Does IP Have A Place in Nurse call and Emergency Response systems?
The drive to modernise and “keep up” with the latest technology can be a compelling one. Over the last decade there has been a perception that IP systems are leading the charge in Nurse call systems. In the wider environment, IP communications systems provide the opportunity to unify communications and provide improvements in productivity, by having voice and data running over a single platform. The rise of IP based technology can lead to dramatic improvements in user productivity when unified communications is achieved and a positive outcome results for the facility. However, within a Nurse call environment, Pure IP systems can increase risk when deployed incorrectly.

To realise the full value of IP, facilities must be able to effectively integrate services and high end applications into those already present within the healthcare environment. There are many reasons why this is often difficult to achieve including system complexities, other priorities, problems interfacing with existing systems and lack of buy-in across the organisation, to name a few. Even if this can be achieved, there are still the all important issues of reliability, robustness and serviceability to consider.

Combining IP & Digital Nurse call– Some key considerations and common scenarios of deployment::
Scenario 1 – adding IP to an existing digital system
IP and Traditional Nurse call systems can be combined where a hospital may have an existing digital system and then add an IP based system into one of the wards. The main system would be a standard digital Nurse call facility that has worked well for the past 15 years or so, with a smaller IP nurse call systems installed to “upgrade” wards and add messaging and reporting. The problem with this scenario is that the all-important reliability and robustness of the Nurse call can no longer be ensured if IP is used and relied on in isolation. If there is a failure in this part of the network, no infrastructure exists to back the system up and ensure the Nurse call gets through. 

Scenario 2 – Geographically separated buildings required to act as one entity
Another healthcare organisation may have two or more buildings which, while spread out geographically, need to act as one entity and as a result could benefit from IP Nurse call technology. A single data connection can be used for voice as well as data applications. With VoIP technology the computer network can use all or most of the wide area bandwidth for data processes while the voice traffic is inactive or at a minimum. QoS (Quality of Service) is the standard that prioritises voice packets to ensure the quality of the call is maintained at acceptable levels. 

This then raises the issue of prioritising and if voice packets are prioritised above a data packet where do emergency call system packets end up in the scheme of things? Nurse call transmission requires the highest level of reliability. With normal data, a computer can accept packets out of sequence, or some loss, because it fixes or waits for the rest of the information, then places it where it needs to go or drops unnecessary information altogether. In a voice transmission a lost packet or inconsistencies can result in broken conversations, latency or jitter which is annoying, but in a Nurse call packet loss could prove catastrophic for the patient.

Key Considerations for an IP Nurse call system:

• Confirm that the proposed system operates in isolation of any other system to comply with the recommendations of the Australian Standard (AS 3811) and thus reduce risk to the hospital and its patients. 
• It is suggested that the cost implications involved in “cost of ownership” of the system be fully investigated: 
  • What are the current skill sets within the facility and are the resources available to maintain any proposed system, if not what are the costs involved with updating those skill sets or acquiring new staff with those skill sets.
  • Can existing hospital engineering staff carry out simple maintenance and replacement of “patient” hardware such as call points and handsets?
• IP is a constantly evolving protocol and IP systems (computers and servers) typically have a life under 5 years – does the manufacturer guarantee 10 years parts availability as required in AS 3811? 
• A full review of routers, switches and bandwidth available within and between the buildings will be required to determine if the necessary equipment and bandwidth is in place and that they are capable of prioritising nurse call packets. In reviewing the amount of bandwidth we recommend you assume maximum call capacity for the nurse call solution being considered. 
• In an IP based system the component parts of the core system may contain intellectual property from other companies, ownership of any intellectual property can be complicated, the supplier needs to be fully investigated, as does the ownership of that intellectual property – if not wholly owned by a single manufacturer, licensing agreements can be withdrawn and you may end up with an unsupported system into the future.
• A reputable vendor is also a key consideration with a long successful history and it is recommended that reference sites be requested and checked.