Ana Martins of Shepley Bulfinch Richardson and Abbott, architects for the Children's Hospital Boston acute care facility, answers her colleagues' questions about design alternatives in the intensive care room mock-up.
Feeling as though we had inadvertently wandered onto a TV stage set for ER, a contingent of 15 architects from Shepley Bulfinch Richardson and Abbott (SBRA), primarily members of the firm's Healthcare Practice Group, recently explored the real-life setting of an Operating Room and Intensive Care Unit at Children's Hospital Boston. This “real-life setting” was not in operation yet, but in mock-up form, ready for some hands-on design conceptualization by the architects and hospital staff.

Led by Charles Osborne and Ana Martins, designers on the Project Team, the group was given an up-close and personal view of the medical facility, now in the final design stage. James Mandell, MD, president and CEO of Children's Hospital Boston, says the new clinical building is coming at an important time: “This building is vital in order to update and grow the critical-care services that we are being increasingly called upon to provide. It will allow us to continue to focus on our vision of being the preeminent pediatric institution in the world.”

“The purpose of creating a mock-up,” explains Osborne, “is to help the users understand the design process and evaluate their expectations against the real-life model. The hospital administrators, facility engineers, and clinical staff were instrumental in this exercise.”

Key elements of the model include the layout of the room and the location of the operating table and doors, which determine the activity areas within the 600-sq.-ft. Operating Room. “Our role as architects was to help them achieve their family-centered philosophy and goal of creating the highest-quality facility for children,” says Uma Ramanathan, lead programmer and planner for the project.

“Children's Hospital Boston was committed to building an entire 2,200-sq.-ft. ‘theater set’ for the two ICU rooms and OR, including the scrub room and substerile area, to make sure that the final design would meet their expectations,” adds Osborne. “For example, we tested the idea of adding an induction room, where patients are anesthetized, to the OR. In viewing the mock-up, the users were able to evaluate what was required to move anesthetized patients into the OR, as well as to assess the space that would be needed to successfully serve as an induction room. They ultimately decided to use this adjacent area for readily available storage of critical clinical equipment and supplies for the OR.”

In response to the full-size model OR, the nurses and doctors could also reposition the table and experiment with moving around other equipment. “They are an important part of the process at this critical stage,” says Osborne. “We listened and, with their input, revised the mock-up. It's gratifying for the design team to see that what we originally designed has been modified with the users' participation and is now working for them.”

Osborne adds, “The surgeons, nurses, anesthesiologists, and technicians are the key people in the OR, and each views his or her area almost as a separate country. It's important for architects to know how they define and defend their turf. As it turned out, they liked the orientation of the operating table, but shifted the placement of the anesthesia equipment and the location of the overhead booms. The surgical team even performed a simulated operation in this model OR, and the outcome was successful.”
Two locations were considered for the sinkone in the back of the patient room grouped with all the plumbing and another by the entrance. The users decided on the latter, as it ensured that there would be better and easier compliance with infection-control procedures. Based on the mock-up, the sink, as positioned in the photos (above and below), will be relocated to the entrance. Glass in the doors ensures that clinicians can see easily into the patient rooms

A continuous 1′ × 4′ light fixture with an asymmetrical lens was installed to “wash” the perimeter walls. It reduced contrast for surgeons by dispersing the light more evenly on the walls, providing 360-degree coverage of the operating area. Colored cut-outs on the ceiling indicate mounting locations for booms, should the model room be used as cardiovascular ORs, and cut-outs on the floor demonstrate the location of the body of the booms

Beginning with the big pictureevaluating the size and layout of the roommembers of the design team and the client facility then reviewed materials and finishes and, finally, utilities and outlets. “They wanted to understand the details as clearly as the overall space,” says Osborne. To wit: a Post-it® note was affixed to an electrical wall outlet, with “Wrong Location?” scrawled in large letters. Osborne notes that the nurses even dropped needles on the floor to see if they could be seen more clearly against blue or beige sections. The client requested welded-rubber tile flooring, because rubber is more comfortable to stand on for long periods of time than the traditionally used sheet vinyl.

With an opportunity to see the lighting in place, the client agreed that “washing” the perimeter walls with light was more effective than the 2′ × 4′ fixtures conventionally installed in ORs. Instead, a continuous 1′ × 4′ light fixture with an asymmetrical lens was installed. Not only did the innovative lighting use fewer foot-candles of energy, but it reduced contrast for surgeons by dispersing the light more freely on the walls, providing 360-degree coverage of the operating area.

Across the hall from the model OR, Martins conducted a similar tour, explaining the different design approaches for the two adjacent models of ICU rooms. Each 240-sq.-ft. space has the same facilities (patient area, bathroom, and outer sink, as well as a rest alcove for parents), but in slightly different configurations.

“We are particularly excited about the new family space being built into all the units,” says Eileen Sporing, MSN, RN, senior vice-president of Patient Care Services. “It will allow patients to spend more time with their families, and that contact is invaluable to everyone.”

“When we were in the preliminary design stage, visibility was a big issue,” says Martins. “The clinicians wanted to be able to see into many rooms at once, so we built model rooms with breakaway doors between patient rooms. When they saw these, they decided that usable wall space was more important. We ended up using a design that combined integral blinds on the door and windows set above a low wall.”

Several design challenges were encountered in the mock-up stage, for example:

Lighting: General room lighting and its dimming capabilities. Was the night-light near the floor bright enough and in the right location? Nurses were concerned that the light would be blocked by equipment, so it was redesigned as indirect light near the ceiling.

Power booms: One or two mounts for the two arms? Based on the model, the client decided on a separate mount for each arm.

Finishes and colors: While yellow interiors have long been eschewed by most hospital workers and healthcare facility designers, the client felt that the pale yellow accent on the soffit, selected by Project Interior Designer Diana Jackson, added a warmth to the otherwise cold surroundings of glass and medical equipment. Touches of color also are seen in the rubber flooring selected for the patient rooms
Healthcare professionals from Children's Hospital Boston tour the OR mock-up. At left and rear: An AV specialist and anesthesiologist inspect their activity areas. Center: Three surgeons assess the positions of the table and coverage of the surgical lights and flat-screen monitors. Right: Two infusionists confer

Sink location: Two locations were consideredone in the back of the patient room with all the plumbing nearby, and another beside the entrance. The users decided on the latter, because it ensured that there would be better and easier compliance with infection-control procedures.

After the various hospital groupsfrom physicians and nurses to administrators, engineers, and even housekeeping staffhave toured the models, their opinions will be consolidated and incorporated into the final project design. Corrections are being made in the models, which will be revisited and approved before the project design moves ahead toward its final completionthe ICUs in November 2004 and the ORs and other areas in 2005.

Concludes Bill Mead, SBRA principal-in-charge of the project, “This real-life evaluation process has enabled the client and design team to take a significant step closer to a collaborative decision about the design of these critical-care facilities. We now have the confidence that, together, we will have created the highest-quality healing environments for children, their families, and caregivers.” HD

Deborah Johansen is communications manager of Shepley Bulfinch Richardson and Abbott, a national architecture firm based in Boston. Her articles on healthcare issues have appeared in professional and consumer publications.