Kinder, Gentler Cardiac Care

Mike Tangney, AIA
Mike Tangney, AIA
When the 60-bed, 127,000-square-foot Wisconsin Heart Hospital opened its doors in early 2004, it was widely thought to serve as a national model in cardiac care. In fact, the design recently garnered a Health Care Award of Merit in the Best of 2004 category from Midwest Construction magazine. In addition, the West Suburban Chamber of Commerce in Wauwatosa, Wisconsin presented a Civic Appreciation Award in 2004. Surprisingly, however, state-of the-art characteristics for this top-notch cardiac care facility do not come from great scientific advances but from applying traditional philosophies of caring and comfort and minimally invasive treatment to the facility™s layout and flow. The progressive design reflects a trend in heart care toward less invasive approaches, more catheter-based treatments and universal interventional suites, which can accommodate modalities such as catheterization labs, vascular labs and nephrology labs, and fewer open-heart surgeries. While patient-focused approaches have increasingly been the norm in healthcare in the past five years, Wisconsin™s unique way of embodying these concepts is where it departs from the typically designed healthcare center. It achieves a manner of health delivery that may be the start of an evolution involving a less institutionalized environment. Situated in Wauwatosa, a suburb of Milwaukee, the width of the site was confined by a restricted urban setting. Using the tight, sloping site to its advantage, the Dallas-based architecture design team of HDR created an aesthetically pleasing two-story hospital divided in the center by a two-and-a-half story atrium. The atrium extends the entire length of the hospital, and is arched at the two ends, giving a contemporary, attractive appearance. From the natural lighting to the building™s zoning, all features work together to provide an inviting atmosphere and level of comfort unheard of in hospitals built just a decade ago. All diagnostic and outpatient services, including the imaging department, six outpatient interventional suites, and day patient unit, are situated on the first floor near the main entrance for easy outpatient access, precluding outpatients from having to penetrate into inpatient zones. Cath labs also are immediately adjacent to the emergency department in the event an emergent patient needs prompt, life-saving cardiac intervention. Since a patient being treated in a catheterization lab on the first floor may unexpectedly need open-heart surgery, one of the catheterization labs has been designed for immediate conversion into an operating room. Interventional labs typically do not require the amount of air exchanges a surgical room requires, so this room is outfitted with additional air-handling capacity sufficient for surgery. The extreme rectilinear configuration and 28-foot slope of the ground north to south were also limiting in terms of planning and construction. The selected building zoning worked in favor of a patient-friendly environment. A vertically separated stacking plan permitted the loading dock to be placed on the lowest level, while the mechanical equipment was placed on the topmost level, thereby separating these elements from the patient levels in-between. Rather than traditional positioning of operating rooms in proximity to cath labs, three ORs are situated on the second floor, adjacent to inpatient rooms. Positioning in-patient rooms on the second floor segregates them from less invasive treatments, keeping cross-departmental procedures separate. For ease of transport, patient pods on the second floor are situated centrally around surgical suites. Patient rooms are subdivided into four neighborhood pods of 10 beds each. This arrangement of 10 beds per nursing staff offers more custom treatment, allowing nurses to observe patients more closely, creating a less institutional, small-scale feel. It results in less patient travel, privacy protection and limits potential infection from intermingling in public corridors. Universal Care Rooms Another unique feature of the hospital™s philosophy is the universally designed single-point-of-care rooms for both treatment prep and recovery associated with interventional labs. Using the same room for prep and recovery allows the same nursing staff to care for a patient throughout his or her procedure, lending a feeling of cohesiveness and solace to the patient, as well as providing a designated place for the family to wait. Unique Suite Arrangement Building on the current philosophy OR suites use for flow, the cath lab suite arrangement in Wisconsin Heart Hospital has separate entrances for staff and patients into procedure rooms. In the past, everyone accessed the room from a single corridor, and dirty and clean materials also went through this single access point, with the potential for contamination. In the new design, patients access the procedure room through a corridor on an outside loop, while staff, physicians and supplies use an inner-core access. This allows for a better flow from a patient, physician and materials-management perspective. A separate circulation allows clean to come in from the center, soiled and dirty to go out with the patient on the outer loop, maintaining a more systematic clean-to-dirty flow and providing better hygiene. In addition, separate entrances allow for segregated scrub areas, physician reading rooms and catheter storage areas, without overflowing and interfering with waiting patients and their families. Staff can be more focused on off-stage work, and patients may feel less intimidated by not seeing behind-the-scenes activities or medical equipment. This, again, allows for a more family- and patient-oriented approach. Feel of Comfort In addition to key changes in procedural flow, owners at Wisconsin Heart Hospital sought patient comfort in interior-design details. The higher-level interior finishes and furnishings are meant to exude warmth. Natural woods, stone and earth tone furnishings resemble an upscale hotel rather than a healthcare setting. But the Ritz Carlton look requested by the client did not end there. Natural lighting enters through the wide windows in patient rooms and family waiting areas. These communal areas overlook the sun-filled atrium, giving families a chance to take a break while remaining close to their loved ones. Small details are appreciated by both visitors and patients. For example, parking was not overlooked. Parking space is at such a premium near the front entrance that the hospital offers a valet parking service free of charge, making circling for a good space a thing of the past. Feedback While the overall size of the hospital is fairly expansive, breaking it down into distinct neighborhoods gives the impression of a smaller, more patient-focused environment, while still being able to draw on the resources of a major cardiac center, says James King, MD, medical director. While cardiac treatment often is a serious and intimidating process to patients, the design integrated the technology in a way that did not overpower the architecture, he continues. It really makes patients feel more at ease, and that helps to speed their recovery. This type of kinder, gentler cardiac care is attracting new patients, and that is comforting to hospital executives. The end result is a hospital that delivers cutting-edge medical treatment in a setting that conveys a sense of comfort and well-being to patients and families. Mike Tangney, Senior Project Designer with HDR, served as lead designer of The Wisconsin Heart Hospital. He works out of HDR™s Dallas office and can be reached at (972) 960-4106.