Special Delivery: The Colorado Fetal Care Center
The ribbon had barely been cut on a new fetal intervention suite when surgeon-in-chief Dr. Timothy Crombleholme scrubbed in to remove a life-threatening bronchogenic cyst from a baby before it was even fully born. With the fetus delivered only halfway (from the chest up) via c-section and anesthetized by a pediatric anesthesia team, Crombleholme removed the mass, put in a chest tube, intubated the baby, and—once the baby was stabilized—finished the delivery and cut the cord. More than 30 people were in the room, tending both mother and child.
Complicated surgeries like this were anticipated and planned for during the creation of the Colorado Fetal Care Center (CFCC) on the fourth floor of Children’s Hospital Colorado’s new East Tower. Opened in November 2012, CFCC—part of the Colorado Institute for Maternal and Fetal Health (CIMFH), a joint venture between Children’s and University of Colorado Hospital, Aurora, Colo.—focuses on the care of high-risk pregnancies and fetal anomalies. It incorporates leading-edge equipment and meticulously calibrated spaces, with the goal of providing an industry benchmark within this highly specialized field of medicine. And it does so in a high-end hospitality environment.
Brains and beauty
The design team ran dozens of scenarios to assess the check-in process, wayfinding, room comfort, and pre-op steps; simulated mom and baby dummies were used to test the efficacy of the OR suites. The lessons learned from these scenarios—along with nationwide field research and plenty of input from Crombleholme, a renowned fetal and pediatric surgeon—shaped the size, setup, and finishes of the 12-bed, two-OR unit.
At the same time, the interiors team was repeating the mantra: “Spa-like.”
“From early on, the design concept was based on creating a spa-like experience: relaxing, calming, soothing, healing,” says Claudia Styrsky, associate partner, ZGF Architects (Portland, Ore.). “These are high-risk moms; we want to take down some of that stress and worry.”
Natural materials, a variety of lighting levels, and luxurious bathrooms play their part in creating that vibe. So do the huge patient rooms, which, at 395 square feet, are designed to accommodate the mother’s labor, delivery, recovery, and postpartum stages (LDRP), as well as the needs of co-parents and other children.
Maple wood finishes with accents of natural sorghum straw can be found throughout the unit, providing warmth while also creating a connection to the adjacent Children’s Hospital (which features similar wood details). The lighting design, especially within the LDRP room, really embraces the relaxation concept. “What makes spas successful is the use of more indirect light, with varied sources,” Styrsky explains. “There are a number of switches in the patient room so you can create different light levels based on function or mood.” Likewise in the bathrooms, where the mother can soak in the tub beside an indirectly lit glass panel featuring the image of a flowering tree. When she’s finished, a different light setting at the sink allows her to “feel like she’s doing her makeup at home,” Styrsky says.
It certainly doesn’t sound like a typical patient bathroom, and it isn’t. Every one includes a separate shower and bathtub, both generously sized, with high-end glasswork, tile, fixtures, and counter surfaces. But the design team didn’t break the budget. “When you really get down to it, it’s paint and tiles and glass—materials we use all the time in healthcare, but just done in a really nice way,” says Victoria Nichols, medical planner and associate partner with ZGF. Styrsky adds: “The bathroom tile looks like it’s stone, but it’s not. It’s a reasonably priced, nice porcelain tile. The countertops are a quartz solid surface material.”
The family way
In the LDRP room, there’s plenty of room for a table and chairs, a recliner, and a sleeper sofa to accommodate the co-parent. Most of the furniture is on wheels, so a family can reconfigure the space at will. “There’s space carved out for everyone,” Styrsky says. “Some of these patients are going to spend quite a bit of time here, so it becomes like their home away from home.”
The family focus was a key priority for the design team, and the unit includes a full kitchen and an adjacent respite area, accessible to all patients and their visitors. The spaces are not only intended to allow individual families to make themselves at home, but to encourage intermingling with other patients and their support teams.
“Community tables can be pulled together for a shared meal,” Styrsky says. “These patients spend a lot of time with moms in similar conditions, and they become like an extended family.”
Sensitivity and safety
The enveloping luxury and emphasis on keeping the family close are support mechanisms, secondary to the unit’s purpose of providing highly specialized care for in utero babies and newborns facing grave medical issues. This introduced a high degree of delicacy in terms of designing the unit in a way that’s not only sensitive to the mothers’ physical and emotional needs, but also fully equipped with high-tech, easily accessible equipment, supplies, and systems that will allow staff to respond swiftly and skillfully in an emergency.
So while the movable furniture in the patient room does allow the family to stay close to the patient, it also allows the staff to get everything out of the way easily during delivery or in an emergency. And those lighting options, where moms can adjust a number of switches to fit their mood, also include an option for staff to illuminate the space with additional functional lighting when necessary. “It was all about striking that balance, between spa-like and functional,” Nichols says. “And one doesn’t have to win out over the other.”
Sometimes it does, though. For example, the headwalls were redesigned because of care concerns. “Originally, the access to medical supplies was all hidden, because we wanted it to feel like you were just in a bed and not necessarily in a hospital,” says Mary Beth Martin, RN, executive director of CIMFH. “But we found through several simulations that the room didn’t offer the patient the safety we needed in the event of an emergency. With OB patients, anything can happen, and happen rather urgently. So today, those supplies and emergency equipment are more visible. But there are so many other things in the room [to look at] to provide that calming, relaxing environment.” (See “Trade-offs and Modifications,” below, for more on changes made during construction.)
The maternal operating room and adjacent fetal intervention suite compose the crown jewel of CFCC, designed to be the absolute optimal space for performing everything from c-sections to the first-of-its-kind procedure described at the beginning of this article. Crombleholme has been performing and studying complicated fetal and pediatric surgeries for more than two decades, and he founded the world-class fetal care program at Cincinnati Children's Hospital Medical Center. His experience in Cincinnati (and prior to that, at Children’s Hospital of Philadelphia [CHOP] and the New England Medical Center in Boston) played a huge role in guiding the design of CFCC’s procedural spaces.
out of all the equipment and supplies in the fetal suite was ultimately determined by Crombleholme’s prior setup at Cincinnati Children’s. But the size of the room—about 800 square feet—is much larger. “He was really able to take the best practices from Cincinnati and CHOP, and bring them here,” Martin says.
“We went through several simulations and mockups on how to lay out the room so you could have the most flexibility,” Nichols says. “Other programs we saw relied on pediatric ORs or adult ORs and some combination of pulling adjacent spaces together. But Colorado was really committed to providing a dedicated fetal OR with adequate space, because there are huge teams of people and adjacent support spaces, as well.”
From a construction standpoint, the intervention suite’s ambitions created a timing challenge, because planning for inclusion of the latest technology and equipment creates a lot of uncertainty. Doug Mangers, project director, McCarthy Building Cos. (St. Louis), explains: “You don’t go and look at 20 of these, choose the one you like best, and then duplicate it. You’re trying to do something quite extraordinary as far as what’s happening in that room, and nobody wants to shortchange the physical space and create any sort of limitation.”
With all the various team members weighing in—Crombleholme, the designers, the owner—“It just led to delay through the design,” Mangers says. “So it’s hold up, hold up, hold up—OK, let’s go. Meeting our completion date was particularly difficult, because we waited until the very end to get the last of that technology and everyone’s great ideas incorporated. And we did that. Everyone really came together to make that happen.” Because the East Tower was constructed under an integrated project delivery contract, the team had additional incentive to complete everything on time and on budget.
CFCC has gradually been adding new services since its November opening, starting with c-section deliveries only and just recently beginning to take patients for vaginal delivery (finally allowing for full use of the LDRP rooms). As of this writing, the facility is not yet accepting patients who arrive in labor. Martin calls the rolling-out process “slow to be safe.”
In the end, the facility provides a contiguous connection of patient rooms, the fetal intervention suite, support services, and NICU (housed adjacent to CFCC in the connected Children’s Hospital). In the event that the mother is seriously ill, she can be cared for at the University Hospital right across the parking lot.
“Many of the other programs we saw are relying on multiple facilities,” Nichols says. “So they may have a center, but in reality, the birth is happening somewhere else, or they’re taking them over to the pediatric OR for the procedure, or taking the baby back to the NICU or somewhere else. For a lot of different reasons, Colorado was able to pull the best of all of these things together into a collocated program.”
TRADE-OFFS AND MODIFICATIONS
Before the new Colorado Fetal Care Center (CFCC) was built out in the new East Tower of Children’s Hospital Colorado, the project team did a small Phase 1 renovation (two LDRP rooms, a c-section delivery room, and some support spaces) within the existing hospital to get the program off the ground and begin some of the training. It provided a perfect opportunity to test everything with real patients and work out a few issues before the launch of the full unit.
“We also built full-scale mock-ups in an offsite warehouse for all key driver rooms, like the LDRPs, NICU resuscitation areas, and operating room,” says Barbara Anderson, a nurse, medical planner, and associate partner with ZGF Architects. “The staff simulated all the key functions they’d have to go through.”
Based on these simulations and feedback from patients, several modifications were made, including:
Patient shower. Phase 1 patients begged for bigger bathrooms (which they got in the new space), and more accessibility in the shower. “Our initial design had a shower with a glass door, and it really looked fancy and nice, but that just didn’t meet the needs of the patients and nursing teams,” says Mary Beth Martin, executive director of the CFCC’s parent group, the Colorado Institute of Maternal and Fetal Health. “Some of our patients are having twins and triplets, and they need assistance in the shower. So we went back to a different design that allowed mothers to walk into the shower and have two nurses attend them.”
Wood finishes. Claudia Styrsky, associate partner with ZGF who led the interior design process, says the team had tried white oak for the casework, but found it difficult to get a consistent look and opted for maple instead. And to fit the desired spa-like aesthetic, she says, “We originally tried a darker floor color, a wood-look resilient flooring, but it was too dark and showed marks.”
Headwall design. Patient safety required a compromise in the design of the headwalls, sacrificing a seamless hospitality feel in order to keep supplies and emergency equipment more easily accessible (and visible).
Pre-op procedures. Once the CFCC unit in the East Tower was nearing completion, the team went through practice scenarios with real mothers and staff. For patients arriving to have a procedure, the plan had been for moms to enter the unit and then go straight to the pre-procedural suite to get changed and receive IVs and anesthesia. But the mothers’ feedback was strong: “Way too scary,” says Martin. “They’re coming to have surgery on their baby, maybe at 20 weeks, or they’re having a c-section without knowing what the outcome will be. They really needed time to check in, go to their own room, change, and have time to get oriented to the environment.”
Now, those parents have the opportunity to arrive as early as like to go to their rooms and even have IVs and anesthesia consultations there, if that’s what they prefer. “It seems to calm them a lot,” Martin says. “We had put lockers in [the pre-procedure suite], and they’re just obsolete.”