Healthcare Design - August 2017 - 34

behavior. "This new unit will help us coordinate
an effort to understand why a child did this and
help put the child and the family on a better path
to move forward," Hagerty says.
Moving from project concept to opening was
not an easy process, however. In fall 2015, CHOP
physicians and clinicians and designers from
ZGF Architects (Washington, D.C.) began an
extensive benchmarking process, quickly realizing that although solutions were in place at
other facilities, what they wanted to create-a
medical behavioral unit-didn't exist. For example, Seattle Children's Hospital in Seattle
has a psychiatry and behavioral medicine unit
located adjacent to a medical unit. Other facilities, such as Hasbro Children's Hospital in
Providence, R.I., have psychiatric units where
minor medical issues can be managed. CHOP's
goal, though, was to create a freestanding unit
for patients with complex medical conditions
that's equipped with multiple safety features
to reduce stress and anxiety, such as improved
acoustics to reduce noise on the unit and ligature-free bathrooms. "We wanted to design it
in such a way that you can't throw a chair or rip
things off the walls, to make the rooms as safe as
possible for these kids," Hagerty says.
Next, ZGF led a multidisciplinary team, including physicians, nurses, and psychologists,
through design charrettes to create six avatars
that represent the types of patients who will
likely use the unit: an aggressive patient; a postop aggressive patient who might be at risk for
pulling out his or her lines or other self-harming

34

AUGUST 2017

ABOVE: Open care team

stations offer visibility
to the patient rooms
and corridors, while
a wood canopy and
surround adds warmth
and interest to the
hallways. BELOW: Room
detailing, from the
selection of materials and casework to
tamper-proof hardware
and ligature-resistant
plumbing fixtures, was
developed with safety
in mind.

activity; a suicidal patient; a patient who tries to ingest foreign bodies; a
flight risk; and a patient with acute psychosis. The process allowed the
team to anticipate the needs of these specific patient populations and answer those needs in the design.
In conjunction with the new unit, CHOP created a care model that would
bring together a multidisciplinary team, including providers, social workers, and therapists-in one spot. "They could be more instantly available,
more physically present, to support these children as they are treated for
their medical needs," Carney says. CHOP assigned two co-medical directors-a pediatrician and a psychiatrist-to the unit to give equal weight to
the medical and behavioral sides of care and involved them in the planning
and design process to help guide operations and layout. (For more on the
staffing of the unit, go to HCDmagazine.com/CHOP-staffing.)
With these pieces in place, the team then spent nearly two months prototyping room mock-ups in the hospital basement, starting with building a
patient room out of foam core and eventually creating a room to finish level. Throughout that process, Carney says several hundred staff members,
including clinicians and environmental services and facilities staff, were
brought through the room to test different features and provide feedback.
The process resulted in modifications such as changing the angle of the staff
handwashing sink so nurses could maintain eye contact with patients and
installing a new locking mechanism on cabinets that hold medical equipment and monitors to improve speed of access for the staff. "Without an archetype to follow, the prototype [process] was the only way to get feedback
on the design, so we needed time to do that," Carney says.
CHOP also conducted mock patient events and ran simulation codes-
from medical events to a child acting out emotionally-to ensure that all
the safety, patient, and staffing needs were being addressed cohesively.
Marla Vanore, RN, director of nursing, trauma, and injury prevention
at CHOP, says one of the biggest challenges was finding the right bed, because a medical bed has features, such as multiple long cords, that children
with suicidal tendencies could use to harm themselves, while a behavioral
health bed isn't designed for medical procedures. "If a child went into cardiac arrest, we needed to be able to quickly drop the head of the bed down,
lower the whole bed, and do resuscitation," she says. Ultimately, the team
chose a medical bed that's customized with fewer and shorter cords.
In January, the new 10-bed, 11,000- square-foot medical behavior unit

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S TA R T I N G F R O M S C R AT C H
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Healthcare Design - August 2017

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