Ports, cords and hos­pi­tal de­sign

Hos­pi­tals re­vamp, re­wire to han­dle new technology

Modern Healthcare - - Front Page - Andis Robeznieks

T he in­flux of in­for­ma­tion technology in health­care means to­day’s hos­pi­tal ar­chi­tects and de­sign­ers have to ac­com­mo­date more wire, more con­duit, more plugs and more clos­ets hold­ing more racks of flash­ing lights than ever be­fore. But they also have a lit­tle more room to do so be­cause of smaller—or even nonex­is­tent—cen­tral nurse sta­tions, fewer IT-ded­i­cated em­ploy­ees on-site and dis­ap­pear­ing file rooms.

If they do it right, ex­perts say, no one re­ally notices. “It just feels sub­stan­tially dif­fer­ent,” says David Sides, vice pres­i­dent of Cerner World­wide Con­sult­ing, a di­vi­sion of the Kansas City, Mo.based elec­tronic health-record sys­tem ven­dor. “But the good ones do it so it’s un­ob­tru­sive.”

Von Lam­bert, a technology so­lu­tions man­ager at HDR, an Omaha, Neb.-based ar­chi­tec­tural and en­gi­neer­ing firm, agrees.

“To the stan­dard ob­server, you wouldn’t no­tice this,” Lam­bert says of the flood of IT de­vices be­ing used by doc­tors, nurses, pa­tients and their fam­i­lies and the elec­tronic in­fra­struc­ture that’s needed to keep them run­ning. “It’s be­hind a door, so peo­ple don’t no­tice, but it does take up space, and it’s get­ting larger and larger.”

Janet Paden Faulkner, an ar­chi­tect and prin­ci­pal with NBBJ, notes, “We’re cer­tainly get­ting more savvy as de­sign­ers with hid­ing the hard­ware.”

The typ­i­cal pa­tient room is now loaded with the lat­est IT med­i­cal marvels at the pa­tient’s head­board, which can in­te­grate monitor and pump sys­tems, take read­ings and even al­low for re­mote pro­gram­ming of those sys­tems.

Mean­while, the op­po­site wall holds a 42-inch flat-screen tele­vi­sion that not only of­fers ba­sic cable chan­nels but also movies on de­mand as well as ed­u­ca­tional videos about a pa­tient’s con­di­tion, pro­ce­dures and med­i­ca­tions. It can also be used to ac­cess the In­ter­net, a per­sonal health record and in­for­ma­tion on care­givers, Sides says.

A com­mon pa­tient com­plaint, Sides ex­plains, is that hos­pi­tal staff come and go through a room, and pa­tients have no idea who they are and why they are there. Now it’s pos­si­ble to equip em­ploy­ees with ra­dio-fre­quency iden­ti­fi­ca­tion badges so that when they walk in a room their pic­ture, care­giver role and a short bi­og­ra­phy will flash on the pa­tient’s TV screen.

“It will say some­thing like: ‘This is Dr. Sides, he went to Har­vard Med­i­cal School and he’s a car­dio­vas­cu­lar sur­geon,” says Sides (who, for the record, grad­u­ated from the Uni­ver­sity of Cal­i­for­nia at Berkeley with a bach­e­lor’s de­gree in bio­physics and has mas­ter’s de­grees in busi­ness and health ad­min­is­tra­tion from the Uni­ver­sity of Mis­souri at Columbia).

Pa­tients “see it more as a TV set in­stead of part of a com­puter sys­tem that’s driv­ing their care,” Sides says, adding that peo­ple of­ten have to be con­vinced that they won’t be charged for movies or us­ing the In­ter­net. “They ask, ‘You’re not charg­ing us $10 a day like a ho­tel does, are you?’ But it’s not a rev­enue cen­ter. You be­come in­volved in your care—that’s what we ask in re­turn for a free movie.”

Out­side the room, Sides says small mon­i­tors can alert hos­pi­tal staff to a pa­tient’s al­ler­gies or the risk of suf­fer­ing a fall.

Lam­bert adds that pa­tient rooms now in­clude sep­a­rate ar­eas for pa­tients, fam­ily mem­bers and staff. “There are three dis­tinct zones, and you have to de­sign for each,” he says.

For staff, Madhu Gresla, vice pres­i­dent of the Chicago-based Pratt De­sign Stu­dio, says elec­tronic medicine cab­i­nets are be­ing added un­der coun­ters in the staff work area of pa­tient rooms. Phar­ma­cists fill them, and then nurses us­ing key cards and codes can take out med­i­ca­tions as needed while sys­tems track who opened the cabi­net and when.

Track­ing ar­rivals, de­par­tures

For fam­i­lies, Gresla says screens—sim­i­lar to those used in air­ports to dis­play flight in­for­ma­tion—are be­ing mounted on walls that use a code to iden­tify pa­tients and in­form fam­i­lies where the pa­tients are in the hos­pi­tal.

“A pa­tient in surgery could be gone for hours,” she says, ex­plain­ing that dash­boards help re­move the need to flag down a staffer or vol­un­teer for a fam­ily mem­ber seek­ing an es­ti­mated time of de­par­ture from the op­er­at­ing room.

Ted Moore, a health­care de­sign project ar­chi­tect with the Haskell Co., says IT in­fra­struc­ture “used to be an af­ter­thought” and was shoved into a closet. “But no longer is IT go­ing to look like a ne­glected el­e­ment in our de­sign,” he says. “And it’s be­ing put in a per­ma­nent lo­ca­tion in real es­tate that is nor­mally be­ing fought over for some­thing more vis­i­ble.”

Prefer­ably, a hos­pi­tal should stack its IT “technology dis­tri­bu­tion rooms” one on top of the other like it does with bath­rooms, ar­chi­tects say, so all the wiring stems from one cen­tral spine. And these rooms may con­tain cable, com­po­nents and equip­ment for data and voice com­mu­ni­ca­tion sys­tems, fire and se­cu­rity sys­tems, nurse call sys­tems, mu­sic and video en­ter­tain­ment, pag­ing, med­i­cal gas mon­i­tor­ing and myr­iad other elec­tronic com­po­nents pro­vid­ing sup­port for technology func­tions.

“It has be­come a core el­e­ment like a stair­way or an el­e­va­tor,” Moore says.

This topic has re­ceived more at­ten­tion than ever be­fore in ref­er­ence pub­li­ca­tions such as the 2010 edi­tion of Guide­lines for De­sign and Con­struc­tion of Health Care Fa­cil­i­ties, pub­lished by the Fa­cil­ity Guide­lines In­sti­tute and the Amer­i­can So­ci­ety for Health­care En­gi­neer­ing as well as the Na­tional Fire Pro­tec­tion As­so­ci­a­tion’s NFPA

Pa­tients and clin­i­cians at 25-bed H.B. Ma­gruder Me­mo­rial Hos­pi­tal in Port Clin­ton, Ohio, get plenty of screen time in the fa­cil­ity’s new pa­tient rooms. They fea­ture a 42-inch TV with In­ter­net ac­cess, a bed­side com­puter to ac­cess med­i­cal records, and

a monitor to track pa­tients through the hos­pi­tal. It’s all quite a change from the old rooms, at right.

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