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Inpatient considerations

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An eICU also requires significant physical infrastructure. Typically, each patient room requires an A/V server in an enclosure, which requires a power outlet and a network connection. The camera, microphone, speaker, and call button are wired back to the A/V server, preferably through conduit pathways. The camera also may require a power outlet. The camera, speaker, and monitor need to be wall- or ceiling-mounted. The placement of the call button is important and requires clinician input. Even if a single-gang, low-voltage provision is free on a headwall system, there may not be sufficient clearance for the call button. The call button should be no more than 48 inches above the finished floor to meet Americans with Disabilities Act (ADA) requirements. A telephone in the patient room that directly dials the eICU remote intensivists is required as a backup means of communication. The eICU system also requires rack space for servers in the data center. 

Facilities dedicated to telemedicine are a recent development, and best practices for design have not yet been established. The design of Mercy Virtual Care Center focused on large, open work areas. These open work areas are intended to increase collaboration as well as provide flexibility for future changes. To offset the long hour’s caregivers spend in front of computers, floor-to-ceiling glass walls provide views of nature. Privacy screens placed behind the caregivers serve the dual purpose of protecting patient privacy and serving as the video backdrop. 

Equipment used for telemedicine, including computers, monitors, VTC equipment, and carts, should be powered by an uninterruptible power supply (UPS) connected to critical power, if possible. Network connections should be wired rather than wireless. Even if the wireless network can support a telemedicine session, the traffic will negatively impact all other devices connected to the wireless network nearby. 

Because telemedicine solutions likely use the hospital’s local area network (LAN), the network must have high availability. Network equipment should be powered by a UPS connected to critical power. Additionally, each network switch may have redundant power supplies that protect against internal power supply failures and allow separate circuits, or even separate power feeds, to provide redundant power. Redundant fiber links may be provided between telecommunication rooms and the network core to protect against the failure of a single link. Links may take separate pathways for additional protection. 

Services to the building may be redundant as well. Separate service pathways are even a requirement in the National Fire Protection Association (NFPA) 99, Health Facilities Code, 2012, and 2015 editions. In the past, video teleconferencing systems used an integrated services digital network (ISDN) lines dedicated to the VTC system. Most systems now use Internet Protocol (IP) with the VTC traffic sharing the facility’s connection to the Internet service provider. Because this arrangement lacks the predictable bandwidth of dedicated lines, network Quality of Service configurations is important. 

The bandwidth required for a video teleconference varies depending on the resolution, frame rate, and video encoding. ATA guidelines call for a minimum of 384 kilobits per second (Kbps) bidirectional. High-definition video teleconferencing typically requires between 768 kbps and 1024 kbps. Because most LAN ports are 100 megabits per second or 1 gigabit per second, data rates from the service provider, not the LAN itself, are the most likely bottleneck. This is especially true if multiple video teleconferences occur simultaneously in the same facility. 

Bring the outside in with some live plants and don’t take for granted the power of a few decorative accents. If a nice wastebasket, decorative rug, and matching leather desk accessories make you happy, go ahead, add them to your office. We spend a lot of time at work, so it’s nice to make a space that truly feels yours. 

Working from a home is a new luxury of today’s world. And while it’s convenient to avoid a commute, working in your own environment with your own equipment can also make you really happy. Take advantage of that freedom and spend a little time creating a space tailored just for you. vii