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PDC_2007_Intensive Care Design

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PDC_2007_Intensive Care Design

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PDC_2007_Intensive Care Design

  1. 1. Intensive Care Design Wh ill b ?Where will we be? A th St A d MD FCCMArthur St. Andre, MD FCCM Washington Hospital Center Washington, DC Tom Harvey AIA MPH FACHATom Harvey, AIA MPH FACHA HKS Inc. Dallas, Texas Debajyoti Pati, PhD AIIA © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 1 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 1 Debajyoti Pati, PhD AIIA HKS Inc. Dallas, Texas
  2. 2. Outline • A Day in the Life on the Unit • Critical Care Teams • Demand / SupplyDemand / Supply • Expectations Needs E i t f C• Environment of Care • Constraining Forces • Guidelines Minimalism • Evolving Trends / Predictions / Future © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 2 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 2 Evolving Trends / Predictions / Future • The Ideal Room
  3. 3. Intensive Care Design Wh ill b ?Where will we be? A th St A d MD FCCMArthur St. Andre, MD FCCM Washington Hospital Center Washington, DC Tom Harvey AIA MPH FACHATom Harvey, AIA MPH FACHA HKS Inc. Dallas, Texas Debajyoti Pati, PhD AIIA © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 3 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 3 Debajyoti Pati, PhD AIIA HKS Inc. Dallas, Texas
  4. 4. Shadowing Studyg y • Washington Hospital CenterWashington Hospital Center • Two critical care units – SICU and CCU • Shadowing: MD Intensivist, RN, Unit Clerk • 6-Hour Period: 7 am to 1 pm• 6-Hour Period: 7 am to 1 pm • HKS Researchers: RN, RRT, PhD Arch • 2-Hour shadowing rotation • RN staffing ratios: SICU 2:1 / CCU 1:1 © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 4 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 4 • RN staffing ratios: SICU-2:1 / CCU-1:1
  5. 5. Washington Hospitalg CC CCUCCU SICUSICU © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 5 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 5 1990’s 11 Beds 1990’s 11 Beds 1970’s 14 Beds 1970’s 14 Beds
  6. 6. MD Intensivist Time LOCATION ACTIVITY 75% LOCATION 37% Roomside Station 18% Corridor ACTIVITY 33% Consultation 19% Info Gathering 83% 75%18% Corridor 18% Patient Bedside 12% Off Unit 19% Info Gathering 16% Reporting 15% Document / OE 10% 7% Lounge (Birthday!) 3% Central Station 6% Procedures 5% Break 3% Consult Room 1% Conf Room 4% Patient Care 1% Phone Call 1% Searching © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 6 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 6 1% Searching 0% Hand Washing
  7. 7. SICU vs CCU RN Time LOCATION ACTIVITY SICU CCU 76 -27% Patient Room 8 -20% Central Station SICU CCU 34 -45% Patient Care 20 -28% Documentation8 -20% Central Station 7 - 1% Med Room 5 -20% Roomside Station 20 -28% Documentation 13 - 5% Consultation 8 - 1% Medications 2 - 5% Corridor 1 -14% Patient Toilet 1 11% Lounge 6 - 3% Procedures 6 - 0% Reporting 4 0% Phone1 -11% Lounge 0 - 2% Nourish Room 4 - 0% Phone 4 - 3% Searching 3 - 4% Socializing © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 7 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 7 g 1 - 1% Hand Washing 1 -10% Eating
  8. 8. SICU vs CCU Unit Clerk Time ACTIVITYLOCATION ACTIVITY SICU CCU 28 -19% Phone LOCATION SICU CCU 71 -69% Central Station 8 9% o e 26 -42% Documentation 21 - 6% Socializing 69% Ce t a Stat o 13 -13% Off Unit 10 -13% Break Room g 9 - 6% Consulting 9 -16% Eating 4 - 3% Corridor 1 - 0% Roomside Station 3 - 9% Search/Gathering 3 - 0% Relaxing 1 - 0% Staff Toilet 0 - 2% Nourishment Room © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 8 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 8 1 - 2% Organizing25 - 33% impacts nurses!
  9. 9. Posture (Ergonomic Interest) NURSEPHYSICIAN CLERKNURSE SICU CCU 0 - 3% Bending PHYSICIAN 0% Bending CLERK SICU CCU 0 - 0% Bending0 3% Bending 3 - 0% Squatting 0 -13% Leaning 0% Bending 0% Squatting 0% Leaning 0 0% Bending 0 - 0% Squatting 0 - 0% Leaning0 13% Leaning 0 - 0% Reaching 4 -36% Sitting g 0% Reaching 56% Sitting 0 0% Leaning 2 - 0% Reaching 79 -77% Sittingg 92 -56% Standing 1 - 5% Walking 41% Standing 0% Walking g 19 -23% Standing 0 - 0% Walking © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 9 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 9
  10. 10. Intensive Care Design Wh ill b ?Where will we be? A th St A d MD FCCMArthur St. Andre, MD FCCM Washington Hospital Center Washington, DC Tom Harvey AIA MPH FACHATom Harvey, AIA MPH FACHA HKS Inc. Dallas, Texas Debajyoti Pati, PhD AIIA © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 10 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 10 Debajyoti Pati, PhD AIIA HKS Inc. Dallas, Texas © HKS 2007
  11. 11. Rooms Lav/ ToiletCare Zone 3 16 ‘ gross IV Pumps Physio Monitors Utility Boom @ Ceiling Toilet Waste Zone Dialysis Machine Overbed TableCare Zone21’ Care Zone 1 Balloon Pump M/S Supply Cart Hypothermia Unit Family Zone Zone 2 21 gross Data Entry/ Access A 320 f A 320 f Sleeper Chair Data Entry/ Hand Washing Sink © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 11 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 11 320 nsf320 nsf y Access © HKS 2007
  12. 12. Rooms Lav/ Toilet Care Waste 16 ‘ gross Physio Monitors Utility Boom @ Ceiling Toilet Zone 3 Waste Zone Dialysis Machine IV Pumps Overbed Table Care Zone 1 Care21’ Balloon Pump M/S Supply Cart Data Entry/ Access Hypothermia UnitFamily Zone Care Zone 2 21 gross BB Sleeper Chair Hand Washing Sink Data Entry/ © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 12 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 12 320 nsf320 nsf y Access
  13. 13. Rooms Lav/ Toilet C Waste 18’ gross Toilet Care Zone 1 Care Waste Zone Balloon Pump Physio Monitors Zone 3 21’ IV Utility Boom @ Ceiling Hypothermia Unit Overbed Table Data Entry/ Access Family Zone Care Zone 2 21 gross Dialysis Machine Pumps @ Ce g M/S Supply Cart CC Sleeper Chair Hand Washing Sink Data Entry/ © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 13 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 13 360 nsf360 nsf y Access
  14. 14. Rooms Lav/ Toilet Waste 18’ gross Sl Toilet Care Zone 2 Waste Zone Dialysis Machine IV Pumps Family Zone Sleeper Chair Care Zone 321’ Utility Boom @ Ceiling Hypothermia Unit Pumps Overbed Table o e Data Entry/ Access Care Zone 21 gross Balloon Pump Physio Monitors M/S Supply Cart DD Hand Washing Sink Data Entry/ 1 © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 14 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 14 360 nsf360 nsf y Access
  15. 15. Toward an Ideal Room Idea © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 15 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 15
  16. 16. BedBed © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 16 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 16© HKS 2007
  17. 17. BedBed Equipment Pumps & Monitors IT Cart Overbed T bl Ventilator Balloon Pump TableDialysis Machine Hypothermia Unit © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 17 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 17© HKS 2007
  18. 18. BedBed Equipment Power / Linkages Pumps & Monitors Pumps & Monitors IT Cart Overbed T bl Ventilator Balloon Pump TableDialysis Machine Line TraysLine Trays Hypothermia Unit Line Trays Along Bedsides Line Trays Along Bedsides © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 18 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 18© HKS 2007
  19. 19. BedBed Equipment Power / Linkages Pumps & Monitors Circle of Access Pumps & Monitors 16’ dia Rolling Stock for Work Surface And Supplies Rolling Stock for Work Surface And Supplies M/S Supply Cart IT Cart Overbed T bl Ventilator And SuppliesAnd Supplies Balloon Pump TableDialysis Machine Hypothermia Unit © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 19 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 19© HKS 2007
  20. 20. BedBed Equipment Power / Linkages Pumps & Monitors Circle of Access Staff / Physicians Pumps & Monitors 16’ dia M/S Supply Cart IT Cart Overbed T bl Ventilator Balloon Pump TableDialysis Machine Hypothermia Unit © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 20 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 20© HKS 2007
  21. 21. BedBed Equipment Power / Linkages Pumps & Monitors Circle of Access Staff / Physicians Imaging Pumps & Monitors 16’ dia M/S Supply Cart Overbed T bl Ventilator Portable X-Ray Balloon Pump Table Hypothermia Unit © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 21 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 21© HKS 2007
  22. 22. BedBed Equipment Power / Linkages Pumps & Monitors Circle of Access Staff / Physicians Imaging Pumps & Monitors 16’ dia Procedures M/S Supply Cart Ventilator Portable C-Arm Monitor Balloon Pump Hypothermia Unit © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 22 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 22© HKS 2007
  23. 23. BedBed Equipment Power / Linkages Pumps & Monitors Pumps & Monitors 16’ dia Circle of Access Staff / Physicians Imaging M/S Supply Cart IT Cart Overbed T bl Ventilator Procedures Lines of Sight Balloon Pump TableDialysis Machine Hypothermia Unit © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 23 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 23© HKS 2007
  24. 24. BedBed Equipment Power / Linkages Pumps & Monitors Pumps & Monitors 16’ dia Circle of Access Staff / Physicians Imaging Toilet M/S Supply Cart IT Cart Overbed T bl Ventilator Procedures Lines of Sight Work Areas Balloon Pump Data Entry/ Access TableDialysis Machine Work Areas Hypothermia Unit Data Entry/ Access © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 24 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 24© HKS 2007
  25. 25. Bed Toilet Bed Equipment Power / Linkages Toilet DeskCloset Couch Pumps & Monitors Pumps & Monitors 16’ dia Circle of Access Staff / Physicians Imaging M/S Supply Cart IT Cart Overbed T bl Ventilator Procedures Lines of Sight Work Areas Balloon Pump Data Entry/ Access TableDialysis Machine Work Areas Family Areas Hypothermia Unit Data Entry/ Access © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 25 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 25© HKS 2007
  26. 26. BedBed Equipment Power / Linkages Pumps & Monitors Pumps & Monitors 16’ dia Circle of Access Staff / Physicians Imaging M/S Supply Cart IT Cart Overbed T bl Ventilator Procedures Lines of Sight Work Areas Balloon Pump Data Entry/ Access TableDialysis Machine Work Areas Family Areas Consult / Education Hypothermia Unit Data Entry/ Access © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 26 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 26© HKS 2007
  27. 27. BedBed Equipment Power / Linkages Pumps & Monitors Pumps & Monitors 16’ dia Circle of Access Staff / Physicians Imaging Swing Away Privacy Swing Away Privacy M/S Supply Cart IT Cart Overbed T bl Ventilator Procedures Lines of Sight Work Areas Privacy Screen Privacy Screen Balloon Pump Data Entry/ Access TableDialysis Machine Work Areas Family Areas Consult / Education Hypothermia Unit Data Entry/ Access Room Enclosure © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 27 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 27© HKS 2007
  28. 28. BedBed Equipment Power / Linkages AccessAccess Pumps & Monitors Pumps & Monitors 16’ dia Circle of Access Staff / Physicians Imaging without moving Bed! without moving Bed! M/S Supply Cart IT Cart Overbed T bl Ventilator 23’ gross Procedures Lines of Sight Work Areas Balloon Pump Data Entry/ Access TableDialysis Machine Work Areas Family Areas Consult / Education Hypothermia Unit Data Entry/ Access Room Critical Access © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 28 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 28 18’ gross© HKS 2007
  29. 29. BedBed Equipment Power / Linkages Circle of Access Staff / Physicians Imaging Pumps & Monitors Pumps & Monitors 16’ dia Procedures Lines of Sight Work Areas M/S Supply Cart IT Cart Overbed T bl Ventilator 23’ gross 23’ gross Work Areas Family Areas Consult / Education Balloon Pump Data Entry/ Access TableDialysis Machine Room Critical Access Patient View Hypothermia Unit Data Entry/ Access © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 29 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 29 18’ gross 18’ gross Patient view outside via mirrors on furr-down Patient view outside via mirrors on furr-down © HKS 2007
  30. 30. BedBed Equipment Power / Linkages LCD panel in ceiling projecting LCD panel in ceiling projecting Circle of Access Staff / Physicians Imaging Pumps & Monitors Pumps & Monitors p j g family photos or favorite images p j g family photos or favorite images Procedures Lines of Sight Work Areas M/S Supply Cart IT Cart Ventilator imagesimages Work Areas Family Areas Consult / Education Balloon Pump Data Entry/ Access Dialysis Machine Room Critical Access Patient View Hypothermia Unit Data Entry/ Access © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 30 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 30 Focused Imagery © HKS 2007
  31. 31. Toilet DeskCloset Couch Pumps & Monitors Pumps & Monitors 16’ dia M/S Supply Cart IT Cart Overbed T bl Ventilator 23’ gross 23’ gross Ideal Room 397 nsf Ideal Room 397 nsf Balloon Pump Data Entry/ Access TableDialysis Machine Hypothermia Unit Data Entry/ Access © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 31 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 31 18’ gross 18’ gross© HKS 2007
  32. 32. Intensive Care Design Wh ill b ?Where will we be? A th St A d MD FCCMArthur St. Andre, MD FCCM Washington Hospital Center Washington, DC Tom Harvey AIA MPH FACHATom Harvey, AIA MPH FACHA HKS Inc. Dallas, Texas Debajyoti Pati, PhD AIIA © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 32 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 32 Debajyoti Pati, PhD AIIA HKS Inc. Dallas, Texas
  33. 33. Demographics of ICU Care 1998g p • 6,000 Adult ICUs • 72,000 ICU beds • 55,000 ICU patients/day • 5,000,000 admissions per year • 20,000,000 patient days per year • Estimated expenditure $60-80 B/yr • 8-10% of Hospital Beds • 10-12 Avg. bed complement • Mixed Med/Surg patient populations © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 33 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 33
  34. 34. The Team © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 34 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 34
  35. 35. Critical Care Team • Intensivists • Respiratory Therapists • Residents • PAs/NPs • Nutritionists • Social WorkersPAs/NPs • Bedside Nurses • Nurse aides Social Workers • Clergy • Others -Clerk PSAs• Nurse aides • Senior nurses - facilitator • Others -Clerk, PSAs • Quality, Utilization and Risk Managementfacilitator • Pharmacists Risk Management Personnel © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 35 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 35
  36. 36. An Intensivist • A physician with the training and skills top y g assess and manage patients with or who are at risk for severe single or multi t d f ti f di lsystem organ dysfunction from medical or surgical illnesses or injuries • Care provided from the earliest phases of t d ti th h thacute decompensation through the complex high risk periods of recovery © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 36 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 36
  37. 37. Critical Care Physicians • Primary Specialtyy p y • Subspecialty training • Board certificationBoard certification • “Intensivist model” – Leap Frog © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 37 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 37
  38. 38. Models of Care Unit Typesy Closed • Primary Attending = Critical Care Physician Openp • Primary Attending Not Always = Critical Care • Often multi-organ system consultants without a CC physician as the leader of a team Transitional • Any Primary Attending • And an Intensivist Assumes Management © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 38 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 38 No Intensivist Availability
  39. 39. The C’s of Critical Care • Patient CarePatient Care • Collaboration • Consistency - Continuity C di i• Coordination • CommunicationCommunication • With Availability and Responsiveness © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 39 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 39
  40. 40. Programmatic Responsibilities Mission g GoalGoalMission – Effective patient care – Mandates - Throughput Customers DemandDemand GoalGoal Customers Resources SupplySupply Organizational Structure O ti l F t Chain of CommandChain of Command Operational Factors – Mandates – Constraints Coalescence …Coalescence … © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 40 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 40 – Processes
  41. 41. Patients and Providers Demand: Patients Supply: Resources – Quantity – Quality E t ti pp y – Providers • Quantity – number, commitment – Expectations • Skills • Personal expectations – Clinical equipment and– Clinical equipment and supplies – Non clinical accoutrementsaccoutrements – Physical Infrastructure (i.e. built environment) © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 41 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 41
  42. 42. Patient Populations • Quantity - Baby Boomers – oldest turn 60y y in 2006 at a rate of 7918/day • ‘Quality’y – Healthy but elderly – Chronic Co-morbid factors Ob it f ilt– Obesity, frailty – Insults – new medical illnesses or exacerbations, surgical procedures, trauma, complicationsg p p • Expectations • Surges – seasonal, biological, man © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 42 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 42 Surges seasonal, biological, man induced
  43. 43. Patient Expectations • Good outcome • Safe • ResponsiveResponsive • Comfortable • Information rich• Information rich • Efficient Family convenient (time and space)• Family convenient (time and space) • Healing environment © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 43 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 43 • Minimum cost
  44. 44. Providers • Youthful vs. Aged labor poolg p • Availability – professional and personal satisfaction and commitments • Skill set development - OJT • Expectations – personal amenities, restorativeExpectations personal amenities, restorative and refreshment areas, communication devices, conveniences (e.g. baby care, banks, laundry, grocery) V i t• Variety – physician and nurse ‘extenders’, patient and family services, utilization quality and risk reviewers, supply chain, device maintenance, facility © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 44 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 44 pp y y personnel
  45. 45. ‘Moveable’ Objects • Clinical activities – monitors, testing equipment, therapeutic devices, documentation and communication technology, supplies (inc. medications) • Non clinical accoutrements implements• Non clinical accoutrements – implements related to waste, hygiene, ‘transition’ activities, environment of care © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 45 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 45
  46. 46. Techno Evolution - Devices • Sensor development • Devices – Monitoring monitoring • Communication devices • Merge monitoring and – Plug and Play – Simplicity – set up, use, take down • Merge monitoring and therapeutic modalities • Electronic Medical Record – Reliability – Light weight – small size – Wireless ?? tubeless capture and display, task management, transaction processing Wireless, ?? tubeless – Voice control – Data sharing (2 way) • Positive ID • Medication delivery mass inventory pharmacy • Devices – Testing – Portable (e.g. sonography) – Transportable © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 46 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 46 mass inventory pharmacy unit beside nurse (pharmacist) patient a spo tab e
  47. 47. Devices Wars! (need title) © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 47 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 47
  48. 48. RemoDoc™ Pardon me, may I cut in? © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 48 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 48 may I cut in?
  49. 49. Performance Expectations • Patient preferencesp • Superior results – Quality • Efficient Use of Resources• Efficient Use of Resources – Timely E i l Effectiveness – Economical – Resource conscious (rationing)(rationing) © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 49 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 49
  50. 50. From Data to Orders Recognition / Deducing / Concluding HISTORY – TRENDS Sufficient, accurate, THINKING Knowledge Schooling’, Literature, Texts Experience , , timely data THINKING ‘Learned’ Expectations DECISION Clinical Conclusion - Assessment WISDOM © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 50 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 50 Resources Expectations WISDOM
  51. 51. For Providers • Education and Conference rooms • Restorative atmosphere – personal / communal • Nourishment facilitiesNourishment facilities • Personal effects – ‘uniforms’, coats, purses • Toilet/shower• Toilet/shower • Communication devices ADLs l d hild b ki i• ADLs – laundry, child care, grocery, banking, exercise • Office S © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 51 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 51 • Sleep
  52. 52. Familyy • Information exchange • Accommodations – waiting (inc. long and short), nourishment, rest • Mutual support • Privacyacy • Participation in care © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 52 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 52
  53. 53. Patients • Bed features • ‘Transition’ activities • Reduced tethering• Reduced tethering • Nourishment - food processing • Physical therapy • Environment – Ceilings – Day/night cycling – eyes, ears, positioning © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 53 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 53 ay/ g t cyc g eyes, ea s, pos t o g
  54. 54. Infection Control • Susceptible patients • Infection Control – ICU – Portals of entry into patients – Antibiotic usage and – reservoirs, contamination (structures and people) • Aerosols and fomitesg availability – Immune compromise • Aerosols and fomites – Barriers – Hand washing • Hand cleansing • Protective barriers • Airborne isolation – Protect other patients P iti i l ti• Water • Surfaces • Positive pressure isolation – Protect a single patient © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 54 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 54
  55. 55. Results! • 12 m Baseline average VAP rate 16.33 • 12 m Project Average VAP rate 1 57 = 90% Reduction• 12 m Project Average VAP rate 1.57 = 90% Reduction • 9 out of 12 months with zero VAP Critical Care VAP Process/ Outcome 0% 100% iance 20 00 25.00 30.00 35.00 Rate Started PI 0% 50% Compli 0.00 5.00 10.00 15.00 20.00 VAPR F- 04 M- 04 A- 04 M- 04 J- 04 J- 04 A- 04 S- 04 O- 04 N- 04 D- 04 J- 05 F- 05 M- 05 A- 05 M- 05 J- 05 J- 05 A- 05 S- 05 O- 05 Vent Bundle Compliance 0% 0% 0% 0% 0% 0% 0% 16% 40%50% 100 100 100 100 100 96% 100 100 100 96% 100 Critical Care VAP Rate 12.6 33.518.6 25.317.5 5.055.99 16.3 5.856.25 0.000.00 0.000.00 10.8 7.140.00 0.000.00 0.000.00 VAP Cases 2 5 3 4 4 1 1 3 1 1 0 0 0 0 2 1 0 0 0 0 0 04 04 04 04 04 04 04 04 04 04 04 05 05 05 05 05 05 05 05 05 05 © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 55 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 55 VAP Cases
  56. 56. Equipment and Supplies • Storageg • Accessibility • CompatibilityCompatibility © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 56 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 56
  57. 57. Equipment and Supplies Increases in monitoring, pumps, and equipment requirements © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 57 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 57
  58. 58. Patient Rooms • Occupants • Over bed tablesp – Patient – Family – Staff • Restraints • Back walls– Staff • Sitting • Documentation • Furniture • Documentation centers• Documentation • Circulation • Cabling Documentation centers • Cabling • Reaching Comm nication © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 58 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 58 • Communication – TV, Radio, Computer
  59. 59. © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 59 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 59 Royal Alexandra Hospital - Edmonton, Alberta WSAG Architects
  60. 60. Environmental Factors • Visual • Temperature • Auditory • Tactile p • Chemical – including humidity • Tactile • Olfactory • Particulate • Electromagnetic • Gustatory • Spatial ec o ag e c p • Familiar – cultural, ethnic, personal • Unfamiliar psychosomatic interplay © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 60 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 60 • Unfamiliar – psychosomatic interplay
  61. 61. Environment of Care Continuum EnrichingEnriching Encouraging HealingHealing Helpful SoothingSoothing Neutral Irritatingtat g Noxious Dangerous’ © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 61 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 61 g Hurtful
  62. 62. Entrance Hallway?y © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 62 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 62
  63. 63. The Soda Machine? © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 63 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 63
  64. 64. Resource Constraints • Labor shortage and retention – RNs, MDs, therapists, pharmacists, technicians • EMRs – underdeveloped and installed • Physical infrastructure • Capacity • Sq. Feet / ICU • Adjacencies • Capital © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 64 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 64
  65. 65. Need Title © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 65 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 65
  66. 66. Constraining Forces • Confines of real estate • Renovation projects • Capital limitationsCapital limitations • Minimum standards mind set • Ineffective Clinical/Design professional• Ineffective Clinical/Design professional dialogue • Paucity of research and its application• Paucity of research and its application © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 66 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 66
  67. 67. Maslow’s Hierarchy of Needs © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 67 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 67
  68. 68. Title Needed • Functional Programg – Programmatic Missions Needs ~ Acuity – Throughput – Contingency surges Ri k ( )– Risk (e.g. age) – Physical characteristics (e.g. obesity) – Operational paradigmsOperational paradigms – Future directions • ‘Minimum’ Standards/Guidelines – Level I – Level II L l III © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 68 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 68 – Level III
  69. 69. ‘Minimum’ Standards • ‘Code’ – Guidelines for Design and Construction of Health Care Facilities, NFPA • Resources – real estate, capital Functional program i i• Functional program – mission • Patient vs./and Provider needs • Provider availability• Provider availability • Environment of Care – hierarchy of needs • Patient and provider expectations• Patient and provider expectations • Safety, longevity • Societal – environmental sensitivity © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 69 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 69 Societal environmental sensitivity • Surge
  70. 70. Title Needed bil t t f t f b d © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 70 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 70 mobile system at foot of bed CVICU, Methodist Hospital – Houston, Texas WHR Architects
  71. 71. Evolving Trends - Novel Ideasg • Obesity, age, acuityy, g , y • Design to augment staff effectiveness and retentionretention • ‘Environment of care’ • Telemedicine – eICU © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 71 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 71
  72. 72. Evolving Trends - Novel Ideasg • Move tests to the ICU • Laboratory - portable analyzers ? R di l i d h– ? Radiologic procedures – e. g. sonography • EMR (Acquiring) Pattern (Recognition/Deducing/Concluding) plus electronic process management tools • Sensitivity to our environment © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 72 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 72
  73. 73. Future - Predictions • Demand/Labor Resource mismatch – Labor imperatives – professional and personal decisionspersonal decisions • Regionalization – ICU Certification • Team – Composition – midlevel practitioners – ‘Model’ evolution - O/P I/P specialists - hospitalists © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 73 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 73 p
  74. 74. Future - Predictions • Expanded prescriptive authorityp p p y • Family participation • Other resources limitationsOther resources limitations – medications, blood products • Telemetry in the ICUTelemetry in the ICU © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 74 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 74
  75. 75. Future - Predictions • Marriage of monitoring and therapeuticMarriage of monitoring and therapeutic devices • Complication prevention methodologies • Organ based dysfunctional metabolismOrgan based dysfunctional metabolism measurements and interventions End organ perfusion monitoring- End organ perfusion monitoring • Genetic profiling © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 75 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 75 • Simulation
  76. 76. Suggestions • More robust clinician/user participation inp p design planning • Translate research into designTranslate research into design – Research into Learned Design Evidence Based Design– Evidence Based Design • National POE database • Research • Write a proposal © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 76 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 76
  77. 77. Intensive Care Design Wh ill b ?Where will we be? A th St A d MD FCCMArthur St. Andre, MD FCCM Washington Hospital Center Washington, DC Tom Harvey AIA MPH FACHATom Harvey, AIA MPH FACHA HKS Inc. Dallas, Texas Debajyoti Pati, PhD AIIA © HKS 2006 University of Texas at Arlington School of Architecture - Graduate Studio in Healthcare Design, Spring Semester 2007 Page 77 ASHE/AIA-AAH Planning, Design & Construction Conference 2007 Page 77 Debajyoti Pati, PhD AIIA HKS Inc. Dallas, Texas

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