Eilish hardiman planning and designing the new children’s hospital


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Eilish Hardiman, CEO, National Paediatric Hospital Development Board
Presentation at 2011 National Healthcare Conference in Dublin

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  • This is your ‘why not the M50?’ slide? Big argument is co-location of the three Also an argument for families of long=stay children being in the city centre – public transport access, shops, restautants etc
  • Eilish hardiman planning and designing the new children’s hospital

    1. 1. Planning and Designing the new Children’s Hospital Eilísh Hardiman CEO National Paediatric Hospital Development Board
    2. 2. Planning the new Children’s Hospital <ul><li>What is best for children’s health? </li></ul><ul><li>Why do we need a new children's hospital? </li></ul><ul><li>What makes a children’s hospital comparable with the best children's hospitals in the world? </li></ul><ul><li>Can planning the new children’s hospital contribute to healthcare reform? </li></ul>National Healthcare Conference 2011
    3. 3. Designing the new Children’s Hospital <ul><li>How can design make a difference to quality care (clinical outcomes and patient experience)? </li></ul><ul><li>How can design drive efficient operations in a hospital? </li></ul><ul><li>How can children and young people influence the design of the new children's hospital? </li></ul>National Healthcare Conference 2011
    4. 4. What is best for children? <ul><li>The sickest children have better clinical outcomes if treated in a hospital that has a high caseload volumes (scale) requiring a ‘critical mass’ of clinical specialties and sub-specialties (over 25 sub-specialities), combined with advanced medical technology and ICT, an integrated approach to education and research and evidence-based designed facilities. </li></ul>
    5. 5. Critical Mass and Better Clinical Outcomes <ul><li>Trent versus Victoria study </li></ul><ul><li>Trent healthcare trust in UK: several small PICUs </li></ul><ul><li>Victoria, Australia: single large PICU </li></ul><ul><li>Population based study </li></ul><ul><li>All children from each region admitted to PICU </li></ul><ul><li>in a 12 month period </li></ul><ul><li>Pearson et al. Lancet 1997; 349:1213-7 </li></ul>National Healthcare Conference 2011
    6. 6. National Healthcare Conference 2011 *Neonates: including cardiac cases (excluding others) The excess ICU mortality accounted for 11% of all child deaths in Trent Trent Victoria Population < 16 years 833,000 1,011,000 Child ICU admissions* 1014 1194 Per 1000 < 16 year* 1.22 1.18 Died* 74(7.3%) 60(5.0%) SMR* 1.75 1.00
    7. 7. Critical Mass and Better Clinical Outcomes <ul><li>“ Many studies of neonatal care have shown a lower mortality rate in hospitals with higher volumes of patients” </li></ul><ul><li>Phibbs et al. New England Journal of Medicine 2007; 356: 2165-75 </li></ul>National Healthcare Conference 2011
    8. 8. <1500g, adm/yr, OR mortality (N = 48,237) National Healthcare Conference 2011 Phibbs. New England Journal of Medicine 2007; 356:2165 - 75 Level 1 Level 2 Level 3 Level 4 ≤ 10 2.72 ≤ 10 2.53 > 10 2.39 11 – 25 1.88 ≤ 25 1.69 ≤ 25 1.51 > 25 1.22 26 – 50 1.78 26 – 50 1.30 > 50 1.80 51 – 100 1.19 > 100 1.00
    9. 9. Critical Mass and Better Clinical Outcomes <ul><li>Bristol Royal Infirmary Inquiry 1984 – 1995 (children’s cardiac surgery) – Kennedy Report </li></ul><ul><li>30 – 35 children died that might have expected to live after cardiac surgery </li></ul><ul><li>Cardiac surgery split between 2 sites, no dedicated cardiac intensive care beds, no full time paediatric cardiac surgeons, too few cardiac paediatric nurses </li></ul><ul><li>Children’s acute hospital services should ideally be located in a children’s hospital, as close as possible to an acute adult hospital </li></ul>National Healthcare Conference 2011
    10. 10. Critical Mass and Better Clinical Outcomes <ul><li> “ Children’s specialist acute services should be co-located with adult, maternity and neonatal service”. </li></ul><ul><li>The Scottish Review of Paediatric Services 2004 </li></ul><ul><li>Yorkhill Children’s Hospital, Glasgow, a tertiary children’s hospital, currently co-located with a maternity hospital, is in the process to moving to the Southern General Campus where adult, maternity and paediatric services will be tri-located </li></ul>National Healthcare Conference 2011
    11. 11. Critical Mass and Better Clinical Outcomes <ul><li>Quality is driven by volume, with higher volumes / larger scale resulting in improved clinical outcomes </li></ul><ul><li>Quality is dependant on a ‘critical mass’ of sub-specialities (over 25 sub-specialities) </li></ul><ul><li>Minimum population of 3.5 – 5 million required to support a tertiary children’s hospital. </li></ul>National Healthcare Conference 2011
    12. 12. Critical Mass and Better Clinical Outcomes <ul><li>McKinsey & Co (2006) Children’s Health First </li></ul><ul><ul><li>Ireland’s population can only support one world-class tertiary hospital </li></ul></ul><ul><ul><li>Located in Dublin, ideally be co-located with a leading adult academic hospital </li></ul></ul><ul><ul><li>Provide secondary care for the greater Dublin area </li></ul></ul><ul><ul><li>Central component of an integrated national paediatric network </li></ul></ul><ul><ul><li>Incorporate outreach capabilities at key non-Dublin hospitals and an adequate geographic spread of emergency-type facilities in Dublin </li></ul></ul>National Healthcare Conference 2011
    13. 13. McKinsey & Co (2006) Children’s Health First <ul><li>Review of 17 leading children’s hospitals in Australia, Canada, Scandinavia, UK, USA and New Zealand (15 out of 17 co-located with adult hospital) </li></ul><ul><li>Highest quality of care (outcomes and patient experience) </li></ul><ul><ul><li>Scale / Volume of caseloads </li></ul></ul><ul><ul><li>Breath and depth of services (critical mass of sub-specialists) </li></ul></ul><ul><ul><li>Access </li></ul></ul><ul><ul><li>Efficient use of resources </li></ul></ul><ul><ul><li>Attract and retain high calibre staff </li></ul></ul><ul><ul><li>Teaching and research fully integrated in to service provision </li></ul></ul>National Healthcare Conference 2011
    14. 14. Tri-location Children’s Hospital Maternity Hospital Adult Hospital Neonates Mothers Staff Staff Adolescents Staff
    15. 15. Paediatric activity in the Dublin children’s hospitals Some Facts National Healthcare Conference 2011
    16. 16. Volume of Paediatric Activity 2009 National Healthcare Conference 2011
    17. 17. Where do children attending the three Dublin children's hospitals come from? National Healthcare Conference 2011
    18. 18. Dublin Children’s Hospital’s Activity - 2009 Greater Dublin Area Dublin, Meath, Kildare, Wicklow *2009 Figures
    19. 19. Dublin Children’s Hospital’s Activity - 2009 National Healthcare Conference 2011 DONEGAL In-patients 1.35% Day care 1.30% GALWAY In-patients 1.45% Day care 1.63% LIMERICK In-patients 1.07% Day care 1.22% CORK In-patients 2.15% Day care 2.18 %
    20. 20. Emergency Care Attendance Patterns National Healthcare Conference 2011
    21. 21. National Healthcare Conference 2011 Temple Street Crumlin Tallaght New Children’s Hospital Ambulatory Care Centre
    22. 22. H H
    23. 23. Children’s Hospital Infrastructure National Healthcare Conference 2011
    24. 24. Planning the new children’s hospital <ul><li>Sickest children have better clinical outcomes in hospitals with high caseloads and a critical mass of specialities and sub-specialities </li></ul><ul><li>Tri-location is the optimal model of service provision </li></ul><ul><li>Highest volume of paediatric services (>90%) are ambulatory (OPD, ED and Day care), warranting localised access (Ambulatory & Urgent Care Centres) and outreach clinics </li></ul><ul><li>Existing infrastructure is unsuitable for contemporary health care </li></ul>National Healthcare Conference 2011
    25. 25. 2006 Policy Decisions and Reports February March June July McKinsey Report published, endorsed by the three children’s hospitals Report adopted as Government policy Joint HSE / DoH&C Task Group Report published on hospital location Report endorsed by Government 2007 January May November RKW High Level Brief commenced Development Board established HSE Board endorse RKW Report 2008 July HSE commissioned an independent review of maternity and gynaecology services in the greater Dublin area 2009 July Development Board facilitated the development of National Model of Care for Paediatric Healthcare Services in Ireland, which was endorsed by the HSE 2010 July Project Brief for the new children’s hospital at Eccles Street and Ambulatory & Urgent Care Centre at Tallaght is approved by the HSE with the prior consent of the Minister for Health and Children
    26. 26. Designing the new children’s hospital National Healthcare Conference 2011
    27. 27. Projected Activity and Capacity Accommodation Hospital on Eccles St A&UCC, Tallaght Activity Forecast Year 2021 In-Patient Beds 392 0 27,207 discharges Operating Theatres (in-patient) 9 0 - Day Care Beds 53 28 28,303 discharges Operating Theatres / Procedure Rooms (Day Care) 6 4 - Out-patient rooms 58 26 223,438 attendances Short-stay beds Emergency Department / Urgent Care Centre 12 8 122,438 attendances
    28. 28. Design Brief for the children’s hospital <ul><li>445 beds (392 in-patient of which 62 critical care & 53 day care, 75 C/E rooms in OPD) </li></ul><ul><li>100% single rooms – ensuite, with parent area </li></ul><ul><li>Advanced diagnostics and theatre facilities </li></ul><ul><li>Parent accommodation for critical care </li></ul><ul><li>Parent / family accommodation adjacent to the hospital </li></ul><ul><li>Play areas, external gardens and courtyards </li></ul><ul><li>Therapy area with hydro pool & gym </li></ul><ul><li>Hospital school </li></ul><ul><li>Education Centre and Research Centre </li></ul>
    29. 29. Evidence Based Design National Healthcare Conference 2011
    30. 30. Fable Hospital™ Project <ul><li>The Center for Health Design (US) </li></ul><ul><li>The need to balance one-time construction costs against ongoing operating savings and revenue enhancements. </li></ul><ul><li>Analyzed the operating cost savings resulting from </li></ul><ul><ul><li>reducing infections, </li></ul></ul><ul><ul><li>eliminating unnecessary patient transfers, </li></ul></ul><ul><ul><li>minimizing patient falls, </li></ul></ul><ul><ul><li>lowering drug costs, </li></ul></ul><ul><ul><li>lessening employee turnover rates, </li></ul></ul><ul><ul><li>improving market share and philanthropy </li></ul></ul><ul><li>Compelling case to build better, safer hospitals </li></ul>National Healthcare Conference 2011
    31. 31. Evidence Based Design Design Intervention Quality and Business Case Benefits Single patient rooms Reduce infection, increase privacy, increase functional capacity, reduce errors, increased patient satisfaction Adequate space for family to stay overnight Increased patient and family satisfaction, reduced patient and family stress Acuity adaptable rooms Reduce intra-hospital transfers, reduce errors, increased patient satisfaction, reduce unproductive staff time HEPA filtration for immunosuppressed patients Reduced airborne infections Decentralised nurses stations Increased time spent on direct patient care
    32. 32. Evidence Based Design National Healthcare Conference 2011 Design Intervention Quality and Business Case Benefits Efficient way finding Reduced staff time giving directions, reduced patient and family stress Natural light in patient / staff areas Reduced anxiety and depression, reduced length of stay, increased staff satisfaction Positive distraction (images, music) Reduces stress, reduces pain and medication use, reduces sedation Artwork – virtual reality, images Reduces staff and patient stress, reduces pain and medication use Noise reduction measures Reduces staff and patient stress, reduced patient sleep depravation, increased patient satisfaction
    33. 33. Pet Scanner Imaging Artwork Play Room <ul><ul><li>Play Installations </li></ul></ul>Artwork and Positive Distraction
    34. 34. Getting children and parents to influence the hospital design National Healthcare Conference 2011
    35. 35. Consultation with children and parents <ul><li>Children and young people: </li></ul><ul><ul><li>8-18 year olds – 2 day event in Dublin Castle, Dec 2009 </li></ul></ul><ul><ul><li>Youth Advisory Panel </li></ul></ul><ul><ul><li>5 – 8 year olds – research in the children’s hospitals </li></ul></ul><ul><li>Family Forum –parents & illness support groups </li></ul><ul><li>Others – illness support groups, patient advocacy groups </li></ul>
    36. 36. National Healthcare Conference 2011
    37. 37. Sliding Glass Doors Patient Views over Dublin Personal Social Space that incorporates Privacy Ward Concept Plan Ward Concepts
    38. 38.
    39. 39. National Healthcare Conference 2011
    40. 40. Thank you National Healthcare Conference 2011 www.newchildrenshospital.ie