 |
|
Like many 1950s-era hospitals, new departments were added to Memorial University Medical Center (MUMC) in Savannah, Ga., over the years as technology advanced and patient services expanded until, by the late 1990s, it resembled “a big maze” inside, says MUMC cardiologist John G. Spellman.
To determine just how challenging that maze was for patients and their families to navigate, Spellman and the medical center’s director of cardiology decided to walk through the facility as if they were arriving for a cardiac catheterization. By the time they’d hiked from patient registration to the laboratory, radiology department, EKG area, 23-hour outpatient unit and the cardiac catheterization lab, they had criss-crossed the building several times. “We were all over everywhere,” says Spellman. “And this is a pretty big hospital. It was just amazing.”
It was also, he says, inefficient and rather daunting.
Even the medical center’s director of facility planning, design and construction, Jimmy Kicklighter, was tested by the layout of the MUMC treatment process during his own recovery from a heart attack several years ago. “It would have been easier if I could have just accessed one point the whole time—and I was somebody who knew the facility very well,” he says.
Spellman was concerned how the maze of departments affected patients who were elderly, from out of town and anxious about their health. He remembers thinking, “Wouldn’t it be nice if everything was under one roof and easy for people?”
To increase efficiency and improve patient care, MUMC physicians, administrators and board members resolved to create just that situation. They built a new facility to house all specialties involved in the diagnosis and treatment of cardiovascular conditions. And in December 2005, the MUMC Heart & Vascular Institute opened its doors.
Public spaces
While the construction of the Heart & Vascular Institute helped the medical center bring together cardiovascular services, it also enabled the hospital to upgrade the amenities available to patients’ families and visitors.
Kicklighter says, “We always think about patients and staff, but as we move forward—and I say this about health care in general—you’ve got to focus on the family and the visitors and the friends as well. It’s a bigger picture than it was 25 years ago.”
The designers included several features to help lessen the anxiety of visiting a hospitalized patient. For example, the building’s lobby features a fountain that creates the soothing sound of falling water. Outlets for food retailers Starbucks and Einstein Bros. Bagels are also included in the lobby for visitors’ enjoyment. Hotel-style seating, large palm trees and plentiful natural light from a skylight and windows enliven the lobby as well.
The architects took special care in designing the public corridor on the first floor, which connects the lobby of the cardiovascular institute with waiting areas and the main hospital, says Jeff Fogle, AIA, principal at Greenville, S.C.-based Batson Architects Inc.
Carpeting, an arched ceiling, pendant lighting, artwork and windows that overlook an outdoor garden all contribute to breaking up the 250-foot-long hallway and making it an attractive space.
In addition to providing natural light and an outdoor area for families and visitors, Fogle says the garden space, which spans 20 feet between the new building and the existing hospital, helped in the structural design of the institute. “We’ve got some very big foundations, and it just made it easier for our building to be 20 feet away” from the existing building, he explains.
One of the most striking elements of the new facility is its distinctive, circular entrance. The circular form is designed to be both attractive and recognizable, making the Heart & Vascular Institute stand out from the rest of the medical center’s buildings as a signature piece, according to Fogle. The entrance’s design is meant to say, “Enter here. This is something special,” he says.
The circular entrance also helps fill a void in the facade of the overall medical campus. The void became apparent after the opening of a newly constructed section of Savannah’s Harry S. Truman Parkway, a major north-south freeway through the metropolitan area that runs behind the medical center.
A fountain wall that reaches up to 35-feet high enhances the building’s exterior and hides some of the facility’s mechanical equipment from view.
Consolidating cardio
When the design of the new building started, the medical center had already begun to consolidate cardiovascular services.
Rather than place specialists like thoracic and vascular surgeons, cardiologists and radiologists in different departments, such as surgery, internal medicine and radiology, MUMC grouped all clinicians involved in cardiovascular care in one department, the department of cardiovascular surgery and medicine, to foster collaboration. As Spellman notes, “Cardiologists have a lot more in common with cardiovascular surgeons than [they do] with a rheumatologist.”
But since the cardiovascular care areas were spread across the medical center, these specialists were literally not able to work as closely together as they would have liked. To develop a design for a facility that would advance the cardiovascular medicine and surgery department from a concept to a physical construct, representatives from several disciplines within the department, along with hospital administrators and architects from Batson, traveled to several hospitals across the country that were also working to consolidate cardiovascular care.
Including people from all aspects of the project team in the site visits was “probably the best thing we did,” says Spellman. Visiting the facilities helped everyone on the team understand what physicians deal with every day, he says—and this understanding led to a design that truly meets the needs of doctors and their patients.
Interventional labs
One design idea that was influenced by the site visits is the layout of the facility’s interventional laboratories. The interventional labs are on the first floor of the new building, strategically placed near the medical center’s existing emergency department to speed treatment. In an emergency, every minute counts, says Spellman. “The more direct the route is, with the least interference, the quicker you get to doing what you need to do.”
Six interventional labs flank a central work core. Two dedicated cardiac catheterization labs and a cardiac electrophysiology lab are on one side of the central core; on the other side are two angiography suites and a swing lab that can be used for cardiac catheterizations, angiographies or peripheral arterial work, as needed. The central work space provides good visibility into each lab.
This arrangement is convenient for physicians who perform, for example, both cardiac and peripheral work. It also enables clinicians to work together easily across disciplines for the good of their patients. For example, Spellman describes a recent patient who began bleeding and rapidly losing blood pressure during a cardiac procedure. A vascular radiologist who happened to be standing nearby was able to assist with the patient very quickly. “That patient could have had a major bleeding problem” had transport to another area of the hospital been necessary, says Spellman. Likewise, he adds, cardiologists have intervened when patients in the peripheral lab have experienced chest pain. “We’re there and we can help. We’re like a big family down there,” he says.
Unit adjacencies
An eight-bed clinical decision unit is also located adjacent to the emergency department. Here, patients who report to the hospital with chest pain can be observed for several hours to determine the best course of treatment.
A pre- and post-procedure unit is situated next to the interventional labs. This 24-bed unit provides private rooms for outpatients undergoing invasive laboratory procedures. Patients have the same room for the duration of their stay; they recover in the room in which they were prepared for their procedure. Previously, “you didn’t necessarily recover in the same room you started in,” says Kicklighter. Since the rooms are assigned to specific patients, family members can use the rooms as private waiting areas while their loved ones are being treated.
Spaces for noninvasive cardiac care, such as stress testing and echocardiograms, as well as a cardiac rehabilitation gym, are also located on the first floor, near the entrance lobby and patient registration area. As patients move deeper into the building, it becomes more clinically intensive, with ever more restrictive corridor access. This design helps separate public circulation from that of patients and staff.
Custom elevator
The hospital’s former cardiac catheterization labs and cardiovascular intensive care unit (CVICU) were located next to one another, which was useful when unstable patients needed to be moved into the lab as quickly as possible. “You could just wheel a patient right over through one set of doors and have them on a cath lab table within about two minutes,” says Spellman. “As a practicing physician, that was real important.”
But, he adds, “things are changing in cardiology. We have stents now, so those types of patients really are kind of few and far between.”
Based on current medical practice, the project team felt it was more important to place the Heart & Vascular Institute’s pre- and post-procedure unit next to the interventional labs, with the CVICU on the floor above. However, to expedite the transport of critical patients between the CVICU and interventional labs if needed, they commissioned a custom-built oversized elevator from United Technologies Company’s Farmington, Conn.-based Otis Elevator Co.
This dedicated elevator opens directly into the interventional lab area on the first floor and CVICU on the second floor. At approximately 9-by-11 feet in size, the elevator is large enough to hold a patient along with an entire medical team and all necessary medical equipment. The construction crew first built a mock-up elevator, which was loaded with staff and equipment to ensure the final elevator would be appropriately sized. Spellman says that with this elevator, medical staff can still transport cardiovascular intensive care patients to the lab in just minutes.
Intensive care units
The second floor of the Heart & Vascular Institute includes the eight-bed CVICU and a 10-bed coronary care unit. The floor also includes a 12-bed trauma unit and eight-bed neurology unit. The hospital’s trauma and neurology units needed to be updated. By constructing them in the new facility, the medical center was able to make all its ICUs—including two existing units in an adjacent hospital building—contiguous. The ICUs in the cardiovascular institute are mirror images of one another, with patient rooms around the exterior of the building allowing access to natural light, a central workspace and an elevator core located in the middle.
Medical gas and electrical systems are installed in the ICU rooms so that the left side of each patient bed is designed for respiratory personnel and the right side is designed for nursing staff. This eliminates the need for cables to cross the patient or run under the bed. “It just made things much cleaner,” says Kicklighter.
Patient satisfaction
Further consolidation is expected in the near future as shell space on the institute’s third, fourth and fifth floors is built out for a telemetry unit, neurovascular unit and physicians’ offices.
As measured by health care performance improvement firm Press Ganey, headquartered in South Bend, Ind., 94.3 percent of inpatients seen in the new facility rated their overall experience as “good” or “very good,” and 100 percent of inpatient respondents gave the Heart & Vascular Institute the highest marks when asked if they were likely to recommend the hospital. Of outpatients surveyed, 96.7 percent rated the facility as “good” or “very good,” and again, 100 percent indicated they were likely to recommend the hospital.
It is satisfaction numbers like these that indicate the project team’s success in creating an efficient, comfortable environment for patients, solving the puzzle of the mazelike health care facility of the past.
Amy Eagle is a freelance writer who is based in Homewood, Ill. She regularly contributes articles to Health Facilities Management magazine.
This article first appeared in the December 2007 issue of HFM.
To respond to this article, please click here.
Related Articles
Spec/Sheet
Project goes subterranean
Click here for a FREE subscription to Health Facilities Management.
