Model Update – Nemours Children's Hospital
The new Nemours Children’s Hospital in Orlando, Fla., situated on a 60-acre greenfield site, is surrounded by well-landscaped scenery, continuing the legacy of its sister hospital in Wilmington, Del.
The hospital’s founder, Alfred I. duPont, built a classic French-style mansion with formal gardens in Wilmington on a 222-acre site, where the current Alfred I. duPont Children’s Hospital now lies. The Nemours Foundation wanted to recreate the setting in Orlando and develop a concept of a hospital in a garden with a healing connection to nature.
In 2008, after looking at five different locations with architect Stanley Beaman and Sears (SBS; Atlanta), Nemours chose a location with adjoining existing native wetlands and a storm water retention pond. Nemours saw potential for fostering a relationship with the neighboring Lake Nona Medical City, a developing 650-acre health and life sciences park.
SBS and Perkins+Will (Boston) coordinated on the master planning efforts for site development; Skanska USA Building Inc. (New York), as construction manager for the project, carried out the preconstruction services.
A family advisory council was drawn from families that had been visiting a Nemours Foundation multispecialty physician practice in central Florida and had the experience of being with their children in a hospital setting. Nemours invited these families to be an integral part of the design and to make decisions for care right from the beginning. The design team built a fully functional “preview center,” a mock-up of the patient room, and once a week the council provided feedback on each design element as it progressed.
Roger Oxendale, CEO, Nemours Children’s Hospital, says that each council concern was analyzed and incorporated into the design, such as adding a mirror, instead of frosted glass, on the bathroom doors so parents will always be visible to the patient, reducing separation anxiety if they need to get something from the bathroom.
“The patient rooms have a sofa bed that sleeps two so that more family members can stay with the child. All of the furniture in the rooms was thoroughly tested by the patient care team and the families,” says Veronique Pryor, project manager, principal, SBS. There are also safes to lock up valuables, a small refrigerator in each room, and a small alcove with a desk. Patient-controlled technology can change the color of the lighting in the room at night and personalize the space for the child.
From hospital to home
Nemours established special family programs that would help with the adjustment period once patients are able to return home. On the first floor, a program called KidsTRACK—teaching, research, advocacy, community, and knowledge—was designed so that families can learn about their child’s illness, diagnosis, and treatment outcome.
A demonstration kitchen provides an area for parents to learn how to cook meals that may be related to their child’s ongoing illness while also teaching them about nutrition in general. The KidsTRACK also gives families the opportunity to learn how to use any equipment that their child may need once he or she goes home. From ventilators to special wheelchairs, parents are educated on how to adjust, clean, and maneuver the equipment.
All the KidsTRACK programs are geared toward serving the patient’s healthcare continuum while also attending to the family as a whole.
At the heart of it
Core medical specialties were programmed to be shared by inpatient and outpatient visitors; the goal was to provide a continuity of care whether patients are in the hospital for an extended stay or coming back for frequent visits as they grow up. “Nemours wanted to make this a medical home for children and families and provide a consistent care team for both clinic visits and inpatient stays. This resulted in the conscious decision to align inpatient and outpatient care in a single building with medical specialties colocated on the same floor in adjacent wings with shared waiting,” says Betsy Beaman, design principal, SBS.
The shared spaces—such as surgical services, hematology, oncology, and physical or infusion therapy—were organized to be in the same building, on the same floor, to minimize anxiety and travel time for patients and families and to cultivate familiarity and bonds with the staff.
In the clinical spaces, most of the exam rooms were designed to be same-handed and acuity-adaptable, with only slight differences. “Specifically for our inpatient rooms, we used the design requirements for an ICU room and duplicated that for med/surg rooms,” says Michael Cluff, staff architect, Nemours Children’s Hospital. “Generally, other than looking at the quantity of infrastructure for medical gases and electrical outlets on the headwall, every room throughout the building is the same, which allows for operational flexibility.”
There’s also one floor of shelled space to accommodate growth from 95 to 137 beds without having to expand the existing building footprint.
Letting the outside in
The design team, unrestricted by contextual limitations, oriented the building for maximum sustainability along an east-west axis, with the structure’s broad faces placed toward the north and south, according to Moses Waindi, project architect, SBS. With the south face of the building having the most potential for solar gain, the ventilated façade, clad with terra cotta, was designed to allow for a cavity of airspace between the exterior skin and the cladding to provide extra cooling.
“The north side of the building, on the other hand, does not receive as much direct sunlight; therefore, we maximized the use of a curtainwall. The waiting rooms were placed on the north side to allow for ample daylighting as well as great views,” Waindi says. The use of two types of sunshade devices on the façade of the building also allows diffused sunlight into patient rooms and deflects direct sun glare into patients’ eyes without obstructing the view of the gardens.
Nemours’ emphasis on healing gardens and landscaping led to the creation of a one-acre discovery garden with mature trees, terrace gardens, and child-inspired outdoor areas with water play as one of the many features designed to highlight the hospital’s connection to nature as well as its connection to the Wilmington campus.
For a source list relating to this project, see Nemours Children's Hospital: Project Breakdown.