Mobile phones and hospitals don't mix, yet many trust staff are essentially mobile. The Royal Marsden trust found an ideal halfway house in digital cordless technology, explains Gary Burkill

The Royal Marsden, a 300-bed teaching hospital for cancer care, is based at two sites - Chelsea, London, and Sutton, Surrey.

Over the past 18 months its facilities directorate has been managing an ambitious project to update and improve its telecommunications systems. This project has now come to fruition, and one of the main features of its new systems is the extensive use of digitally enhanced cordless telephony (DECT).

How did this come about? By the late 1990s, the need to review and update our telecommunications was well overdue. The situation was typical of many other NHS hospitals.

The existing PABX equipment (across the two sites) was old, unreliable and unable to incorporate new features.

The system and the cabling infrastructure were running at capacity. Network services were in need of review. Internal and wide area paging needed attention. There was limited reliable call-traffic activity information and a proliferation of expensive direct exchange lines.

In May 1996, we put a paper to the Marsden's management executive board outlining proposals for overcoming the many problems with the telephone system. The board granted approval for major capital investment, and an action plan was drawn up. A project team was set up to manage the process, supported by an external consultant.

The value of the various types of telephone equipment to be procured meant that we had to embark on a full market-testing exercise. The detailed specification invited proposals on a number of additional services beyond a basic replacement telephone system.

We received many expressions of interest in providing a new system.

Several included a strong case for introducing cordless telephony.

It became increasingly clear that cordless telephony was indeed affordable, and would also be of significant benefit to the trust.

Following extensive evaluation of formal bids, the Marsden decided to purchase a replacement telephone system from Philips.

The system is a Sopho iS3090, capable of handling up to 10,000 extensions, and is supplemented with DECT iSMobile.

By the early part of 1999, the replacement telephone system was in place. The result is that the Marsden has replaced its two outdated PABX systems with a centralised switchboard servicing the two sites.

The new equipment is state of the art, and includes features such as voicemail, digital lines/handsets and user-friendly PC-based consoles for the switchboard operators.

The backbone telephone cabling has been updated and/or replaced, and it is now possible to meet the continually increasing demand for additional extensions. Network services have been rationalised, and one main supplier is now used: the trust has also introduced direct dialling (DDI) for its 1,800 telephone extensions. This, in turn, has meant that most of the expensive direct exchange lines have been removed.

We now have access to accurate call activity information. The PatientCall telephone service has been introduced, which allows every inpatient access to a personal telephone.

The main reason for cordless telephony was to improve contactability for key members of staff. Like most hospitals, the Marsden has many mobile staff. The traditional means of contacting these people is via the internal paging system. The problem with this system is that the person who is bleeped then has to interrupt what they are doing, find an available telephone to return the call - often to discover that the line is engaged or the call non-urgent.

Allocating a member of staff a cordless handset means that they are directly contactable.

The cordless handsets were first allocated to only about 40 staff, but the pilot was so successful that they were quickly given out to over 400 people across several disciplines.

The technology has been particularly useful to those staff who previously had no fixed extension, and therefore no regular means of direct communication - for example, junior doctors and portering staff.

It has also proved useful to the many staff who move between the Chelsea and Sutton sites, and who previously needed a separate extension for each site. The two sites are networked together so that these people have only one extension, which will find them whichever site they are on, and only one cordless handset that operates on both sites.

The trust has also twinned most of its cordless handsets with existing wired extensions, so handset users have the full range of telephone facilities already available to them on wired extensions off the new PABX (particularly DDI). We do not foresee entirely replacing wired handsets with cordless, however.

Coverage is a big issue. We need 100 per cent coverage on both sites, and to achieve this Philips installed slightly over 100 base stations on the Chelsea site (whose buildings cover 24,308m 2)and slightly under 100 base stations on the Sutton site (26,848m 2).Only a few calls are affected by reception problems: where it happens, the supplier either repositions existing base stations or provides additional ones. It has proved to be a ver y reliable system.

Other advantages to the new system include:

Improved 'contactability', reducing the number of outgoing (returned) calls, so reducing our call costs. This has yet to be demonstrated. What is demonstrable is the number of staff who are now talking while walking, making them significantly more efficient.

Like other hospitals, our accommodation is frequently being reconfigured, with consequent telephone moves and changes.

Cordless telephony reduces the cost and disruption of having to re-cable.

Cordless handsets have also replaced two-way radios, which were used by portering, security and works staff, but which might have interfered with medical equipment.

By allocating DDI to cordless handsets, we have further reduced the number of incoming calls to the switchboard, so its operators can concentrate on callers who really need their help.

Cordless has not been without the occasional difficulty. Despite a general positive response, there is a recurring gripe that cordless handsets make staff too contactable.

But this has more to do with how the system is used.

Staff can divert calls to alternative extensions or to the new voicemail facility, or even turn the handset off.

We have had to give an operational procedure (and conditions-of-use contract) to all cordless users to deal with these issues.

A further concern is that cordless (and the other improvements) might have made calling so much easier that call costs are actually on the increase.

We are also conscious that the public might confuse the cordless handsets with mobile phones - which are prohibited, of course - so we are careful to publicise the difference between them.

The main difficulty now is meeting the demand from staff for cordless handsets, because the technology did not come cheap. We invested more than£500,000 in the system, and over£100,000 of this was on the infrastructure for cordless telephony.

We are now looking to replace most of our internal pagers with cordless handsets, and only a relatively small number of emergency pagers will remain. The next challenge will then be to replace the internal paging system completely.

Talking points Cordless telephony, already familiar in the home, has all the facilities of a hard-wired handset, but the advantage of being portable. It is not a mobile phone, and will not operate beyond the range of a base station. Nor are there any of the health and safety issues associated with mobiles. In particular, cordless handsets do not adversely affect medical instruments, so that they can be used anywhere on the site.

In a hospital environment, cordless handsets work in much the same way as in the home except that a hospital site needs a large number of base stations in order to give total coverage.

There are two types of technology used in cordless phones: analogue and digital.

Analogue phones transmit conversations to a base station by turning speech directly into an electrical waveform. This signal fades quickly over relatively short distances and is affected by obstacles and interference from electrical equipment such as televisions. So these phones tend to be limited to home use.

DECT overcomes these limitations by translating speech patterns into a bit stream. If any of these bits are 'lost' on their way to the base station, the system can use error correction to calculate which are missing and replace them so that the line quality is not compromised (much as a CD player would ignore a minor scratch on a CD). The result is an interference-free signal that provides fixed phone-line quality over longer distances.

Gary Burkill is deputy director of facilities, the Royal Marsden Hospital, London and Surrey.