Electronics in the Hospital

(source: Electronics World, Mar. 1966)

by John Frye

Greatly expanded use of electronic devices offers the best hope of relieving heavily overtaxed medical institutions.

IT was Mac's first day back at work after a three-week siege with a kidney stone, and Barney was genuinely glad to find the boss sitting at his accustomed spot at the service bench. He said as much. "Don't think I'm not glad to be back," Mac admitted with a rather wan smile lighting his drawn face. "Those six days I spent in the hospital were especially unpleasant. Of course, a retrograde pyelogram and cystoscopy accompanied by the removal of a stone are not exactly conducive to a happy, contented hospital visit; but there was more to it than that.

"The hospital was terribly overcrowded. When I left, several patients were out in the halls with screens around their beds. I was lucky to get a bed in a four-bed ward in the old wing of the hospital. But that meant I occupied an old fashioned bed which, since I was forbidden to get out of bed, had to be cranked up and down by a nurse every time I wanted it changed. There was no intercom for talking to the desk or for summoning help. You pushed a button that lighted a bulb over the ward door and then waited for up to a half hour until an overtaxed nurse, orderly, or aide came to see what you wanted. And this part of the hospital was not wired so a patient could use a telephone from his bed, no matter how urgently he needed to do so.

The Old and the New

"I could not resist comparing these conditions with my previous stay in the new wing of this same hospital three years ago. There I had an electric bed I could control completely with a touch of my finger. Only a person who has spent several days in a hospital bed knows how much it rests a tired, aching body to be able to raise or lower the head or foot a few inches whenever you want to do so. And by pushing a button I had immediate communication with the desk. I could ask a question directly of the nurse in charge, or I could request specific help. There was no time wasted trotting back and forth relaying information, locating and sending the specific kind of help needed, etc. Furthermore, the urgency of the calls could be evaluated, and they could be handled accordingly. I remembered three years ago when a man in our ward suffered a sudden and unexpected heart attack. We other three were helplessly bedfast after operations, but we were able to summon the nurses immediately over the intercom. I do not know what we would have done if this had happened in the old wing of the hospital. Finally, a telephone could be plugged in at the patient's bedside whenever he needed it."

"I'd guess the electric and electronic gadgets in that new wing not only contribute to the comfort and peace of mind of the patients; they must surely make things a lot easier for the nurses."

"Precisely! When patients are rendered more self-sufficient and communications between nurses and patients are improved, fewer nurses can more easily care for a given number of patients. Hold that thought while I go on to another area.

"I also had an intravenous pyelogram in the hospital, and that meant a trip to the x-ray department. The man in charge there is an electronics buff, and every time I fall into his clutches he tries to pump me about gadgets he wants to build and I try to pry information out of him about what he is doing to me and what he sees on those x-ray plates.

This particular test is not painful, but it takes considerable time; so the x-ray technician and I had quite an opportunity to chat. I got him talking about electric and electronic equipment used in hospital laboratories-not just in our modest hospital but also in much larger institutions. I particularly sought information about equipment that enabled tests to be run automatically, quickly, and accurately.

Electronic Lab Equipment

"He first described a machine that prepares tissue specimens for microscopic examination. These have to go through variously timed staining processes and immersions in different concentrations of alcohol. The whole thing, from microtome to microscope slide is handled automatically by this electrically operated machine. Another instrument called the Coleman photometer does 90% of the chemistry tests for sugar, non-protein nitrogen, blood urea nitrogen, and cholesterol by electronic color-determination testing. Another instrument called a fibrometer determines the density of the blood for evaluating the prothrombin rate, a test important in determining the clotting factor. And then there is the electrophoresis tester that automatically and electronically analyzes serum. The auto analyzer does the same thing for blood. This instrument is so useful that even our hospital has two of them: one in the hematology section of the lab and the other in the chemistry section. A Colter counter is used to count rapidly the red and white blood cells in a specimen of blood. Water baths, refrigerators, and culture-growing ovens have their temperatures maintained precisely with electronic temperature controls.

"But this barely scratches the surface of how electronics is helping out in hospitals. An electronic 'reader' is said to analyze electrocardiograms faster and more accurately than a jury of physicians. A similar device in connection with an electroencephalograph, is claimed to be able to automatically analyze a brain malfunction as well as a highly trained doc tor can. We already have computer-like instruments that can compare a patient's heart sounds with a storage bank of normal and abnormal heart recordings and come up with a quick diagnosis of the heart's condition. In fact, it takes little imagination to foresee the feeding of a patient's symptoms into a computer in which are stored hundreds of thou sands of case histories against which the patient's symptoms can be matched for a readout diagnosis." "A friend of mine just returned from a big clinic," Barney interrupted, "and he was telling me that when a nurse wanted to take an electrocardiogram she simply plugged a set of electrodes into a wall receptacle beside his bed from which a cable led to a permanently mounted machine at a remote monitoring position. The nurse and the operator at the monitoring position talked back and forth on the intercom until the electrodes were all satisfactorily positioned; then the operator took the re cording. Without moving from his chair, he could take an electrocardiogram of any patient in his area with only the help of a nurse's aid to place the electrodes.

"Another hospital provides a central monitoring console for keeping a constant check on patients in the intensive care ward. Sensors for temperature, blood pressure, respiration, and pulse are attached to every critical patient, and information from each set of sensors is fed to an individual panel of the monitoring console where each parameter is recorded on a chart. Upper and lower limits can be set for each function being recorded so that an alarm will sound if these limits are exceeded. In addition, a scope can be switched on to monitor information coming in on any panel for immediate observation of a critical body function. One operator sitting at that console can keep a very close check on the condition of several patients simultaneously-a far closer and more meaningful check than could be made by a nurse actually in the ward."

"Let me underscore just one more point," Mac said, "and then we'll try to pull all this together into an idea that has been gnawing at me. Overcrowding at our local hospital is not an exception; it is typical .of conditions in practically every part of the country. A few months ago, 1600 people queued up in front of a major hospital in our state capital.

Each person represented a patient waiting to get into that hospital. It was stated that some would have to wait more than a year for a hospital bed. While this was a publicity stunt aimed at raising funds for new hospital construction, it revealed the desperately overcrowded conditions in a great many of our hospitals. They are short of beds, short of nurses, short of orderlies, and short of trained laboratory technicians.

What About Medicare?

"But think how much worse things are going to get when Medicare goes into effect July 1st. At that time, millions of people in an age group with a high incidence of illness are going to have a right to hospital care they could not previously afford. For the first time, many of these people will have hospital insurance, and they are going to expect to be able to use it when they need it. It seems reasonable to expect that hospitals that are floundering now will be swamped unless something is done quickly.

"But it takes a long time to build new hospitals and equip them, and it takes several years to train new doctors, new nurses, and new laboratory technicians.

For the next few critical years we are not going to have those new hospitals, doctors, nurses, or technicians. We must ‘make do' with what we have. That means everything possible must be done to increase the efficiency of those people dedicated to healing the sick, and patients must be rendered as self-sufficient as possible."

"Hey! I get what you're driving at!" Barney exclaimed. "You think the best way to take up the immediate slack is through electronics! You think installing new electric beds, new intercom equipment, new patient-monitoring equipment, and new up-to-date automatic lab oratory equipment in all hospitals-not just the big clinics-is the best way to cope with the expected flood of Medicare patients."

"Right. An electric bed is expensive, but it is cheap when you think of it in nurse-hours saved. The same goes for an intercom installation. Automatic diagnostic equipment will make quicker 'and more accurate diagnoses possible. That means quicker cures and shorter stays in the hospital. Much of this equipment, because it is automatic, can be used by less highly trained personnel, leaving the trained technicians free to supervise and do work that instruments still cannot per form."

"All this is going to cost a wad of dough," Barney observed. "Where's it going to come from?"

"I believe local communities will raise funds to help their hospitals when they grasp the enormity of the problem," Mac answered, "but these funds very probably are going to be supplemented by grants from the same government that is providing Medicare. If Medicare beneficiaries cannot obtain benefits to which they are entitled and for which they are paying because hospital facilities simply are not available, a terrific howl is going to be heard in Congress.

"And we do have a War on Ill Health as well as a War on Poverty. While most of the big guns of this war are presently trained on distant, long-term objectives, such as the establishment of new medical schools and the development of new clinics for the treatment of major killers, I think expediency is going to dictate lowering the sights of some of these guns to provide much-needed immediate help to hospitals, large and small. And if it comes to a question of priority between the needs of the War on Ill Health and the War on Poverty, the former wins hands down. If you doubt it, ask any ill person, be he wealthy or poor, which should be first."

Barney had been sketching on a pad while his employer talked, and now he showed the latter what he had been drawing. Around the winged, snake-twined staff of the caduceus were very carefully drawn the circular orbits of the electron.

"I gather that's how you think the medical symbol of the future should look," Mac said with a grin as he turned back to the service bench.