk about best practices. Once you've made the commitment to upgrade, what are some good things to do on any base emergency power system?
STYMIEST: One of the things that I think existing facilities ought to be doing right now is risk assessments for internal failures. They've all done it for external utility failures, but they need to look at the failure of more than just one generator. They need to look at distribution system failures further on down the line and have plans in place for dealing with such eventualities. Many healthcare facilities do not turn off the branches—the life-safety branch, the critical branch and the equipment system—for maintenance, because it's so difficult to do. And if you don't turn it off for maintenance, it's going to turn itself off. You just don't know when.
CSE: So this is where a good bypass isolation transfer switch comes in handy.
STYMIEST: Yes, and also a design with flexibility, so that people can deal with the loss of on-down-the-line distribution elements.
DEITSCH: My hospital, as well as my sister hospitals, have done risk assessments. We actually do them quarterly. We continually work through the risk indicators, which were previously identified because we know we will have a failure at one point or another. One thing we've done at Saint Joseph is to have dual electrical systems feeding most parts of the building.
We've seen too many failures. In all of the facilities I've worked at, failures on different parts of the electrical system happen often. You can have the best maintenance department in town, and it doesn't happen as often, but when [a system fails], you need something else to go with it. The hospital isn't going to stop patient care just because we had a failure.
KESLER: A lot of it goes back to planning—having an action plan in place. If something happens, how are you going to address the situation? Do you bring in temporary generators? Do you have arrangements already made for temporary gensets and the hookup capabilities—on down the line from not only the generating source, but all the way to the ultimate load. Is there a way to transfer a piece of equipment to another panel board or transfer switch? All of these issues can be brought up early through an up-front planning stages.
PETRIC: That's right. By planning early, you can design to accommodate the surprises. We've designed redundant emergency systems for healthcare facilities so that even if they lose the critical branch serving a patient floor, they would have another critical branch available on the same floor. Plan for the unexpected and design your system accordingly. It is important to have the facility share that philosophy, because you are designing for patient care.
CSE: The “digital hospital” is the big trend right now, allowing you to have everything online. But what is needed to make this happen?
GILSON: With the IT explosion, different applications and technologies are converging in a common cabled network and wireless distributed antenna system. A lot of facilities now are looking at handling cell phones from multiple carriers within a facility so that, as physicians are shared between facilities, they have the necessary communication systems available anywhere in or outside the hospital.
Also, applications such as medical records, PACS, patient monitoring, telemetry, bedside charting, dictation, security integration, digital control systems, electronic metering and the like are all converging on a common platform for networkability. The possibilities and applications are absolutely endless.
DEITSCH: We have digital metering all over the place and at different parts of the building such as radiology and oncology—all of these places that you'd never think about having them before. They asked flat out for it: Give me the information.
BROWNRIGG: The biggest issue I see with the actual management of the facility from a digital perspective is standards. Right now, as with any technology or industry that's growing very rapidly, you don't have standards. Getting all these systems to work is extremely difficult. And because it's early, there are a lot of black boxes or a lot of integration points that we've got to get past—those are complicated and don't always work—to make those systems talk. So it's really about getting enough standards with the software and the data to implement so that the cost to maintain a digital hospital comes down. Right now the costs are high, because they're difficult to put together and difficult to manage.
CSE: Besides the need to increase generator capacity, what other impact does the digital hospital have on your emergency power infrastructure?
BROWNRIGG: The issue goes beyond digital. The fact that we're building more and more hospitals in a flexible nature. In other words, you used to have back-of-the house functions that had different codes, different emergency power requirements, different air requirements, and different air change requirements. But now we're building hospitals that have the same code throughout, because the back of the house may be a clinical space in the future.
Jerry Petric , P.E.
David Stymiest , P.E., CHFM, SASHE, CEM, GBE
Senior Consultant, Compliance and Facilities Management
Smith Seckman Reid
Rick Gilson , P.E.
KJWW Engineering Consultants
Rock Island, Ill.
Vice President of Healthcare and Research Projects
Turner Logistics LLC
Scott Kesler , P.E.
Director of Electrical Engineering
Saint Joseph Hospital
Great Falls, Mont.