An integrated design for patient care and translational sciences
Chili's Care Center, St. Jude Children's Research Hospital, Memphis, Tennessee
Owner: St. Jude Children's Research Hospital
Project Completed: January 2008
Interior Design: Inventure Design (formerly O'Neill Hill and Associates) and SmithGroup
Construction Management: Skanska
Photography: © Hedrich Blessing; Jere Parobek; Peter Barta; Seth Dixon
Total Building Area (sq. ft.): 340,000
Total Cost: $106,000,000 construction (no equipment/furniture)
Cost/Sq. Ft.: $312
St. Jude Children's Research Hospital is the type of facility that reminds healthcare architects why we do what we do. The mission of this organization is to advance cures and means of prevention for catastrophic childhood illnesses through research and treatment. It serves all children regardless of race, religion, or a family's ability to pay, and scientists and clinicians freely share their findings with the worldwide scientific and medical community. The work conducted by St. Jude is truly a national resource.
SmithGroup recently designed the Chili's Care Center, a vertically integrated patient care and translational sciences facility at the hospital's campus in Memphis, Tennessee. This new facility houses major treatment and research programs for brain tumor and stem cell/bone marrow transplant patients. It was designed to promote the multidisciplinary collaborations needed to provide integrated therapy to critically ill children.
Integrated, healthy design
In the new eight-floor, 340,000-square-foot tower, all major program activities take place just a few floors apart. Laboratories are stacked above patient units, which are stacked above diagnostic imaging and radiation oncology areas. Diagnostic and treatment modalities include four 3-T MRI machines, five CTs including one PET scanner, a cyclotron, and a three-vault radiation therapy suite. This vertical layout, the first of its kind, facilitates the bench-to-bedside approach St. Jude researchers and caregivers take toward discovering today's best therapies and tomorrow's new cures. Colocating research, diagnostic and treatment, and patient care spaces enables researchers to be as much a part of a child's care team as his or her parents and the clinical healthcare team.
The building's mechanical systems also support patient care. Because patients' immune systems can be weakened during cancer treatment, infection control is of the utmost concern at the hospital. In fact, even individual packages of pepper are autoclaved for patients' protection against potentially deadly infections. Two completely separate locations for air handling systems prevent crossover between the public and patient spaces. Each floor is served by a dedicated air handling unit with 100% HEPA-filtered air. To further enhance infection control, an interstitial level, featuring walkable slabs, separates the floors, allowing for system maintenance to be conducted outside of patient areas. Elevator cores are located outside the building footprint, with negative pressure to the patient floors, preventing infectious organisms from entering the floors through the elevator shafts.
The patient care floor contains 18 patient beds and was designed for an average 45-day length-of-stay, as the children treated at the facility require lengthy hospitalization. Considering the extended nature of these hospital visits, each patient's room is adjoined by a room where his or her parents can stay. The needs of parents and patients were considered paramount in the development of the patient unit design.
Integration of patient and parent expectations
To determine those needs and establish an empirical basis for the design, SmithGroup worked with the hospital's clinical leadership to develop a survey questionnaire for patients and their parents.
Over 200 surveys were administered by the St. Jude staff to comply with HIPPA regulations. The surveys consisted of 12 questions for children and 28 questions for parents, ranging from Likert-type questions asking whether certain room features were “not at all,” “somewhat,” or “very important,” to yes/no and more open-ended questions. Parents were also asked how long their children had been at the hospital.
The surveys showed that the features patients liked best about their rooms were the TV/VCR/DVD, the view to the outside, and the private patient bathroom. Nearly half of the patients indicated they preferred visiting siblings to spend the night in the parent room; a third of the patients preferred the patient room (with some children expressing no preference).
The top three features parents appreciated were the private bathroom, the window between the parent and patient room, and the TV/VCR/DVD and Internet connection. Their most important design concern was the ability to sleep in the same room as their child. Enough space for visitors, and access to laundry facilities within the hospital were also highly ranked by parents. The changes parents most wanted to see were the addition of a tub or shower to the parent bathroom and a bed or couch to the parent room.
A new patient and parent room module
The survey results illustrated more space was needed to meet the needs of patients and families during long hospital stays. The new patient rooms cover 225 square feet; the parent rooms are 145 square feet in size—equal to the patient rooms on the existing unit. Measured as a whole, the entire new patient and parent room module spans 28 feet of corridor.
This affords ample space for parents or siblings to sleep in the patient or parent room. Visitors are easily accommodated in either room. Furnishings have been added to both rooms for families' comfort.
A hard wall separates the two rooms to assist with infection control. The patient rooms are positively pressurized, with positive airflow to the parent room and the corridor. A doorway provides direct access between the two rooms. The window between the parent and patient room, which parents had rated so highly on the survey, is much larger in the new design, for better visibility.
Adjacent to each parent room, there is a private bath room that includes a shower. Separate toilet facilities for families afford not only privacy and convenience, but also increased infection protection for patients.
By rating the TV/VCR/DVD and exterior window as the best features of the existing patient rooms, the children surveyed expressed a clear desire for positive distractions. Each new patient room includes a window that is significantly larger, provides more natural light, and is easier to see from the patient bed than the window in the existing rooms. Nintendo Wii gaming systems were installed in each room to help entertain patients. Physical therapists at the hospital report the systems have proven to be a great source of activity for the children.
The unit is designed like a neighborhood; different colors designate each patient and parent room module as a “house” with its own front porch area. At St. Jude, patients' rooms are considered their safe haven. When a child is in his or her room, no one else is allowed to enter besides parents, caregivers, and up to two visitors at once. A vented under-counter pass-through is provided at each room to hold soiled material and trash, where it can be picked up by environmental services staff from the corridor. The holding area is hidden behind cabinet doors.
A supply station or a decentralized charting area is also located in the corridor outside each room, with clear site lines to the patient bed. When parents are in the room with their child, they may draw the blinds for privacy, opening them when they leave so nursing staff will have a clear view to monitor the patient.
The patient rooms are arranged around the outside of the unit in a racetrack formation. Two rooms at the outer corners are oversized for lead shielding and other necessary isolation requirements of radioactive treatments.
Integrated support services
The interior of the support core contains two large central nurses' stations, at opposite corners of the unit, and a variety of ancillary services. Most notable of these is a full clean-room pharmacy where radioactive and chemotherapy drugs can be produced specifically for individual patients on the unit. The hospital reports that locating the pharmacy on the unit itself has significantly reduced concerns over delay in medication delivery and has been very successful in integrating the staff pharmacists as an essential role in the health team.
Other key support services, such as the unit manager, child life, social work, and chaplain's office, are also located on the unit. This, too, has reportedly helped in creating better communication among the multidisciplinary team. A room for physical therapy enables a more proactive plan to support the patient's activity needs during their long inpatient stays. Patients also benefit from having spacious child and teen life play rooms located on the patient floor.
Two secure medication dispensing rooms adjacent to the central nurse stations have been described by staff as a “life saver” for direct access and maintaining regulatory compliance.
A staff lounge and family amenities, including a dining area and laundry room round out the patient unit. Parents say these resources are extremely helpful, given their children's acuity levels and length of stay.
Designers of pediatric health facilities are always challenged to create interiors suitable for children of many ages. Child development experts state that the sea is an image that remains evocative throughout the distinct stages of childhood. The main public entrance and waiting areas, as well as the diagnostic and treatment spaces, use water imagery to establish a soothing environment that appeals to all ages. Shades of blue; curved, bubbly glass features reminiscent of a waterfall; aquariums; and an enclosed stairwell that evokes a wishing well all contribute to this theme.
In the spirit of St. Jude's research mission, SmithGroup and St. Jude have committed to conducting an ongoing postoccupancy evaluation of the facility to assess the facility's novel design. The hospital's master plan suggests the opportunity for a second tower to adjoin the Chili's Care Center. The future design of this tower will benefit from any changes identified through this ongoing evaluation to allow even more children and families to gain the benefits of this teamwork-focused design.
After almost a year of occupancy, our preliminary results suggest that our integrated approach has been a meaningful success for our patients, their parents, and caregivers. The facility is enhancing the mission of the St. Jude community. HD