Healthcare Design - May 2017 - 38

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BEFORE

R E N O VA T I O N C H A L L E N G E S

The conversion involved constructing nine new patient rooms, renovating 11 patient rooms, and demolishing and reconstructing staff support
areas. Designing the new unit within an existing footprint presented
limitations because some structural elements wouldn't allow for desired
reconfigurations. For example, the northern wing of the eighth floor,
which houses nine patient rooms, has a narrow floor plate, and six of the
rooms averaged 200 square feet in size compared to 240 square feet in
the other rooms. This meant that the pull-out couches specified for larger
patient rooms were too big for the smaller rooms, so convertible sleep
chairs were provided for families and visitors in those rooms. Designers
also opened up these tighter quarters by reconfiguring the layout, such
as moving personal protective equipment (PPE) storage into a recessed
unit in the corridor to reduce clutter and maximize space. On the rest of
the unit, where the floor plate isn't as narrow, PPE is located inside the
patient room, near the door.
Another challenge involved working within a functioning hospital,
which required contractors to schedule work at hours that would minimize noise and disruptions. For example, a dialysis unit located beneath
the north wing was open from 6 a.m. to 9 p.m., so all under-floor plumbing
demolition and installation of water and waste lines had to be performed
between 9 p.m. and 6 a.m. The remainder of plumbing work was conducted two rooms at a time so that each patient room below would be out of
service for only one day. Additionally, loud activities, such as floor coring
for new waste lines, were done during the daytime so sleeping patients
weren't disturbed.

Nature-themed art
glass and resin panels
were installed at
the unit coordinator
reception desk.

TEAM EFFORT

The team held strategic brainstorming sessions with clinical staff throughout the process to address obstacles as they arose. During demolition, for
instance, an existing critical plumbing riser was discovered in a wall that
was thought to be dead space. With the staff's input, the team decided to
change the layout of the equipment room and leave the riser intact so that
the floor below didn't experience downtime.

MAY 2017

HCDMAGAZINE.COM

Staff also guided several design and layout
decisions, such as the placement of headwall
equipment, including thermometers, telemetry monitors, switches, and electric plugs. "We
went over full-size mock-ups of the headwalls
with the designers to figure out where the most
accessible heights would be for each feature,"
Serrano says. "Nurses no longer have to reach
awkwardly over obstructions for frequently
used equipment."
Another key change involved overhead ceiling lift docking stations. In the original plan,
the stations were wall-mounted within a cabinet to keep them out of sight. However, during
scenario planning, the staff acted out code responses and realized that the cabinet would be
an obstruction at head height, so the hanging
cabinets were removed from the patient room
design.
Additional design suggestions provided by
the nurses included placing hooks instead of
coat rods in the patient wardrobes to avoid the
need for hangers and giving patients a bedside
table so that they can store personal items away
from staff work surfaces. Family zones within
the newly renovated patient rooms are designated next to expansive exterior windows
so visitors don't impinge on staff and patient
space. The unit also houses a nourishment
room and solarium for guests, and personal
lockboxes are constructed into the millwork to
hold personal belongings.
The project also sought to improve workflow
and operations for the staff. Sinks and PPE,
where the floor plan allowed, are located directly inside the patient rooms, so nurses can enter
the room and perform hand hygiene and equipment donning while introducing themselves to
patients and families. This flow eases patientnurse interactions and helps build trust. "Improving communication with patients was one
of our key objectives," Serrano says.
Some technological improvements were also
made to allow for more intimate and simplified
patient interactions. During a staff role-playing exercise, caregivers spoke to patients who
were in bed while using wall-hung computers,
but the interactions became awkward when
patients were seated in recliners located near
the windows, because clinicians would have to
talk over the bed to the patients and staff delivering medications would have to walk around
the bed to scan patient wristbands. With these
challenges in mind, the team decided to replace wall-mounted technology with workstations-on-wheels (WOWs). The WOWs have

JOHN HORNER (AFTER)

In Focus

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Healthcare Design - May 2017

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