Healthcare Design - March 2015 - 54

OPERATIONS | 03.15

Designing more efficient critical
access hospitals
Critical access hospitals face a number of financial challenges not seen by
larger urban counterparts, calling for creative design solutions that maximize
operational efficiencies and rein in costs By John W. Andrews and Jeff S. Monzu

Maximizing efficiency with smart adjacencies
Payroll typically accounts for 50 percent or more of
hospital budgets, so efficient use of staff time is a
critical component of a CAH's finances. Efficiency
can be improved through designs that create smart
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HCDmagazine.com 03.15

A shared nurses' station at Community Hospital Fairfax in
Fairfax, Mo., allows nurses to keep an eye on inpatient and
emergency departments from a central location.
adjacencies and shared nurses' stations, which allow nurses to oversee multiple departments during
less busy times.
"One reason we designed our new facility the
way we did is to optimize staffing," says Julie Slagle,
head of nursing at Sidney Regional Medical Center
in Sidney, Neb.
Sidney is a town of 7,000 in the Nebraska panhandle, about three hours from Denver. A 25-bed
replacement hospital is currently under construction there, the design of which will greatly increase
efficiency and quality of care.
"The facility we're in now is older and over the
years has had a lot of departments added onto it.
What ends up happening is, it becomes a lot of long
hallways, a lot of walking space, and a lot of inefficiencies," Slagle says.
She describes a nurse's perspective: "A patient
is being admitted, and I need to take him for an
X-ray, labs, and then to his room. Right now, I'm
going to have to walk down two hallways to get to
admissions, get the patient, take the elevator down
a floor, walk down the hallway to the lab, then back
to the elevator, go up, and then walk directly back
to the area above the lab, which is radiology, for an

John W. Andrews

Jeff S. Monzu

LEO A DALY

Critical access hospitals (CAHs) provide essential
medical services to rural communities that otherwise would have little or no access to care. They're
part of a special class of Medicare hospital that,
according to a 1997 law, must be at least 35 miles
from any other hospital (or 15 miles in mountainous
terrain), have 25 or fewer beds, offer a maximum
stay of 96 hours, and have a 24-hour emergency
room.
Without the program's cost-based reimbursements, many of these hospitals wouldn't be able
to sustain operations. They're simply too remote,
and their populations too small, to function with
standard Medicaid and Medicare reimbursements.
They don't benefit from the economies of scale that
their urban counterparts do, their patient counts
are lower, and their operational costs are higher by
proportion.
To make matters worse, recent changes in
healthcare have hit CAHs hard, creating pressure
to reduce inpatient stays and drive patients toward
less costly (and less profitable) outpatient care. The
decision by 23 states not to expand Medicaid under
the Affordable Care Act has strained the budgets of
small hospitals in those states.
Furthermore, with the 2013 recommendation by
the Office of the Inspector General that program
requirements for CAHs be tightened, the designation that helps ensure the survival of these hospitals
is under threat. Some experts now predict that 20
percent of these hospitals will close by the year
2020.
Because of these tough economic realities, it's
crucial that CAHs improve their efficiency and find
better ways to serve their communities. Now more
than ever, the financial health of CAHs and the
health of the populations they serve depend on
facility design that maximizes operational efficiency
and reins in costs.

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Healthcare Design - March 2015

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