Hospital security is a multilayered issue with hospitals of varying sizes struggling with how to keep the facility safe from intruders, both human and bacterial, without hindering accessibility. Making hospitals both safe and accessible generally requires technology. Just how much security hospitals use is often determined by their budgets.

Robert Wood Johnson University Hospital (RWJUH) in New Brunswick, N.J., is a large city hospital with a complex web of security concerns. This community hospital is visited by 2,000 to 4,000 people every day. Recently, it experienced enormous growth as it added a new children’s hospital and oncology unit.

The New York-area hospital includes 510 inpatient beds. More than 200,000 patients are treated annually, and the number is growing. There were 24,707 admitted in 2002, not including newborns.

RWJUH is the principal hospital of the University of Medicine and Dentistry of New Jersey (UMDNJ), a member of the University Health System of New Jersey and the Robert Wood Johnson Health System and Network. It is considered one of the nation’s leading academic health centers, and treats the most severely ill patients referred from community hospitals around the state and from around the country.

The Bristol-Myers Squibb Children’s Hospital addition at RWJUH is New Jersey’s first free-standing children’s hospital. It features 70 private rooms with in-room sleeping for parents; a Level 1 trauma center, a pediatric intensive care unit and a family resource center.

The oncology unit, opened in November 2002, is a $113 million, state-of-the-art cancer facility, adding 92 beds and consolidating the hospital’s existing cancer services. The 200,000-square-foot facility includes private rooms for medical oncology patients and the relocation of the bone marrow transplant unit from the CORE Pavilion.

The Children’s Hospital, with its interactive toy atrium, is intended to be not just a source of good healthcare but also a comfortable and pleasant place to visit. At the same time, hospitals have a significant security concern that includes protecting the building from intrusion, protecting patients from unwanted visitors as well as contamination or dust. Security for medical records, as well as pharmaceuticals and laboratory specimens is state mandated.

Accomplishing this is made more challenging by the fact that the RWJUH hospital campus includes numerous buildings of varying ages and architectural designs. The brick-and-mortar administrative building, for example, was built in the 1920s. Since then, buildings have been added in the 1950s, 1980s and 2000s. The buildings are physically linked to each other by a system of corridors and visitors stream between them constantly.

To connect these buildings and to secure the right places from hazards requires a plan to controls the flow of foot traffic throughout the campus, encouraging people to pass through the proper areas without veering into a secured section where they do not belong.

Doug Campbell, assistant vice president of operations at the hospital, oversees the facility’s additions as well as technological upgrades. As the hospital grows, it has an overall need for access control for patients, medical records or personnel. Computer rooms, lavatories and children’s areas are all secured with identification cards.

Campbell must strike a perfect balance between keeping the hospital secure and making it accessible for the community. And he must also keep one eye on the constant changes in technology. Part of Campbell’s wish list includes a biometric access control system that can operate through thumbprints or retinal scans. Whatever the technology, it must work with the hospital’s life safety plan without hindering evacuation sites.

“I’m always looking at what’s available,” Campbell said. “You’ve got to justify what you need.” For example, the hospital is now in its third phase of access control software, which grows outdated about every five years. “We’re phasing out old technology” which, he said, was “cumbersome compared to new technology.”

Whatever the technology, hospitals try to consider the importance of the human element of security first. “You can’t substitute people,” Campbell said. The hospital employs 29 full-time security guards to keep an eye on important access sites. Included in the buildings are 82 closed-circuit television surveillance cameras and eight multiplexers. Within the year, Campbell says he expects the hospital to be equipped with recorders that can record directly on disk. Panic alarms are installed at key locations throughout the hospital and an infant abduction system sets off alarms and locks doors when triggered.

RWJUH uses BASIS Lionel software to drive the security access system. Personnel carry identification cards for Best card readers that are hardwired to the controllers. Controllers tie the card readers together, which then link with the head-end software. The software allows the hospital to view transactions, run reports, establish time frames for entry and exit and establish status levels for entry into controlled locations. This system is on the hospital network, which allows for secured storage and retrieval of security data.

On the entrance doors, the hospital uses electric strike Locknetic magnetic locks and rotund hinges further ensure the integrity of the doors. RWJUH also uses Best interchangeable cores.

Video cameras include Sony, Panasonic and Pelco units. The new installations are high-resolution color cameras, all hardwired to the security dispatch system. Multiplexers, 16 channels, tie the cameras together for ease of viewing and retrieval. These units are tied to timelapse recorders for retrieval and review. Panic alarms are also installed at identified sensitive areas and are hardwired back to the security dispatch enunciator panel.

RWJUH also recently incorporated a new network-based Kronos Identification Badging System. This allows them to take photos, encode hospital identification cards, store information and tie the cards in to the security access system and the time attendance system.

Most of the wiring at the hospital for security and for other electrical needs was done by Scholes Electric and Communications in Piscataway, N.J. Ed Fiedler, project executive at Scholes is well acquainted with the wiring at Robert Wood Johnson Hospital. The company does enough work at the hospital that it has several full-time electricians who are trained specifically for hospital-related work. Scholes installs security systems that the hospital provides.

“When it comes to security, the hospital wants to make it secure but not a fortress.” Fiedler said. “What is unique is the system of allowing the common access area, so people are walking without confusion, funneling people specific ways.” If they go in the wrong direction, they are likely to come upon a secured area, or a locked door and be forced to turn back.

RWJUH offered specific challenges because of the variety of architecture within the campus. In the older buildings, Fiedler said, work in the basement can be especially challenging. “You’re pulling wires in areas that are filled with duct work and steam lines,” he said. The design of the hospital creates another challenge. The security system needs to be integrated, but much of the wiring needs to span the entire campus to bring a camera’s image to a security room monitor on the other side of the hospital.

Working around the needs of the hospital requires some flexibility as well as training, Fiedler said. His staff has received training that ensures they do not bring bacteria into a sensitive area. “The whole thing is keeping dust and other contaminants confined,” commented Fiedler.

The contractors had the children’s wing to themselves for 15 months before the hospital began moving patients into the completed rooms and diminishing the work-area size. Most of their work, however, comes as follow up; as risk managers, hospital staff and physicians have a chance to evaluate how the security system is working and call the contractors if they need fine-tuning.

Republic County Hospital project

In Belleville, Kan., Republic County Hospital broke ground on its own renovations in October 2003. Although smaller in scale than RWJUH, the renovations underway will more than double the size of this community hospital. The project involves adding 15,000 square feet and remodeling 12,000 existing square feet. The renovation includes adding a new wing with patient care rooms, the Labor and Delivery section and surgical suites. The existing facility will be used for expansion of the pharmacy, outpatient care, physical therapy and X-rays. With a new building comes the opportunity as well as the need for new security systems. Republic County Hospital is a 25-bed critical access hospital and has as much concern related to infection control as to other security issues.

Risk Manager Rebecca Brown is a member of the Safety and Education Committee whose task is to evaluate what the hospital’s safety needs are and how to address them. Like her counterparts at RWJUH, she would like to move toward thumbprint and biometric technology.

IT will also allow a dedicated area for outpatient surgeries, blood transfusions and chemotherapies. The original mechanical equipment in this 42-year-old facility needs upgrading. The addition provides new surgical suites and a sterilizing area as well as a three-bed Monitored Bed Unit, eight semi-private rooms and seven private rooms.

This project will assist in bringing the building into compliance with the 2000 Life Safety Codes. Renovation of the Emergency area will provide a new entrance for patients arriving in their own vehicle, improving ease of access. There will be a dedicated waiting area nearby and greatly increasing privacy.

New labor, delivery, postpartum and recovery (LDPR) rooms will be located directly adjacent to the surgical suite, as required by regulation, to provide for C-sections.

The hospital sits at the intersection of two heavily trafficked highways. Blaine Miller, hospital administrator, said the greatest concern is keeping the hospital secure at night. After hours, when a small nursing staff is on duty, they need to keep the wrong people out while still allowing the necessary people inside.

With the renovation, Miller said, the hospital will have two entrances, which will both be locked at night. Anyone entering the hospital vestibule will have to alert personnel at the nurses station through an intercom system. The entrances will be equipped with television cameras and automatic door locks. Nursing staff can then see the visitor on their monitor before allowing them to enter.

The hospital is accepting bids for security systems that will include a biometric system that reads thumbprints. This system offers personnel the ease of entering quickly without searching for a card to swipe.

SWEDBERG is a freelance writer based in western Washington. She can be reached at claire_swedberg@msn.com