HHE 540

Principles Of Complexity And Leading Innovation: Healthcare Facility Plan Proposal

Alexia Bertsatos, Scott Root, Heather Draper & April McEwan

3/8/2011

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OUR EXPERTISE, THE EMERGENCY DEPARTMENT, AND THE TEAM

As an organization of Pebble Partners, our design firm is also a design research team, focusing on evidence based design for health and healing environments. We possess an innate desire to gain an understanding of how to apply verifiable methodologies to plan, design and construct new healthcare environments. Our design and design research team at ASHA Health consists of Alexia Bertsatos, architect and design researcher, Heather Draper, interior designer and project manager, April McEwan, design researcher and writer, and Scott Root, designer and architect. Of the specific departments and service lines to be included in the health care facility (Emergency department, Intensive care unit, Surgery, Imaging, Laboratory, Medical/surgical unit(s), Labor & delivery, Pediatric med/surgical, Neonatal intensive care unit (NICU), Pediatric intensive care unit (PICU), Administrative spaces, Outpatient rehabilitation, Pharmacy, Outpatient orthopedic services, Palliative care, Oncology), our design team will be specializing in the programming, planning and design of the emergency department. As emergency departments influence patient satisfaction, patients influence hospitals’ public images through their experiences and affiliations. “The emergency department is a core clinical unit of a hospital and the experience of patients attending the emergency department significantly influences patient satisfaction and the public image of the hospital” (unknown, 2007). Not only is the emergency department a primary clinical unit of a hospital; it tenders to teaching, research, administration, and staff amenities. Primary functions of an ED consist of: receiving, triage, stabilizing, and providing emergency management to patients with an extensive variety of conditions, whether they be critical, urgent or semi urgent conditions. Additionally, in concurrence with a region’s disaster plan, EDs provide response and management of disaster patients. “In addition to standard treatment areas, some departments may require additional specifically designed areas to fulfill special roles, such as: the management of pediatric patients, the management of patients following sexual assault, the management of infectious patients, the extended observation and management of patients, the management of prisoners in custody, the management of patients affected by chemical, biological or radiological incidents, undergraduate, postgraduate teaching, transport and retrieval services, telemedicine” (unknown, 2007).

PROBLEM STATEMENT A professor and medical director of the emergency department at Holy Cross Hospital in Silver Spring, Maryland, states, “The physical environment of the emergency room is famous for lack of privacy, for loud, confusing sounds and for very rapid and changing staff interaction” (Shapiro, 2009). Rigorous research has proven that the design of the built environment can directly affect patient, staff, and environmental safety and the quality of care delivered (Goodman & Marberry, 2010, p.28).

200 beds are needed in this 5-story hospital, which is located in a 4-block area in Central Phoenix, Arizona. The 4-block building site occupies the area from 7

th Street East to 9

th Street, and from East Roosevelt Street south to East

McKinley Street.

Phoenix is a growing city, with 4 hospitals within a 3 mile radius, our hospital will help to reduce the overcrowding in the area waiting rooms while providing complimentary and competitive care. The focus of ASHA Phoenix is healing in all aspects. Our research supported and tested design and service models promote a healthier more restful experience for both patients and staff.

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BACKGROUND INFORMATION

Our firm, ASHA Health prides itself on being both the largest and only inter galactic healthcare system and the only system owned by the head researchers and designers. Thus providing the system with a human edge over typical hospital boards. Our goal is to make a difference in the lives of the patients and staff on a daily basis. Our system was ranked #1 best place to work by Forbes Magazine in 2010. ASHA Phoenix will service those coming from the South Mountain and central areas of Phoenix. Due to the competition in the area, ASHA Phoenix has been selected to become the most advanced and streamlined Trauma III Emergency Department in the valley of the sun. With semi critical cases directed here and overflow coming from Banner Good Samaritan, this will improve the bottom lines of both hospitals as well as the patients, by reducing wait times and improving staff attention.

With walk-in emergencies, ambulance emergencies or heliport emergencies, an emergency department needs to be well-equipped to diagnose and treat a wide variety of medical emergencies as soon as possible. Generally upon arrival to the Emergency department, walk-in patients check in at the patient registration station and then are assessed by triage nurses to determine the reasons for their visit as well as acquire patient vital signs. Health care providers then do thorough examinations of patients to determine patient health care needs. It may be necessary for the patient to be tested or x-rayed or examined with further diagnostic exams in order to expedite a patient through the treatment process. After further examination and testing, patients will review results with a health care provider. Depending on test results, a patient may be discharged or admitted to the hospital. Upon check out, patients provide personal information and fill out forms for billing procedures at patient registration. Relatives and friends may accompany the patient, waiting in emergency lobby area and waiting room, even bedside. During this time, prior and after, physicians, nurses and other clinical staff document patient records in an electronic medical record system and use digital imaging technology. As emergency departments have high patient turnover, varied case mix and a large workforce, the patient, visitor and staff flow throughout an emergency department are crucial understandings for emergency department and health care facility design. (Unknown, 2007)

STAKEHOLDERS, CONTRIBUTORS IN PLANNING AND DESIGN

A crucial part of the design phase is collecting information from stakeholders in order to address the needs of particular units and departments of healthcare facilities. Service spaces influence and are influenced by design features, activities and stakeholders of other service line typologies. As evidence based design shows, rationale for design decisions is a major contributor to effective and efficient healthcare facility design. Proving valuable to the programming, planning and design process, involving many stakeholders of the health care facility is crucial in creating effective design solutions that meet the needs and desires of many. Similar to the Pebble Project, engaging others in research and design projects of common interest is beneficial in meeting the highest priority objective of healthcare design—to better understand how the planning and design process affects behavioral and cultural change in healthcare organizations that are striving to create a healing environment (Goodman & Marberry, 2010, p.26). In order to design an emergency department that meets the needs of patients, visitors and staff, we propose interviewing and collecting data from experienced users and operators of health care.

It is difficult to both include many and limit the number of stakeholders to be included in our healthcare facility planning meeting, as all stakeholders provide valuable insights and different perspectives on department and service functions, effectiveness, and design layouts. As it can be difficult to please ‘everyone,’ we have selected ten stakeholders we propose inviting to our planning discussion meetings:

1. Facilities Manager: The facilities manager is a valuable stakeholder to have on board with the team vision from the get-go, as this person is in charge of the hospital grounds and will oversee the construction.

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2. Hospitalist: With experience in many of the departments in the hospital environment, the hospitalist will provide valuable advice as to adjacencies and layouts of departments and service lines within the healthcare facility.

3. Labor and Delivery nurse: Labor and delivery requires a technical layout and the nurses boast superlative

insight into the day to day activities within a typical ward.

4. The director of the Emergency Department (ED): The ED is another highly technical space, input from the users is essential to an intuitive and efficient layout.

5. CNO: A Chief Nursing Officer: As the highest-level senior manager over nursing-related patient care

divisions, and as the chief expert for the hospital regarding professional nursing issues, the hospital Chief Nursing Officer offers experience and perspectives regarding the day to day operations of planning, organizing, and directing the daily activities of the Nursing Services Division. As the CNO works with and considers the needs of other units: Intensive Care, Pediatrics, Medical Surgical, In-patient Surgery, Out-patient Surgery, Neonatal Intensive Care, Mother Infant, Labor & Delivery, Extended Care and Mental Health Units, this is a very valuable stakeholder to include in the design and planning processes.

6. Head nurse for the Neonatal Intensive Care Unit (NICU): Similar to Labor and Delivery and ED, the NICU

requires a stakeholder with in-depth knowledge of the workspace. 7. Environment Manager: Seeing as the Environments Manager oversees housekeeping, a service line that

contributes to efficiency, patient turnover, patient retention, patient safety, health and comfort, this stakeholder will provide valuable insights for effective design decisions.

8. Director of Food and Nutrition: This director of food and nutrition has valuable insights to consider as

he/she influences decisions made within live-well programs, catering, cafeteria and vending, even green initiatives and recycling within the hospital. This stakeholder has much potential to lead the hospital in sustainable initiatives, for the health of patients and staff, benefits of and for nature, surrounding environments and communities, and the success and economic benefits for the healthcare facility.

9. COS: The Chief of Staff, as a doctor of doctors, will provide valuable information and perspectives that

many other doctors concur with. Doctors offer many similar perspectives to nurses, but their input is also important to consider, as; they interact with specialists, nurses, dietitians, technicians, records, orderlies, patients….

10. Director of Information System Unit: Due to the specific needs of IT implementation in hospitals, the

Director of Information System Unit provides valuable knowledge and perspectives on infrastructure, imaging technology, electronic records and information.

OUR RECOMMENDATIONS

When compared to civilian vehicles of a similar size, one study found that on a per-accident basis, ambulance collisions tend to involve more people and result in more injuries. (Ferreira & Hignett, 2005). Evans (2007) states that most serious injuries occur in the patient compartment of the ambulance. The causes of EMS fatalities include: Electrocution & needle sticks (4%)Homicide (9%)Cardiac event (11%)Transportation accident (74%). In 2001, an 11-year retrospective study (Kahn, et al.) concluded that most fatal ambulance crashes occurred during emergency runs, but they typically occurred on improved, straight, dry roads, during clear weather. Because research has shown that ambulances are likely to be involved in motor vehicle collisions resulting in injury or death, we propose locating the Emergency Department on the east side of the hospital with ambulance access on North 9

th Street.

With most patients coming from the south mountain and central areas of Phoenix, most hospital users are likely to

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come from Roosevelt and North 7th

Street and will access the hospital from North 7th

Street and East Garfield Street.

A base station for several Central Valley emergency medical service paramedic units, the Emergency Department also features a helipad for emergency air transport. Research states (Harrell, J. W.) that hospitals with only one entrance or poorly placed dual entrances experience chaos of co-mingling and self-arriving patients with others coming in emergency vehicles. For this reason, we propose positioning the outpatient and emergency walk-in patient entrances on the south side of the hospital, while ambulances will approach the east side of the hospital. Outpatients and visitors will enter through a hospital entrance facing south west, accessing it from East Garfield Street. Emergency walk-ins will also access the emergency department from Garfield Street, but will enter through en entrance facing south east. Regarding parking, we recommend one space for each bed (200) plus one for each employee (800). Additionally, another 100 parking spaces should be allotted for outpatients, totaling 1100 parking spots. (source?)

ED features:

Pod design was adopted to promote optimum space usage and also reduce walking distances for staff

Individual patient rooms with solid doors for privacy and noise reduction.

Direct view to all rooms from the nursing station(s) promoting safety and quick response. Clear sliding

glass doors for the critical care rooms arranged by the ambulance door for quick access.

REU in replacing fast track to reduce bottleneck and increase throughput.

Traditional triage eliminated, patients after a quick registration are transferred directly to a rapid

response bed where bedside registration is available. Time to see md reduced from 2 hours to 10 min.

Fully electronic medical record system implemented

‘feel good’ internal waiting areas for patients waiting for lab results and imaging.

Psyche room has a window with bullet proof glass for observation and has been stripped from all

equipment that can be used as a weapon the door of that room locks from the outside and the water can

be cut off for safety. Psyche room is acuity adaptable and can be also used as an REU room. Located at the

main REU unit for constant monitoring.

Elevator within the er linking it directly to or and ICU units.

Storage facilities located by each nursing station to reduce walking distances for staff

Hand washing facilities and sanitizers located within every treatment room and throughout the

department.

Doctors offices located in a central area.

Ambulance and heliport entrance located by the critical care unit, away from the ambulatory entrance to

avoid confusion and congestion.

EMT staff have been designated their own external facilities for convenience. Staff break room located by

main nursing station for quick access.

A CT scanner was located in the critical care unit for rapid access.

An x-ray machine was also located by the main nursing station to facilitate quick exams and reduce

waiting times

A lab was located by the main nursing station to facilitate quick access and reduce waiting for results.

Security office located by main ambulatory entrance. 24 hour security presence.

ED was designed to assist future expansion. Additional pods can be added adjacent to the critical care unit.

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