Hospital Goal Custom Patient Rooms

June 12, 2003
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GRAND RAPID — West Michigan happens to be the site of two seemingly divergent yet complementary trends in hospital design.

Construction crews are putting one such design into place now in their work on the Spectrum Health Heart Center. Ground will be broken in spring on the other — Zeeland Community Hospital.

The new Zeeland hospital will be a 57-bed facility modeled closely on a first-of-its-kind hospital at the Walt Disney complex in Orlando.

George F. Lewis, a URS architect involved both with the Zeeland hospital and the heart center, told the Business Journal that best practice or innovation has developed ways to reduce the number of patient transfers within hospitals. Such transfers, he said, are costly and personally disruptive to patients.

In the past, as medical sophistication increased, hospitals were constructed with a hierarchy of room types, respectively equipped to afford intensive care, critical care, acute care and so forth.

And, generally speaking, it was standard procedure to transport patients back and forth from room type to room type as their conditions improved or worsened.

But another factor began to intrude upon that tradition: the increasing sophistication of resuscitation technology, associated in popular entertainment with the development of crash carts, defibrillators and Code Blue teams.

Lewis explained that as the teams' capacities have increased, so has their size.

"I've seen where resuscitation teams now are listing in the 15- to 20-person range," he said. "You'll have physicians, medical staff, nursing staff, perhaps respiratory therapists, other specialists, right down to clergy.

"And having that number of people responding," he added, "it can get real crowded in a room real quickly."

He pointed out, moreover, that not only are resuscitation teams bigger, they also are responding more frequently to in-house emergencies. The reason for that, Lewis said, is that — given health care's tremendous emphasis on out-patient treatment and surgery — hospital in-patients tend to be a concentration of sicker people more likely to need such intervention.

"Now, historically — say back in the '70s and the early '80s — the standard for the headwall in critical care and acute care environments was 12 feet," Lewis said.

"But now, to have a headwall that accommodates medical gasses and related equipment and to have room for resuscitation teams means that 12 by 12 no longer is enough. The reality now is that the headwall has got to have 14- to 15-foot width."

And what this demand for space created at Celebration Hospital in Orlando — and will create for Zeeland Community — are what Lewis called "acuity-adjustable" rooms. He said these are rooms that, by virtue of their size, design and the equipment in them, can be customized to fluctuations in patients' need for care.

"The acuity-adjustable room — sometimes called the universal room — is the bleeding edge of hospital design right now," Lewis said.

"The one hospital is operational in Orlando and I know of only one under construction and two or three others in design, including St. Mary's Hospital in Saginaw, that also would have acuity-adjustable rooms."

He explained that any and all acuity-adjustable rooms can accommodate any and all patient types.

"They have all the types of medical gasses that are needed," he said, "and they're all wired for telemetry for physio-monitoring. The equipment might not be in the room, but it can be brought in and put on line.

"So every single room can accommodate any care protocol: anything that's routine or for something that requires more critical or intensive care."

He explained that Zeeland Hospital doesn't have a high population of critical care patients. And having acuity-adjustable rooms, he added, means that it doesn't need to maintain an often vacant, and therefore costly, dedicated critical care unit of, say, four to eight beds.

Lewis said he has learned that the health care industry's thinking is that there's value to patients and hospitals alike in not having to transfer patients back and forth among rooms.

"If a patient first requires critical care and then more routine care, with an acuity-adjustable room you don't have to move that patient," Lewis explained.

"As the patients' acuity level goes down, they stay right there for their entire stay," he said.

"There's a significant cost associated with patient transfers," he added. "With an acuity-adjustable environment, you don't transfer patients so much and you don't have to tear down a room and remake it so often. There's a lot of efficiencies being realized."

He said that not being transferred is regarded as leading to better clinical outcomes for patients, and a higher level of patient satisfaction.

"You don't have the feeling you're being manhandled," he said. "You're not carted from wing to wing, so you have some sense of ownership of space and you're not uprooted in the relationships you have with the people caring for you."

He explained that a similar search for more patient friendliness went into room design at Spectrum's Heart Center.

Typically in heart surgery, he said, a patient is transferred from surgery to a recovery room, then to an intensive care unit, and then a patient room.

He said the heart center, however, will feature a super post-surgical care unit equipped to handle the high-alert functions of both recovery and intensive care, thus eliminating one transfer step.

"It's somewhat of an innovation," he said, "an overnight stay that gets the patient through the critical post-surgery period while eliminating one environment of patient care, and one patient transfer. It also translates to potentially less cost in care."

The 35 rooms on the heart surgery floor, he said, have all the equipment needed to respond to the needs of cardio-vascular surgery patients.

"Any and all patients in critical care beds in a cardio-vascular setting run the risk of cardio-vascular complications," he said.

"The floor is equipped with re-entry carts, so literally each room can be mobilized as an operational area. They can bring in the re-entry cart and they literally can open up the chest and go to work on the patient in the room."

He also said that rather than having to transfer a patient to another site for an evaluation or some other protocol, each room has all the space necessary for portable equipment and space that caregivers need to move around the patient's bed — plus overhead booms affording an added level of technical support.

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