The Wisconsin Heart Hospital Design Responds to Changes in Healthcare
One new heart center, The Wisconsin Heart Hospital, is bringing together new design options in a physical setting that will provide both total care and convenience for inpatients and outpatients. Facility completion is projected for January 2004.
The center’s core physicians wanted a heart hospital that integrated the rapidly changing and less-invasive treatment options for heart disease patients. The heart center design will meet these objectives by placing patient spaces in locations of optimum convenience, creating a calm environment. The design will be enhanced by high-quality finishes and comfortable furnishings.
Rearranging Design Standards
In most heart centers, design emphasis on catheterization laboratory procedures is equal to open-heart surgical procedures. However, developing technology has resulted in a dramatic shift to less invasive, kinder and gentler, catheter-based treatments in the catheterization lab. Correspondingly, there has been a dramatic reduction in patients requiring heart and/or vascular surgery. Catheter-based procedures may generate less income per procedure than open heart surgery, but create a greater volume of procedures.
In accordance with the change in focus, the new heart center will have all outpatient services situated on the first floor, with inpatient and operating rooms on the second floor. A main atrium entrance with glazing for maximum daylight will greet all incoming patients. Scheduled inpatients will be received at a concierge desk and escorted to their private patient room, used for the duration of their stay. Outpatients will be directed to the day-patient reception area, where they will be escorted to a 23-hour observation room. Outpatients will be able to use the same private day-patient room for pretreatment and recovery, utilizing a single bed model.
All catheterization laboratories are situated on the first floor for easy outpatient access for patients and family. This also maximizes the efficiency of the healthcare team. There are three times the number of cath labs as compared to operating rooms, in line with the planned emphasis on less-invasive procedures. In some heart centers, surgery is often directly adjacent to the catheterization laboratories. In this heart center model, all the catheterization laboratories are appropriately located near the first floor admitting. They are strategically placed immediately adjacent to and adjoining the emergency room for a virtual real-time connection, ensuring the fastest time to treat model. The utilization of this practical model will deliver the fastest life-saving emergency cardiac care where every minute counts.
In addition to patient needs, a tight urban site also played a role in the design requirements, adding to the architectural challenge of this new heart center. The first floor simply did not allow enough floor space for both the operating rooms and the catheterization laboratories. The center’s physicians initially suggested moving the operating rooms to the second floor, as they feel there is no longer a frequent, critical need for immediate catheterization laboratory access to the operating room. The center’s design was better served by placing the surgery department on the upper level near the inpatient rooms. This made the most sense because these patients are electively scheduled and will stay for a longer duration. The design result may, however, prove less efficient from a technical staffing perspective. Lockers, staff rooms and other support areas, normally shared by cath lab and operating room personnel, will need to be duplicated on the first and second floors. The resulting additional area was necessary but acceptable, since greater patient care will be provided and physician needs can be more customized.
Accommodating Catheterization and Surgical Procedures
For many patients, there will always be times when open-heart surgery is necessary. Scheduled surgeries will take place in the second-floor surgery suite. Patients being treated in the catheterization laboratories occasionally may unexpectedly need to go for open-heart surgery. For this reason, one of the new center’s catheterization laboratories has been designed so it can be immediately converted into an operating room. From a design standpoint, this involves providing a surgical environment with additional air exchanges in that particular laboratory. Catheterization laboratories typically do not require the same level of air change or sterility as a surgical suite. The convertible catheterization laboratory will therefore have additional air supplied like an operating room, including low-air returns.
Equipment, too, will be a consideration. In a typical catheterization laboratory, the standard catheterization equipment includes a gantry, C-arm, various movable items and monitors suspended by a track on the ceiling. In an operating room, a couple of booms on the ceiling are required to accommodate the monitors, medical gases and power connection lines. The design challenge is in situating all of these items together so that they do not conflict with one another.
In my research, I enlisted the expertise of Dr. James King, interventional cardiologist and Frank J. Kalivoda, CEO of Wisconsin Heart and Vascular Clinics. They have extensive experience in catheterization laboratory design and are on the Design and Equipment Workgroup for The Wisconsin Heart Hospital. They cited the endovascular operating room suite of the Miami Cardiac and Vascular Institute as a prime example of a room designed to allow for the performance of complex surgical and interventional cardiovascular procedures. This type of endovascular suite satisfies the physician’s requirements for an optimal antiseptic environment (surgery) for open procedures, while providing the imaging capabilities of a traditional cardiac catheterization/interventional laboratory. The following were requirements necessary to create this environment:
Air exchange of 20“25 room changes per hour, at least 20% of which is fresh air.
Positive air pressure relative to surrounding corridors
Temperature of 65-75 degrees Fahrenheit
Humidity level of 50-55%
Seamless floors with integral wall bases
Increased focus lighting
At The Wisconsin Heart Hospital, one of the suites is planned to accommodate these capabilities so that certain open surgical procedures can be performed as necessary. Through creative planning and innovation, these suites will allow for the most efficient and highest quality patient care.
The design of this new center ultimately aims to respond to the growth of technology-enabled total heart care, emphasizing easier, less invasive procedures for patients and preventive measures for longer, healthier lives.