Case Study: Casey Hospital, Australia

Hurrairah bin Sohail speaks with Engie about how the integrator helped Casey Hospital expand its facilities to better service Melbourne’s eastern suburbs.

Casey Hospital is a 229-bed facility providing a wide and comprehensive range of health services in Melbourne’s outer East. Funded by the Victorian Government in partnership with Monash Health and Plenary Group, construction of the AUD 135 million [approximately USD 93 million] Casey Hospital expansion project commenced in 2017 and was completed in April 2019.

The 13,000 square metres expansion undertaken enables the provider, Monash Health, to treat 25,000 patients, perform an additional 8,000 procedures and support 1,300 births annually. Engie served as the integrator for the project completing the design, supply, install, testing and commissioning of the AV systems across a range of spaces including collaboration rooms, meeting rooms, digital operating theatres, integrated operating theatres, lecture theatres and more. Engie worked closely with Watpac and CHW Consulting on the design and construction of the Casey Hospital expansion project to deliver a world-class health and science infrastructure.

Glenn Yole, major bid manager at Engie, says: “Casey Hospital needed an expansion to enable residents of Melbourne’s outer South East to access quality critical care closer to home, given both the unprecedented population growth and the need for higher acuity services.” He continues: “The project concerned the expansion of the existing Casey Hospital in Berwick, Victoria. The project scope included a new tower building as well as refurbishment and extension of the existing building.”

The objectives of the project were defined and desired outcomes had been identified early. More specifically, improving service quality, operational efficiency and flexibility were key considerations.

Regarding service quality, Yole says: “The client wanted to improve access to health care services across the whole of Monash Health’s catchment area and to increase the provision of healthcare and hospital services to the under-serviced South East growth corridor of Melbourne.

The goal was to assist Monash Health to achieve best practice in effectiveness of care, ensuring better patient outcomes and enhanced efficiency, both in use and in operating costs. We had to provide infrastructure facilities and services that assist Monash Health to attract and retain quality staff at all levels.

“Engie integrated AV systems that enable the hospital to treat more patients and perform extra and higher acuity procedures, thereby reducing the number of patients needing to be transferred to surrounding facilities. We supplied and installed the AV for the new operating theatre suite which is immediately adjacent to the emergency department to allow direct access for urgent patients. Collaboration rooms in all new clinical areas support interdisciplinary care and facilitate communication between staff from a variety of disciplines.”

Where operational efficiency was concerned, Yole from Engie details: “To build an operationally efficient Casey Hospital meant supporting Monash Health to deliver hospital functions efficiently within the budgets allocated. The layout and design of the expansion has a strong connection with the existing hospital, thereby offering an efficient health services delivery model. In particular, the new operating theatres are co-located with the existing operating theatres and the new day surgical unit to ensure efficient flow of patients and integration of staff.

Meeting rooms are now located on the periphery of inpatient departments so they can be accessed by other areas to maximise use.”

Lastly, Yole talks about how flexibility has been delivered: “Operational sustainability has been supported with the use of standardisation where possible, for example with generic inpatient rooms and reuse of existing spaces where possible while core infrastructure has been provided in locations which will not obstruct change or expansion.”

The operating theatres included as part of the Casey Hospital expansion project have been equipped with two NEC 55-in flat panel displays while digital operating theatres have four NEC 55-in flat panel displays along with videoconferencing capabilities.

The flat panels can be found on the perimeter walls and are configured to show the multiple video sources available and share content with the surgical team during any procedure. A range of custom video connection plates are strategically available throughout the theatre and built into the theatre ceiling pendants. These inputs allow for the connection of PACs, Picture Archive and Communication, PCs, imaging PCs and other medical equipment with video imaging such as scopes.

Two Sony 24-in clinical grade monitors are installed on pendant arms to allow clinicians, surgeons and assistants to view source images whilst performing operations. Two Sony HD PTZ cameras are provided at different locations around the theatre to capture both close up and room views of the theatre operations. The system includes support for capture and recording of operations for teaching and review purposes. Extron SMP 351 recording and streaming solution captures content.

Yole provides further details on how the video system functions: “The AV equipment is integrated into the operating theatres, thereby allowing for connection to pendants, cameras, arm monitors and third-party medical devices. The operating theatres’ AV systems support the requirements for surgical operations, including the ability to display local sources on multiple displays, ability to show live camera feeds from multiple angles and the capability to capture and record theatre surgical operations. Operating theatres are fully integrated with fibre systems and are supported with 4K infrastructure for premium resolution video to provide highest accuracy of imaging from medical equipment.”

Crestron and Extron switching infrastructure are located remotely to reduce heat, noise, and to minimise impact on surgery floor space.

With the accurate functioning of the video system a critical requirement of the operating theatre, the selection of the right infrastructure was crucial. Yole details: “We considered three specific control and switching systems, Extron, Crestron and a Crestron-Extron ‘hybrid’. The aim was to provide the most reliable solution at the best price. The system recommended to and accepted by the review team was the ‘hybrid’ system which allowed the provision of groundbreaking Crestron control designs that were previously deployed successfully in an expansion for Bendigo Hospital. The hybrid system achieved a reduction in cost with the option of mission-critical switching provided by Extron.” Audio in the operation theatres is provided by Quest QTC2080BC 6-in speakers with backcans.

Crestron digital signal processors and Australian Monitor AMP- 2100-100 amplifiers are also employed.

Yole says: “The system includes ceiling speakers that reinforce the audio within the operating theatre and the anaesthetic bay. Ceiling mounted microphones are installed to capture speech within the theatre as well as wireless headset microphones. “A pair of audio input plates are provided to playback music in either the theatre, or the anaesthetic bay. The bay is zoned separately, where a separate audio input plate and volume control pad is provided.”

Yole details the control system for the AV provided in the operating theatre: “Engie chose Crestron control to emulate the award-winning designs that were developed for Bendigo Hospital. Crestron control processors carry out the functional directives of the graphic touch panels, such as showing particular video inputs, controlling all aspects of mic and speaker audio, setting up video calls and turning off and on equipment. Occupancy sensors allow systems to turn off in the event of rooms being vacated without being shut down.”

Yole explains the selection of the control system: “We have provided a Crestron certified design utilising the largest number of consistently branded hardware to allow a ‘Crestron backed’ design end to end. This removes the possibility of ‘finger pointing’ that we see in the digital realm where one manufacturer will blame another manufacturer’s hardware in the chain for any possible issue.”

Provisions were also made for the future during the course of the project. Yole says: “The Crestron certified solution has more parts but it provided consistent performance and whilst it met the FHD component of the specification, 4K infrastructure, 4K transmitters and receivers had not yet been released. We included the Crestron solution in the design as we believed that by the time of purchase the 4K signal devices would be available.”

Paramount importance was given to the fact that the AV systems should be easy to use and serve the surgeons and clinicians in the operating theatre. Yole talks about how this was achieved: “Engie custom- created user interfaces on large, wall-mounted Sony touch panels to allow each surgeon to personalise their own audio-visual layouts and signal delivery to receive an optimum workflow and theatre experience. This reduces set up time and allows a familiar layout for each surgeon depending on their specific procedures. Our designs were based on best of global offerings as far as layout and submitted to state for approval.”

He continues: “The user interface provided can be preprogrammed so that surgeons just need to select their name on the start-up screen to bring up their own custom layout. Only connected devices are shown on the input selection rather than every input available. When the input is in use it appears and when it is selected for viewing on one of the many displays, it has an ‘in-use’ green indicator confirming its connections. The system is controlled via a wired touch panel. The touch panel includes video preview to allow the user to preview content and to adjust camera angles.”

Yole adds: “Custom military expanded beam optical couplers were used on the operating theatre pendant and provide meta data to instantly recognise medical equipment being connected and display this on the touch control screen for availability. This was offered in place of a number of current and legacy connections that are not made for dirty works or theatre scrub. The connectors we provided can be used in the military field under severe conditions with thousands of reliable connections. We believe this is a first in an operating theatre.”

As with any project, the integrator faced challenges along the way. Yole narrates: “Many of the installation mounts and methods briefed in the project were found to be lacking or required changes as we collaborated with the client and their requirements evolved. As much as all functionality is attempted to be documented we find that during the installation process we gain insight into the user intention which enables us to offer cost savings, value management or better functionality. Fixed mounts become rotating mounts, TV sizes are changed for more appropriate viewing, equipment locations change to improve functionality.”

To conclude, Yole says: “The solution deployed by Engie uses current, innovative technology that promotes an efficient work environment for healthcare professionals at Casey Hospital. The facility is now poised to deliver even more services to one of the fastest growing areas in Melbourne’s South East.”

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