East Tennessee Children’s Hospital (ETCH) will open a new 245,000-square-foot surgery and NICU expansion in August 2016. The addition will house 152 beds, including a NICU, consolidated perioperative services, and new clinical exam rooms.

Once the expansion is complete, space freed in the existing hospital will be renovated to provide a unit that meets an urgent demand for neonatal abstinence syndrome infant care.

While it was important that the Knoxville, Tenn., hospital be upgraded to meet the Facility Guidelines Institute’s Guidelines for Design and Construction of Hospitals and Outpatient Facilities, the project’s central goal was to strengthen the hospital’s regional recognition and brand by improving operations and elevating the quality of pediatric care.

The site is a hospital-owned parcel across from the main campus. Physical challenges included integration with the existing hospital and addressing the site’s major grade change. The design team, led by Shepley Bulfinch (Boston) and BarberMcMurry Architects (Knoxville, Tenn.), used the grade change to provide two parking levels—one for medical staff and one for the public—with their own grade-level entrance.

To cross the street, the team created bridges between the new and existing facility, connecting four of the hospital’s five levels. Rather than treating these bridges purely as circulation routes, several were developed as open spaces with public waiting areas, play space, and consult rooms. Floor-to-ceiling glass fills these spaces with natural light and creates a highly visible identity for the hospital from the street. Two other connections are dedicated to off-stage circulation.

The concept of on-stage and off-stage was also implemented in planning the NICU. Families circulate on the perimeter, with staff areas in the center of the unit. Dedicated back-of-house corridors minimize circulation overlap with family members. The same concept was used in the design of clinical exam off-stage areas, with a staff lounge and open workstations at the end of each exam corridor.

ETCH has used the expansion as an opportunity to significantly change workplace culture, as well. Working with the design team, the provider has begun to modify staff processes using Lean design principles.

For example, consolidated and collocated departments will improve efficiency and productivity in operations and materials management, and private perioperative rooms will reduce transport time and staff handoffs while allowing patients to remain in the same room for all phases of recovery. Moving from the existing hospital’s vertical organization to a single-floor operation for surgery and perioperative services also supports opportunities for improving staff efficiency and cross-training.

The NICU is consolidated from multiple floors and open bays to one floor with 48 private rooms. All patient rooms are required to have access to daylight, which was challenging given the need for interior NICU patient rooms. The design response was to provide natural light to these interior rooms with four light courts. These courts are visible from the corridors and offer small breakout spaces for quiet repose. Two larger light courts provide daylight to the main care provider station and family lounge. The adjacent garden provides green space for families and a separate staff area.

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