Security Ranks High in a Hospital’s Anatomy

Security at hospitals is an important issue, especially with the heightened awareness following the 9/11 terrorist attacks. As a hospital that prides itself on providing a safe environment for patients and staff, Frederick Memorial Hospital is an example of what can be achieved through the integration of multiple disciplines.

By Daric Hess, P.E., Electrical Engineer, Healthcare Division and Project Manager for the Frederick Memorial Hospital expansion, TLC Engineering for Architecture, Orlando August 1, 2003

Security at hospitals is an important issue, especially with the heightened awareness following the 9/11 terrorist attacks. As a hospital that prides itself on providing a safe environment for patients and staff, Frederick Memorial Hospital is an example of what can be achieved through the integration of multiple disciplines. By definition, a hospital is really a working environment where people need access to other people and property—and where having access is often a matter of life and death.

Designing a hospital security system requires input and coordination between multiple hospital departments and a design team. Early in the design process, the hospital security department establishes how access will be controlled and monitored while working closely with clinical staff to define how the space will be staffed and used.

During this design process, numerous meetings with the staff are required to ensure that all the ramifications of the design meet their diverse needs. For example, a secure door and related hardware are costly, so it is necessary that all parties concur before that door is specified, purchased and installed. Since the architect specifies door hardware, and the engineer specifies the electronic security components, the architect and engineer must work closely to ensure that the proper equipment is installed.

Once the systems have been designed, installation produces it own challenges. The general contractor (GC) is now responsible for coordinating the integration of several different systems, suppliers and installers, and in some cases, these installers are directly contracted to the hospital. During the current ongoing construction process at Frederick Memorial Hospital, the GC provided raceways, connection to power supplies and the doors with their associated hardware. The card-access, closed-circuit television (CCTV) and infant abduction prevention systems are all contracted directly with the hospital.

Securing the emergency department

The security of emergency department (ED) is crucial because this is often the first area people enter when they come to a hospital. One of the first steps in planning for the security system at Frederick Memorial Hospital was to determine a secure border in the ED. This border was designed to separate the waiting area from the treatment spaces to allow for secure triaging and protection of the patients and staff. The existing card access system was expanded as the ED grew. This card system uses hospital-issued, photo identification cards. Card swipes are located on all doors into and out of the treatment spaces, and the card reader system is programmed to limit staff member access to specific doors.

At Frederick, staff members greet and interact with patients in the ED by use of an intercom system. Several CCTV’s cover department entrances and exits and are monitored in multiple locations, and staff members always accompany patients. Medications are maintained behind a continually manned nurse’s station in locked dispensers. Additionally, a suite of separate locked-down holding rooms is equipped with CCTV cameras.

Frederick security also staffs an office within the ED that is manned 24 hours a day and equipped with large viewing windows for constant visual monitoring to allow quick response to needs that arise.

Keeping moms and babies safe

The hospital’s Birth Place, slated to begin construction soon, posed a unique security challenge for designers: allow reasonable access to the public, and prevent any unauthorized removal of infants, but always provide a means of safe emergency egress. As with the ED, this design process began with establishing a secure border. Card access is provided on all doors to and from the suite, and a receptionist who screens visitors will always staff the suite.

The existing infant abduction prevention system is being relocated and expanded and will allow access to visitors and staff while still protecting the infants. Each infant is tagged with a transmitter, in the form of a bracelet, that can only be removed by manually bypassing the system. The system automatically locks the suite doors and prevents any unauthorized person from leaving the area with an infant. An alarm is triggered if a transmitter is improperly removed. Additionally, strategically placed CCTV cameras monitor this area.

Because security is so crucial in the hospital environment, Frederick’s clinical and security staffs continually review and update the security systems and protocols in coordination with the changing dynamics of healthcare delivery to ensure the hospital’s secure future.

Security Design Is A Tag-Team Effort

Hospital security design is truly a group effort. In addition to the needs of the security staff, each department’s clinical staff has special needs that differ from those of other departments. The security and clinical staff often have to agree how to provide the most secure, yet efficiently usable, space. For example, if a nurse does not want to use a card reader on a door in the suite that staff must pass through several times a day, the security design may readjust the established secure boundary.

Several design meetings are required with the clinical and security staffs, with the architect and engineer facilitating this review and assisting the hospital in visualizing what is represented on the conceptual plans. A new set of doors and associated security hardware can cost upwards of $5,000. Like the old carpenter’s adage, “measure twice, cut once,” it is important that the security and clinical staff define, consider and ultimately accept exactly how the systems will function in each suite for the security system to be cost effective and successful. Then the architect and engineer must ensure that they get this information properly documented in the construction drawings.

Oftentimes, months or years can pass between the original design and completion of construction. In that time, the health care can change, affecting the flow of patients and staff and their interaction with the security system. Similarly, if a key staff member is new or wasn’t involved in the original design process, there may be new issues or concerns identified while walls become a reality. A revision to the security system or a door set may be costly; but it may improve efficiency, be necessary to comply with revised health-care service requirements, or keep key staff positively focused on the construction results. Hospitals are sensitive to these conditions and will want to make reasonable accommodations to satisfy those concerns. The key is that the hospital/design/construction team and the systems designed and installed are flexible and responsive to the hospital’s evolving needs.