AAMC Reporter: June 2006

Patients: The Focal Point of New Hospital Facilities

It is the middle of the night, and you are in the hospital recovering from a surgical procedure. You cannot sleep because your pain medication wore off some time ago. Your roommate, partially hidden by the thin curtain in your semi-private room, is snoring steadily — and loudly — and you cannot seem to locate the nurse-call button. You softly call out for a nurse, but since your room is at one end of a long corridor, and the only nurses' station on the floor is at the other end, nobody hears you.

This scene, once commonplace in many hospitals, may be a thing of the past. With today's new architectural guidelines for hospitals and health care facilities, your private room, along with three others, is grouped around a central nurses' station and equipped with basic medical supplies and computers. The clinician just outside your door will immediately hear your cry for help and come in to administer your medication so you can get back to sleep.

That's the design of George Washington University (GWU) School of Medicine and Health Sciences' new hospital in Washington, D.C. The hospital, which opened in August 2002, was planned by architects to provide patients with quick and easy access to health care providers. The four-room pod around a clinical workstation is a stark contrast to the standard hospital layout in which each floor has one central nursing station, often separated from a patient's room by a seemingly interminable hallway.

Karen Hicks, R.N., associate administrator and chief nurse executive at The George Washington University School of Medicine and Health Sciences' hospital

Karen Hicks, R.N., associate administrator and chief nurse executive at GWU's new hospital, says that placing a number of smaller workstations close to patients enables health care providers to hear and respond more quickly to clinical emergencies in patients' rooms. Another benefit, Hicks adds, is that while patients can enjoy the privacy of their single-occupancy rooms, which make up more than half the patient rooms in the hospital, they do not feel as isolated as they tend to feel in traditional private rooms scattered along a hallway. "Patients can feel and see that there are caregivers just outside their door," Hicks says. "There are people around."

No longer considered a luxury, private rooms have become the norm in new hospital construction. In the 2006 edition of the American Institute of Architects' Guidelines for Design and Construction of Hospital and Health Care Facilities, to be released in June, private rooms are a required feature for all new hospitals. Plans for new health care facilities can include semi-private rooms if approval is obtained from their appropriate state licensing board, according to the guidelines, which architects, engineers, and health care professionals in this country and abroad refer to when planning and designing new hospitals.

Joseph G. Sprague, F.A.I.A., F.A.C.H.A., F.H.F.I., is an American Institute of Architects fellow and senior vice president and director of health facilities at HKS Inc., a Dallas-based architecture firm. Since 1996, Sprague has chaired the interdisciplinary committee that develops the guidelines. He says that a main impetus for incorporating the private-room criterion is research showing that both hospital-acquired infections and hospital errors, such as medication mix-ups, are reduced when patients are in private rooms.

"The committee felt that the patient really has an opportunity to reap benefits that they don't get in a semi-private setting," says Sprague, whose firm designed GWU's new hospital.

Staff benefit from private rooms, as well, because they can more easily talk confidentially with patients. Additionally, single-patient rooms enable hospitals to increase their occupancy rates because roommate considerations are removed, Sprague added.

Clinicians at GWU also enjoy improved and streamlined access to patient records. The entire building, including elevators and stairwells, has wireless connections, which means that clinicians can access patient records from anywhere in the building — even between floors.

"A clinician will run up and down a stairwell between two floors," says Linda L.E. Reino, chief information officer at Universal Health Services Inc., a health care management company that co-owns the hospital in partnership with the university. "They might have a laptop in their hands, and they don't want to drop between floors and have to reconnect or re-sign on."

As an entirely portable system, Reino says, the wireless network also allows clinicians to record patient information at the actual location where much of a patient's care takes place: the bedside. At the same time, cardiovascular patients whose vital signs need constant monitoring are not confined to their beds because the hospital is equipped with a mobile telemetry system that allows staff to monitor patients even when they are moving around.

Throughout the planning and design stage, information-systems specialists at GWU worked closely with design and construction experts to ensure that the new building would be able to accommodate the latest technologies as they became available, Reino says. For example, 64-slice CT scans hit the market when the hospital was ready to open but were not on hand at the planning stage. Nevertheless, the building's adaptable design easily accommodated the new high-tech scanners.

Donald J. Pyskacek, assistant vice president for design and construction for Universal Health Services, agrees. "We have to build in that flexibility right now because what comes to the dock when we're putting the equipment in the hospital is a totally different animal," said Pyskacek, who, with Reino, helped design GWU's new hospital. "It's probably better, but it's not the one we planned for three years ago."

In addition to the latest diagnostic and treatment technologies, GWU Hospital offers students the most up-to-date teaching facilities in its surgical simulation and demonstration area located on the building's sixth floor. Here, students can practice simulated, virtual operations on sophisticated computer programs that closely mimic real surgeries.

Flexible and Easy to Navigate

Like GWU Hospital's designers, architects at the University of Arkansas for Medical Sciences College of Medicine (UAMS) in Little Rock, Ark., are building flexibility into the largest public construction project undertaken in the state in the past 36 years. Expected to open in about two years, the new UAMS facility will house the Psychiatric Research Institute, which will combine outpatient clinics, inpatient care, and research in one state-of-the-art location.

Inpatient rooms at the institute will have movable walls to allow staff to reconfigure and expand specific areas, as needed. Similarly, other floors that are not intended for inpatient rooms are being designed with movable walls, which will enable staff to adapt the available space to fit changing needs, including expanding clinical space, if necessary.

The psychiatric facility's design, both inside and out, is geared toward therapeutic care. Floor-to-ceiling windows on the front of the building overlook "healing" gardens and a landscaped plaza between the new building and the university hospital, which will be joined to the psychiatric facility by an art gallery. Another innovative feature of the five-story building is a wide, three-story staircase, which staff members will be encouraged to use in place of elevators, for the opportunity both to exercise and to talk, informally, with colleagues.

The new University of Colorado Hospital Anschutz Inpatient Pavilion

In Denver, architects took a multidisciplinary approach to designing the University of Colorado Hospital's Anschutz Inpatient Pavilion, which opened in 2004. Infection-control and maintenance experts participated in planning from the beginning, meaning that the people responsible for maintaining the hospital and correcting any problems are thoroughly familiar with the building, according to Kathy Boyle, R.N., Ph.D.c., senior director of patient services at the hospital, which is part of the University of Colorado at Denver and Health Sciences Center.

The planning committee also asked patients and their families what features they would like to see. One of their main wishes was that the new building be easy to navigate, Boyle says. Accordingly, from the moment patients and visitors enter the building, they can easily find their way to clearly marked elevators. Furthermore, each patient floor has a staff member present to greet and direct new arrivals.

In an inspired move, planners at the University of Colorado Hospital consulted with the Disney Institute to see what approaches they could adapt to the new health care facility. They found that the Disney concept of onstage and offstage areas actually works quite well in a hospital, for staff members and medical students, as well as for patients. For example, clinicians and other staff transport patients, in addition to supplies, in "offstage" elevators that are separate from the public or "onstage" elevators used by ambulatory patients and their families.

"It helps not to have people in areas that have things going on that they wouldn't understand or that don't relate to them," Boyle explains.

Another unique feature of the pavilion is that it uses environmentally sensitive materials in a number of its furnishings. For example, during the day when natural light is strong, energy-efficient controls automatically switch off the light fixtures in corridors and public areas. The hospital also used many recycled materials in its construction and non-toxic adhesives, sealers, and finishes, as well as formaldehyde-free furniture.

For the patient, this "green" design may mean better indoor air quality in the place where it may matter the most: the hospital.

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