Innovative design solutions: Second floor emergency department?

July 31, 2010
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When the 23-story Ann & Robert H. Lurie Children's Hospital of Chicago opens in June 2012, it will demonstrate a unique approach to hospital high-rise design. The urban site presented a particular challenge for the design team with a fairly small building footprint, leaving a question as to how to best accommodate growing patient volumes in the new hospital's emergency department (ED). Using research, simulation, and meetings with key internal and external stakeholders, the design team developed nontraditional solutions for both the location and patient access to the ED.

Ann & Robert H. Lurie Children's Hospital of Chicago will replace Children's Memorial Hospital, a 270-bed, freestanding children's hospital and academic medical center located in the Lincoln Park neighborhood of Chicago. This state-of-the-art, 1.25-million-square-foot hospital will house 288 inpatient beds (60 PICU, 60 NICU, 144 Acute Medical/Surgical, 12 Psychiatry, six Research, six Epilepsy), multiple pediatric subspecialty outpatient clinics, and a three-floor interventional/procedural platform with 21 operating rooms, five interventional radiology rooms, and the latest diagnostic imaging services. In addition, Lurie Children's will offer a 45-bed emergency department, named The Kenneth and Anne Griffin Emergency Care Center, though this will be located on the hospital's second floor. The decision to locate the emergency care center on the second floor and the considerations for patient access reflect features unique to the chosen site for the new hospital and substantial operations planning.

The decision process to identify the location of the new hospital began in 2005 and over a dozen sites throughout Chicago were considered during the selection process. In the end, it was determined that the future growth of the academic medical center would be best served by relocating the hospital to the downtown “Streeterville” campus of the Northwestern University Feinberg School of Medicine. The decision to move to the Streeterville neighborhood acknowledged a vision to leverage the tremendous opportunities for collaboration within patient care, teaching, and research on the Northwestern medical campus. This location, however, also offered some distinct challenges for our design team. The chosen site, which is adjacent to the recently constructed Prentice Women's Hospital, offered a footprint of only 1.8 acres and would require the construction of a high-rise. Early design planning indicated that the maximum available space on any one floor would be no more than 55,000 square feet.

The ED at Children's Memorial has sustained significant volume growth over the past decade, well in excess of reported ED growth rates nationally. The ED served nearly 40,000 patients in 2000, and this had grown to more than 60,000 visits by 2007. Planning for continued growth at the Lincoln Park site, combined with further growth expected in the new facility, provided conservative estimates in the 68-75,000 annual visit range for the first two years of the new hospital's operation. It was clear that a much larger facility would be needed than the admittedly undersized ED (18 beds in 9,700 square feet with an additional seven urgent care exam rooms in an adjacent 2,300 square feet) in the existing hospital. Space planning and patient throughput exercises, using a 75,000 annual visit model, projected an optimal ED facility with a range of 45 to 55 examination rooms. The question that remained was the following: how big an ED could the new facility house?

The Pebble Project creates a ripple effect in the healthcare community by providing researched and documented examples of healthcare facilities where design has made a difference in the quality of care and financial performance of the institution. Launched in 2000, the Pebble Project is a joint research effort between The Center for Health Design and selected healthcare providers that has grown from one provider to more than 45. For a complete prospectus and application, contact Mark Goodman at mgoodman@healthdesign.org.

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