It is one thing to have a traditional multispecialty hospital. It is quite another to have a multispecialty unit. But that is what the LifeBridge Health System's Sinai Hospital in Baltimore, Maryland, achieved recently when it assembled the various specialty parts of its Brain & Science Institute into the Rose and Joseph Lazinsky Neuroscience Center. The Center is a 36-bed, all-private room, single-floor grouping of specialty services. Specifically involved are its Neurology Department (promoted to an admitting department from its former consultancy role), Neurosurgery Department and Orthopedic Spine Department, which share beds, space, equipment, and staff to enhance patient comfort and convenience and increase staff collaboration and efficiency. With areas devoted specifically—but not exclusively—to stroke, spinal disorders, epilepsy, and adult hydrocephalus, it presented an unusually compressed design challenge. Recently, LifeBridge Health Brain & Spine Institute Administrative director Jessica Cooper, architect Lee Coplan of Hord Coplan Macht, and nurse coordinator Faith Muigai, CNRN, discussed how the challenge was met with HEALTHCARE DESIGN Editor-in-Chief Richard L. Peck.
Richard L. Peck: Would you give a brief overview of the makeup of this unit?
Jessica Cooper: We have a wonderful mix of faculty and voluntary, or attending, physicians in neurology, neurosurgery, and orthopedic spine surgery, and we have a physical rehabilitation service also on the unit that we consider to be a fourth specialty. We have nursing stations at each end of a racetrack patient room arrangement [figure 1], with support spaces in the interior. We have also included nearby office spaces for nursing leadership, case managers, nurse program coordinators and midlevel providers (nurse practitioners and physician assistants).
Peck: What were some considerations in planning for this mixed use space?
Cooper: When Neurology went from a consulting service to full-admitting department, we expanded our mid-level providers from 4 to 13. Since we had already started planning by that time, finding space for them was a bit of an afterthought. We also had limited space in general because we were located directly over the emergency department within the building's existing footprint. We were fortunate to find space on the floor that had been vacated by the previous occupant. Because it's located near the entrance to the unit rather than within the center, it's worked out well.
Lee Coplan: We also mulled over the centralized versus decentralized nursing station concepts. The nurses wanted to be as close to the patients as possible, so we went with the decentralized nursing stations [figure 2]. Although there was some concern there would be a loss of collegiality of the staff, the desire for efficiency was overriding.
Cooper: Actually, collegiality has not been an issue and was, in fact, enhanced by everyone being able to see patients in the same location. Before we started this unit we had spine patients in one wing and stroke in another, and physicians covering were running from one wing to another. The new unit also gives nurses enhanced visibility of patient rooms. There is also a lot of space for physicians and midlevel providers to get together and discuss cases.
Coplan: Probably the most difficult aspect of the design process was not in coordinating the various specialties, but in coordinating faculty physicians versus attendings. Faculty physicians' schedules were manageable through the hospital, but the attendings had their own practices as well as privileges at other hospitals, and getting them to participate as needed in our design discussions was a challenge. We were fortunate in that most of the faculty physicians were experienced in working with us on various design projects. There were a lot of familiar faces involved—we understood their needs, and they understood how we work, and what the needs of the hospital were. The challenge was to get community physicians to the same level of understanding.
Peck: Would you discuss the design of the patient rooms?
Cooper: We wanted larger rooms that are zoned for nursing, patients, and family [figure 3]. We did what we could to encourage families to stay the night, with lots of cabinet space for storage, wireless Internet, and location of the family zone toward the rear of the room to minimize noise. Families we've heard from say they love it; they think they're staying in a hotel.
Coplan: We moved the bathrooms outboard, which allows for better nursing observation of the room. And, to make things more accommodating for a nursing staff that is aging, as well as for overall convenience and patient safety, we installed tracks for ceiling lifts to move patients from bed to bathroom [figure 4].
Faith Muigai, CNRN: Our patient rooms are computerized for bedside documentation, which enhances patients safety and allows nurses to be more efficient. The epilepsy monitoring area is wired for continuous Video-EEG (brain wave) monitoring. This has provided a more focused diagnostic approach to caring for patients with seizure disorders.
Peck: How does all this seem to be working out in general?
Cooper: All our patient surveys indicate that they're pleased with the space. Family members of stroke patients enjoy the “healing lounge,” which is a quiet, comfortable area adjacent to the unit where they can get away without having to leave the unit altogether. Physicians say they're developing more collegiality and collaboration—the chief of neurology notes that he regularly sees and interacts with the neurosurgeons, and the director of the hydrocephalus area interacts with neurosurgeons who insert shunts for his patients. We have space for multidisciplinary conferences held on a regular basis.
Another positive aspect is that we are designed for growth. Even though the unit is in its “infancy,” we are aggressively planning for even higher acuity—for example, a deep brain stimulation program and a vascular intervention program, with appropriate staffing for each. These patients will be on the existing floor, however, a future floor directly above the unit will be home to neurocritical care.
Peck: What are lessons you learned from designing this unusual unit?
Cooper: You have to be flexible. This design is meeting our needs so well, it's allowing for flexibility. The plan is for 12 spine beds, 10 stroke, 4 epilepsy, 4 hydrocephalus, 4 general neurology, and 2 close observation. Right now, though, not all these beds are used for these specific cases. The rooms aren't designed for subspecialties—with their consistent size, layout, and equipment, we can be flexible and cross over, so that a spine bed might be used for a stroke patient, and so forth. This allows us to deal with both patient census and nurse staffing variability.
Muigai: The unit design allows all the specialists to attend to patients' needs in a timely and efficient way. It has been rewarding for me to be a part of this process.
Coplan: The overriding factor to me was having a single coordinator overseeing this project. Without Jessica riding herd on everyone and getting input when we needed it, I think we'd still be designing this and it would never have gotten done. By having a strong leader on the client side, our team was able to collaborate with all the important audiences and have a clear understanding of the challenges that needed to be addressed through our design, and the goals that they had for improving both the physician and the patient experience. This enabled us to achieve those goals and create a center of excellence. HD
For more information, contact Lee Coplan at 410.837.7311, e-mail firstname.lastname@example.org, or visit http://www.hcm2.com. Contact Jessica Cooper at 410.601.8707, e-mail email@example.com, or visit http://www.lifebridgehealth.org.