When The Indiana Heart Hospital opened re-cently, what has been considered the hospital of the future officially became part of the present. As the first all-digital cardiovascular hospital in the nation, the $60 million, 88-bed facility im-plements an advanced architectural design that, when married to the pioneering technology, creates one of the most innovative patient environments in the country.

The 210,000-sq.-ft. facility was built from the ground up to provide a new level of care for cardiovascular disease by eliminating all paper- and film-based medical records, including medical histories, images, and waveforms. All other paperwork not yet appropriate for electronic signature verification will be scanned into the system. As a fully digital environment, the design revolved around supporting the hospital's technology goals of leveraging data into clinical operations by closing the loop between medical devices and information systems.

We were charged with reinventing the way patients would move through and exist within the facility, accommodating family participation in the recovery process, and expediting medical personnel function on a day-to-day basis. Ultimately, however, the hospital must be simple to use and have the flexibility to accommodate special needs and evolving protocols. Therefore, melding the technology and the environment was necessary to create the framework for this “hospital of the future.” This meant throwing out traditional planning models, as well as the standard programming process of determining the hospital's size and composition.

Operational process, not space allocation, became the driving force of the design-a reversal of the usual design approach. That is, the building and the technology were designed around the refined processes for clinical and administrative operations using the “paperless” approach.
© Hedrich Blessing

© Hedrich Blessing

As a joint venture with Indianapolis-based Community Health Network and Indiana Heart Associates (a group of nationally respected cardiologists and cardiovascular surgeons), The Indiana Heart Hospital partnered with GE Medical Systems to develop the digital capabilities. As a result, there are many firsts in this hospital (including the only gender-specific ECG, focusing on the more subtle cardiovascular risk factors occurring in women, as well as GE's first working digital information system).

Word gets around quickly. Even before the facility opened at the end of February 2003, medical professionals, designers, and hospital administrators were traveling to Indianapolis from all over the world to get a firsthand look at how this unique concept was implemented.

Our design firm, RTKL, was involved from the initial stages of the project, in partnership with BSA LifeStructures, which was the executive architect and provided the engineering for the project. This was designated as a beta-testing site, simply because this concept had never been implemented before. The project took 14 dedicated months, with more than 360,000 man-hours of work under the direction of five directors, with a staff of more than 160 consultants-truly a case study in teamwork. Designing the facility was an evolving process, tailored to support the unique technology and clinical processes that themselves were under development.

Because no such facility existed, part of the design process involved building mock-up rooms to test caregiver and patient movements, the placement of medical equipment, and interfaces with paperless/filmless technology. Additional mock-up rooms were constructed in a 5,000-sq.-ft. software development-training lab. Within this area, staff were trained on the appropriate interaction with technology in clinical and nonclinical settings.

“The design we created with RTKL was specifically targeted to support our digital concept, while concentrating on patient and staff flow,” explains David Veillette, CEO at The Indiana Heart Hospital. “RTKL realized from the very beginning that supporting our technology-and moving patient care back to the bedside-was our primary goal. By creating a healing environment, and using design to improve staff efficiencies and increase patient satisfaction, we are able to provide a healing environment that begins the minute the patient arrives.”

One example of design that supports the hospital's objective is the patient care unit. RTKL designed the unit to the hospital's specific clinical, operational, and patient satisfaction benchmarks, which led to the creation of the hospital's most identifiable feature, the “Hurricane” (see floor plan).

Resembling a hurricane-warning symbol in shape, the patient care unit is laid out in three curved wings on each floor. Each wing contains eight private rooms, with bedside technology. The technology and the design facilitate the location of caregivers at bedside; therefore, access to information must be instantaneous and always within reach. There are 88 beds in the facility and more than 650 computerized work-stations.

The Hurricane incorporates 24 beds per floor with three separate circulation patterns. This configuration reduces walking times, permitting nurses to monitor patients more efficiently and allow cross-coverage between suites through direct visual access to multiple rooms and nursing teams. In addition, all rooms are acuity-adaptable, or “universal,” thus minimizing patient transfer and related adverse outcomes. The intent is to allow the patient to remain in one place during an entire stay, rotating the needed care to his or her room.

Because there is no central nursing station and care is given at bedside, the center of the hurricane design serves as a control station, monitoring public traffic into the patient areas. It also serves as an information/education center for those family members who have been integrated into the patient's rehabilitation process.

Because of the sensitivity of the cardiovascular patient, the impact of environmental factors, such as noise, led to an in-depth study of traffic patterns. Cardiac care patients, who are encouraged to be up and walking within 24 to 48 hours after surgery, are forced in a traditional hospital to walk in the general corridors. They must compete with visitors, carts, equipment, and other foot traffic at a time when they need to concentrate on healing. Our design purposely segregated cart traffic, general corridor traffic, and patient rehabilitation areas. Each eight-bed suite has a “Patient Lane” located directly outside the rooms, making it easy for a family member to participate in the process, yet not be in the way as patients begin their rehabilitation. Each Patient Lane includes a dedicated walking area with an uninterrupted handrail exceeding 25 feet in length, making it safe and easy for patients to tackle their rehabilitation after surgery.

The facility as a whole has incorporated other design elements that further support patient and staff satisfaction. These include enhanced wayfinding and orientation techniques; advanced information centers; immediate acceptance and discharge protocols; an integrated discharge lounge that includes a pharmacy, family nourishment stations, children's play areas, and dietary room service; point-of-care service; readily available educational/Internet hookups; and an infrastructure that has been designed around expansion without interrupting existing operations.

This new patient care experience begins when patients arrive at the hospital-in fact, upon arrival, they can see through the transparent entrance into an inviting environment, providing a sense of orientation and comfort with the overall facility. Anxieties are relieved at the information desk, because patient and family need only go to one information center for all the information they need-and the information is coordinated for them. The lobby, meanwhile, is outfitted with ports for laptop connections so that visitors can keep up with work, if necessary.

Once processed into the system, patients and family will occupy a dayroom area. This 32-room area incorporates four suites of eight rooms on the first floor, allowing dedicated, private space for patients and their families, rather than the more common large waiting room or cubicle stations, as they wait for loved ones undergoing a procedure. Each dayroom is outfitted with a fixed information terminal, a flat-screen monitor, and a keyboard that is connected with the main information system, and which can be connected with other such terminals with the use of appropriate passwords and other security. If desired, the physician can communicate with the family members via audio or video hookup before, during, or after a procedure, thus keeping families within the information loop.

As technology and new clinical advances continue to reinvent the way medicine is practiced, the healthcare environment must support these new directions and reinforce patient and family comfort, as well as staff desires. The Indiana Heart Hospital serves as an example of the new benchmark for the rest of the healthcare industry-reaching for the digital future while advocating humanity, with the assistance of physical design. HD

John L. Castorina, AIA, ACHA, serves as a vice-president for the healthcare sector at RTKL, one of the leading healthcare design firms in the United States. He is based in their Dallas office.

For further information, e-mail jcastorina@RTKL.com.


The Design Team

The RTKL design team included John L. Castorina, AIA, ACHA; Bethany Childress; Aimee Davies, ASID; Jim Johnson, AIA; and Jorge Rodriguez. BSA LifeStructures of Indianapolis served as the executive architect and provided engineering services for the project. Summit Construction Company, Indianapolis, was the general contractor, and EQ International served as the Medical Equipment Planning consultant. The Project Manager representing Community Hospitals Indianapolis was Mark Hayden.

Healthcare Design 2003 May;3(2):17-18