On New Year's Eve, I visited someone in the hospital. I was struck by two things. First, there were patients and staff members in the wards, as, unfortunately, illness doesn’t follow a calendar. But overall, the hospital seemed nearly deserted, with most offices and labs closed, no one in the cafeteria, and only the occasional healthcare worker or security guard roaming the hallways. Second, lights were on everywhere, and it was quite warm, especially given the subzero temperatures outside. Noticing all this led me to an idea about how to help contain still-rising healthcare costs. For the United States, this was an estimated $2.4 trillion in 2008—an average of $7,868 per person—according to the Henry J. Kaiser Family Foundation. The share of the economy devoted to national health spending has increased from 7.2 percent in 1970 to an estimated 16.6 percent in 2008.
In 1996, the Energy Information Administration conducted a Commercial Buildings Energy Consumption Survey (CBECS), which listed healthcare facilities as the fourth-largest commercial users of energy at nearly 600 trillion British thermal units (Btu) and the second highest in energy densities at 240 kilo Btu of energy per square foot, nearly triple the average for commercial facilities.
The largest use of energy was water heating, followed by space heating and lighting. A miscellaneous category, accounting for 14 percent of healthcare consumption, consists mostly of energy used by medical equipment. The primary energy source for the medical equipment is electricity, and although electricity made up 38 percent of the sources of energy, it accounted for 74 percent of the total energy cost. In fact, healthcare buildings had the highest electricity intensity for commercial buildings, at 26.5 kilowatt-hours (kWh) per square foot. Even in today’s digital world, the larger data centers would be less than that. So how do we keep the energy costs down without compromising patient care?
We start with an energy audit. See what equipment is being used, how often, how efficient it is, and whether there are alternatives that are more efficient and have a reasonable return-on-investment. Furthermore, ask if that equipment really needs to be used that much.
Heating and cooling equipment: Depending on the size and layout of the building, there may be considerable use of window air conditioners rather than centralized heating, ventilating and air conditioning (HVAC) units. Likewise, individual space heaters can account for significant electricity usage. Given the age of many large city hospitals, the efficiency is probably well below today’s Energy-Star-rated equipment.
Lighting: Hospitals are well lit, often 24/7. This constitutes the largest single electricity usage for the various types of equipment. While fluorescent luminaires are the most common, there are more efficient ones that may warrant a reballast and relamping. Use of motion-sensor switches for lighting in normally unoccupied areas can keep safety up and costs down. Hopefully, the inefficient incandescent bulbs are on the way out.
Kitchen: Refrigeration, food preparation, steam tables, heating trays, dishwashing—preparing three meals a day for most patients may not be one of the larger energy consumers, but little savings can add up. Are the ovens left on? Are the refrigeration coils kept clean and the temperature at the proper levels? Consider also refrigeration units for pharmaceutical and other medical needs.
Laundry: Where equipment is older and inefficient, outsourcing can be investigated as a cheaper alternative to replacing it (or continuing to run it).
Medical test equipment: Since the time of the survey, the amount of medical test equipment and its energy requirements has likely increased beyond the 13 percent reported. Newer imaging equipment can put a significant drain on the available electrical capacity. Coupled with aging electrical infrastructure, this can lead to power quality problems for not only the imaging equipment, but other equipment in the facility as well.
Computers and other IT equipment: As with other businesses, the proliferation of computers and IT equipment is an increased cost in both purchase and energy usage, with less than a 1-2 ratio of computers to employees. While this has been credited with improving productivity in other industries, inputting data for data’s sake isn’t an efficient use of dollars or people. And such equipment is another example of things left on 24/7, even when not in use.
Though energy costs aren’t the largest reason for escalating healthcare costs, it is easier to reduce the waste of energy than to tackle the things like exorbitant drug and malpractice insurance costs. We’ll leave those to the politicians.
BINGHAM, a contributing editor for power quality, can be reached at 732.287.3680.