Welcome to the world
Moving parallel with the welcoming of new residents to one of the fastest-growing counties in Indiana, a new patient tower extends a cheery, light-filled, warmly sensitive greeting to the area's newborns. Community Hospital North, until a few years ago a modest, reasonably comfortable suburban general hospital, took a giant leap forward in the spring of 2007 to become a full-service urban medical complex with the completion of the new patient tower offering women's and children's services, along with a five-story professional office building and a 1,000-car parking garage. Along the way the architectural team, led by RTKL's John Castorina, and the project team, led by Community Hospital North's Project Manager Mark Hayden, expanded on lessons they learned in creating the Indiana Heart Hospital—“all-digital” and groundbreaking in its own right (see “The Indiana Heart Hospital: The Future Starts Today,” HEALTHCARE DESIGN, May 2003, p. 17). The experience was capped for them this time around with an art program that raised $400,000 from philanthropic local art supporters and led to the creation of 51 original works of art for display throughout the hospital. Recently, Castorina and Hayden took HEALTHCARE DESIGN Editor-in-Chief Richard L. Peck on a virtual guided tour of the highlights of the new facility.
Mark Hayden: Strategically, this was the response of our five-hospital system to the tremendous growth of suburban northeastern Indianapolis and the move of our cardiovascular service line to the Indiana Heart Hospital. This has made our suburban hospital the tertiary hub of our hospital network.
John Castorina: As we did with The Indiana Heart Hospital, we worked to make Community North “paper-light.” Physician order entry (POE) and electronic medical records (EMR) take time to implement and present a cultural issue for staff. From the architectural standpoint, however, it is an infrastructure issue: Locating workstations throughout the hospital so that all data can be accessed and transmitted from anywhere in the hospital. Where there used to be large filing areas and huge file bins for paper records, radiology films, and the like, now there are computers and monitors. There is still some paper storage—temporary storage for the scanning of patient records when referred and the issuance of birth certificates, for example, which is where “paper-light” comes in—but it's much less than it used to be.
Hayden: Again, we took from our experience with Indiana Heart Hospital to take the next step in creating a great patient and family experience, as well as a staff and physician experience. We expanded to 60 all-private rooms, which may be the largest maternity care service in the country. All-private rooms are now the standard of care, according to AIA guidelines and so forth. We're to the point now where they're a reasonable expectation not just for patient satisfaction, but patient and staff safety, better patient/staff communications, and fewer errors. Having room 2222 is one thing, but having rooms 22 A and B leaves more room for errors.
Ergonomics were also a critical issue for us. Having more room to spread the headwalls out and raised outlets result in less bending over by nurses to do their work. Having midboard toilets with convenient handrail access makes it safer for patients, and the ability to assist the patient with one caregiver instead of two means more rapid call bell response. We're finding that the establishment of family areas has led to not only spouses and parents staying overnight, but the adult children of senior patients also tend to stay.
Castorina: The LDRP room consists of multiple components that work in unison to create an environment that can consistently change along the timeline of the birthing process. Each component incorporates design features that cater to its occupants’ needs. For example, the patient headwall is angled away from the room entry to provide maximum privacy from the corridor. Each room has a dedicated storage room for each of transition of trash and equipment. An adjacent area is dedicated to the family and can be isolated from the main room to provide a quiet, comfortable, restful place for the mother; a separated (by half-walls and such) family area with its own TV, refrigerator, and Internet access for privacy and comfort. Another important feature that we introduced based on focus-group input was the incorporation of natural light into the bathroom of each LDRP. The characteristics of soft natural light when combined with specific task lighting have a big psychological effect. Women said they looked better and felt better in such light, so the bathroom is placed to take advantage of natural light coming in from the family area. Another feature of the room is handy storage to allow rapid daily cleaning of the room.
Castorina: We have 36 all-private neonatal intensive care rooms. It's all about privacy and control, including humidity, lighting control, and sound control. We shield the baby from noises which, over a certain decibel level, have been found to cause cranial bleeds. This is why, although there are sleeping accommodations in the rooms, there are no bathrooms—the plumbing noises would be too disturbing.
Hayden: We've learned that the environmental stresses that are issues with adult ICUs are the same for NICUs. Also, the private room versus the gymnasium or fishbowl model NICU allows for more family dignity and avoids their being dragged down by adverse events that happen to other babies in the unit, as often happens in traditional NICUs.
Castorina: Being the father of young children, I consistently try to see the world through their eyes. So, while it's simple to say that we came up with a “treasure hunt” concept for the pediatric unit, it was at times difficult getting there. In a hospital, there are several perspectives that must be applied. The experiences of a healthy child differ from those of an ill child. We come up with ideas and collaborate with the clinical specialists to execute them. These specialists remind us to maximize our design by taking into account issues such as infection, or the need for observation or access. You have to strike a balance for an effective design, and that's where a lot of discussions occur.
Castorina: Natural light facilitates healing. It is one of those aspects of evidence-based healthcare design that we see documented over and over again. It does a lot to promote the biochemistry of healing. In introducing natural light into a structure like a hospital, form does follow function—but the form is not always a box. Curved corridors were incorporated to improve visibility by caregivers, resulting in a football-shaped unit. Patient rooms line the exterior, and a service corridor is flanked by two atriums in the interior. The corridors form a loop so that expectant mothers can walk and progress with labor, all the while monitored by caregivers at strategically placed control stations. Seating areas along the corridors provide rest spots, and the atriums are gathering points. In effect, the mom's need to walk to expedite labor has led to the creation of the skylight atriums. Form does follow function, but you can play with the form.
Hayden: This great art program allowed us to get closer to the philanthropic community and to the community at large. I've worked with several artists on the installation of their work, and their enthusiasm for having their work exposed to people in this setting was tremendous. I personally had never realized that a healthcare institution could function as an art gallery of sorts in ways that could be of so much benefit to patients and families. I'm always looking for a “win-win,” and this was a huge one in many ways.
Castorina: This is a great tribute to the work of Bill Kingston of the Community Health Network Foundation and RTKL interior designer Dori Mommers, among others. The idea of raising funds from patrons of the arts, as well as from healthcare patrons was unique. The interior design, from the structure, to the lighting, to the individual pieces to the palettes used, was Dori's work. Today every family of an admitted patient has access to a guide that describes the art, and I have actually seen them studying the art and contemplating it. It provides distraction and involvement they need in these circumstances. It really works. HD