Ports, cords and hospital design
Hospitals revamp, rewire to handle new technology
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.