Renovation Experience Reimagined
Nature-themed art glass and resin panels were installed at the unit coordinator reception desk.
Patient room doors have windows that allow nurses to maintain sight lines to patients, while patients can close the doors for quiet and privacy at night.
When a visitor walks onto the renovated Farr 8 inpatient floor at Beth Israel Deaconess Medical Center (BIDMC) in Boston, the environment may feel different from other acute care floors. This unit is softened with sconce lighting, warm wooden floors, and natural color palettes; floor-to-ceiling windows offer views of the foliage canopies in an adjacent residential neighborhood; corridors are free of clutter and obstructions; and the floor is quiet. “We wanted to solve the problems that typically plague hospital environments,” says Marjorie Serrano, nursing director for cardiac surgery at BIDMC, who was involved in planning the recent renovation of the floor along with her clinical staff. “Hallways are often congested with equipment and linen hampers, and staff congregate around busy nurses’ stations. In the previous space, shared patient rooms were cramped, didn’t have adequate privacy, and couldn’t accommodate visitors. It was too noisy and too busy.”
Working with architects, planners, and interior designers at Steffian Bradley Architects (Boston), the project team reimagined the patient experience for BIDMC, a teaching affiliate of Harvard Medical School that handles more than 750,000 patient visits annually. The 16,000-square-foot renovation converted a single floor of nephrology offices and a patient observation unit into an all-private recovery floor for cardiac surgery patients in BIDMC’s Farr building, which is located on the Longwood Medical Campus, a dense urban area of Boston that houses some of the country’s top hospitals in one downtown district.
Moving the existing cardiac care unit from the sixth floor to the eighth floor offered the square footage necessary to address growing demand for services and increase the unit size from 14 semi-private beds to 20 private beds, improving the patient experience. “We heard recurring feedback from patients that their rooms on Farr 6 were too small, not private enough, and noisy,” Serrano says. The revamped 20-bed step-down inpatient unit is part of the organization’s larger institutional master plan and will serve as a model for future renovation efforts.
The conversion involved constructing nine new patient rooms, renovating 11 patient rooms, and demolishing and reconstructing staff support areas. Designing the new unit within an existing footprint presented limitations because some structural elements wouldn’t allow for desired reconfigurations. For example, the northern wing of the eighth floor, which houses nine patient rooms, has a narrow floor plate, and six of the rooms averaged 200 square feet in size compared to 240 square feet in the other rooms. This meant that the pull-out couches specified for larger patient rooms were too big for the smaller rooms, so convertible sleep chairs were provided for families and visitors in those rooms. Designers also opened up these tighter quarters by reconfiguring the layout, such as moving personal protective equipment (PPE) storage into a recessed unit in the corridor to reduce clutter and maximize space. On the rest of the unit, where the floor plate isn’t as narrow, PPE is located inside the patient room, near the door.
Another challenge involved working within a functioning hospital, which required contractors to schedule work at hours that would minimize noise and disruptions. For example, a dialysis unit located beneath the north wing was open from 6 a.m. to 9 p.m., so all under-floor plumbing demolition and installation of water and waste lines had to be performed between 9 p.m. and 6 a.m. The remainder of plumbing work was conducted two rooms at a time so that each patient room below would be out of service for only one day. Additionally, loud activities, such as floor coring for new waste lines, were done during the daytime so sleeping patients weren’t disturbed.
The team held strategic brainstorming sessions with clinical staff throughout the process to address obstacles as they arose. During demolition, for instance, an existing critical plumbing riser was discovered in a wall that was thought to be dead space. With the staff’s input, the team decided to change the layout of the equipment room and leave the riser intact so that the floor below didn’t experience downtime.
Staff also guided several design and layout decisions, such as the placement of headwall equipment, including thermometers, telemetry monitors, switches, and electric plugs. “We went over full-size mock-ups of the headwalls with the designers to figure out where the most accessible heights would be for each feature,” Serrano says. “Nurses no longer have to reach awkwardly over obstructions for frequently used equipment.”
Another key change involved overhead ceiling lift docking stations. In the original plan, the stations were wall-mounted within a cabinet to keep them out of sight. However, during scenario planning, the staff acted out code responses and realized that the cabinet would be an obstruction at head height, so the hanging cabinets were removed from the patient room design.
Additional design suggestions provided by the nurses included placing hooks instead of coat rods in the patient wardrobes to avoid the need for hangers and giving patients a bedside table so that they can store personal items away from staff work surfaces. Family zones within the newly renovated patient rooms are designated next to expansive exterior windows so visitors don’t impinge on staff and patient space. The unit also houses a nourishment room and solarium for guests, and personal lockboxes are constructed into the millwork to hold personal belongings.
The project also sought to improve workflow and operations for the staff. Sinks and PPE, where the floor plan allowed, are located directly inside the patient rooms, so nurses can enter the room and perform hand hygiene and equipment donning while introducing themselves to patients and families. This flow eases patient-nurse interactions and helps build trust. “Improving communication with patients was one of our key objectives,” Serrano says.
Some technological improvements were also made to allow for more intimate and simplified patient interactions. During a staff role-playing exercise, caregivers spoke to patients who were in bed while using wall-hung computers, but the interactions became awkward when patients were seated in recliners located near the windows, because clinicians would have to talk over the bed to the patients and staff delivering medications would have to walk around the bed to scan patient wristbands. With these challenges in mind, the team decided to replace wall-mounted technology with workstations-on-wheels (WOWs). The WOWs have long network cords to enable the units to move throughout the room and detachable wireless scanners so that nurses can scan medications and wristbands. A future wireless system will eliminate the network cords entirely.
Attention to detail
The team adopted a guiding principle throughout the planning process: a place for everything, and everything in its place. User meetings involved Lean design processes, and prospective drawings were left up during daytime and nighttime shifts so that nurses could review potential layouts and provide feedback about circulation routes. Interactive floor plan “gaming” allowed staff to shift paper pieces around to test room locations, imagine walking distances, and determine where equipment would be most accessible. As a result, the nursing staff decided to swap the location of the nourishment room and equipment storage room so that family members could access the nourishment room in a more centrally located area. Decentralized nurses’ stations were also placed throughout the corridors in strategic locations to improve access to patients and reduce walking distances.
In addition, alcoves in the corridor walls are used to store medical carts and portable monitors. Originally, the alcoves were intended for linen carts, but staff feedback determined that linen carts would be moved into a clean supply room, making space for wheeled equipment to be stored in alcoves. A multipurpose room across from the main nurses’ station provides a central spot for staff and residents to congregate and hold meetings. The medication room was also expanded and rearranged to accommodate multiple nurses, with entryways from two different hallways.
A nature-themed aesthetic was used throughout the unit, with landscape-inspired photography lining the hallways, and ambient lighting complementing the daylight that filters in from the windows. “Probably the best feature is the benches at the end of each corridor in front of those gorgeous windows,” Serrano says. “Cardiac patients have to walk the corridors as part of their rehabilitation, so this gives them a wonderful place to pause and take respite. It’s thoughtful details like these that have really made such a remarkable difference for us.”