New Rural Surgery Center Supports Both Inpatient And Outpatient Care (Article)

Latest project at St. Anthony Regional Hospital creates space for staff and patients

St. Anthony Regional Hospital, a 99-bed hospital located in Carroll, Iowa, a community of about 12,000, is driven by a commitment to be a regional healthcare leader.

 

This community medical center is no stranger to innovation and creativity.  They have completed a number of exceptional expansion and remodeling projects over the past 20 years using forward-thinking, patient-centered, evidence-based design concepts that many similar facilities are just now incorporating.  

Just a few of these improvements include:  

  • Creating all private resident rooms that are identical in the new and the remodeled areas of the hospital with a clear delineation of family, patient, and nursing zones within the room  
  • Implementing decentralized nurse stations with clustered patient rooms
  • Expansion of the birthing center into Birthplace which has with private LDRP concept rooms with equipment concealed in casework and familiar, home-like amenities
  • Remodeling the intensive care unit from a ward into private rooms with sliding glass doors for visual monitoring.   

St. Anthony is driven to be the forefront of healthcare practice in west central Iowa.   Adapting their spaces to support these practices has resulted in a showcase healthcare facility that belies its out-of-the way location.

 

The New Surgery Center

St. Anthony’s latest project provides the community with a new 120,000 square foot surgery center designed to serve both inpatients and outpatients without compromise to the level of care for either patient type.   The goal of the $28 million, 4- story surgery center was to “provide to the community a surgery center that has the convenience of an ambulatory surgery center with the safety and security of a hospital inpatient surgery department,” according the Ed Smith, Chief Financial Officer for the hospital.  For a hospital of this size, building two separate facilities was just not financially feasible.

 

When planning began for the new surgery center, the hospital created a multi-disciplined transition team that focused on ways to improve workplace performance and improve surgical outcomes.  The importance of having a transition team in place was something they learned from their past experiences and was critical to the project’s success.  St. Anthony again engaged the team which had completed the previous improvements–Wold, a healthcare design firm located in Minneapolis, MN–to provide architecture, engineering, and interior design services.  Having the benefit of 20 years of project history with the St. Anthony team, Leo Monster, the project principal for Horty Elving, knew the high level of care that the team would expect the building to support. 

 

Achieving Project Goals

The design team, along with their client, established the project objectives everyone believed would ultimately improve patient outcomes.  The core project objectives were to create spaces with efficient flow for inpatients, outpatients, and staff–spaces that supported the staff’s patient care activities; create calming spaces focused on patient privacy and recovery; create spaces that reinforced the best safety practices; these objectives guided the entire design process.  The team visited ten recently completed replacement surgery departments to harvest the best solutions from these working examples. 

 

The existing surgery was expanded once since 1970, but the hospital had outgrown the space as demand increased, due to the recruitment of several surgical specialists and rapidly advancing technology.  The space had become so inefficient that it was not used to its capacity and was actually hampering good infection control practices.  According to Linda Peterson, Director of Surgery, “The teams were dysfunctional.  They had to retrace steps during the surgery process and the organization of the spaces sometimes required one to gown-up to pass through a sterile area on the way to and from a non-sterile area.” 

 

In the new third floor of the surgery center, all public and staff areas of the surgery center are located on a single floor.  The lower two floors of the new structure contain 100 parking spaces for surgery center staff, surgeons, and outpatients.  Two large elevators connect these two parking decks, as well as the emergency, radiology, and laboratory departments, to the surgery center.  Inpatients are brought directly from the third floor to the surgery center via a skywalk between the two buildings.  The patient/family arrival area includes private admission rooms, private pre-op rooms, and private recovery rooms. 

 

The layout of the new space is based on a circular process flow. The PACU (post-anesthesia care unit) is the core of the surgical department. The four operating rooms, with two future rooms shelled-in for expansion, are all located in close proximity to the PACU.  Also central is a large sterile supply and equipment storage room located in the core of the clinical areas so there is convenient access from all staff areas.   The operating rooms were designed to be large–800 square feet.–to accommodate all types of surgery.  The rooms are equipped with equipment booms, robotics, and the anticipated space needs of future technology.  The rooms have poured rubber floors that have an integral cushion to reduce leg fatigue for surgeons and staff.  For operational consistency, all surgery rooms have the exact same layout and equipment locations.  There are two sub-sterile rooms between each pair of surgery rooms with direct access into each surgery room.  Two endoscopy rooms adjacent the outpatient prep and recovery rooms complete the range of available facilities.

 

Another state-of-the-art component is the patient information system that is utilized in the surgery center.   The use of this technology has greatly enhanced staff efficiency by providing the staff with accurate and timely information regarding the status of each patient and procedure.  This system gives the staff detailed schedule status information and alerts them where a patient is within the surgical process.  Large flat-screen monitors have replaced the old whiteboard.  These monitors are mounted at strategic areas throughout the surgery space for the staff to view.   Additionally, a future electronic medical records program will communicate with this system, further enhancing the effectiveness of this tool.  Abridged patient status information is displayed on a large monitor in the family lounge area so that families can follow the progress of their loved one; for the privacy of the patient, they are referred to by a number.

 

Considering the concern for patient privacy, great care was taken to separate the inpatient and outpatient traffic within the center.  Outpatient clients and their families enter the surgery center reception area via elevators from the parking garage located directly below.   Creating this direct route greatly reduces the stress of navigating through an unfamiliar facility. The spacious family lounge is located directly next to the reception area and elevator bank.  The family lounge has an expansive window wall that provides dramatic, sweeping views of the Iowa countryside.  To soften the scale of the space, the design team used an open ceiling grid and floating ceiling panels.  More intimate zones were created within the space through the use of furniture arrangements and lighting.  Warm, soft colors reflect the landscape outside. Inpatient flow enters the surgery center via a two-level sky link that ties directly into the med/surg area of the existing hospital.  This entry point leads directly to the PACU.  Since the two entry points are at opposite ends of the center, the inpatient and outpatient traffic remains separate.  This contributes not only to client confidentiality but also diminishes stress and creates a calmer environment.

 

Once a patient is inside the pre-surgery area they are assigned to a patient recovery room.  These rooms are clustered in groups of four and correspond directly to the nursing ratio.  All rooms have walls and doors for acoustical privacy, a big improvement from the fabric dividers of their old facility.  In the new facility patients are assigned to a recovery room that they use both for gowning and recovery without the need to remove them from this room during surgery.  Provisions for a changing area and lockers have been included in the design if an increased demand requires this.  Several recovery rooms were designed with exterior windows to provide natural light and exterior views.  These rooms may be used as inpatient rooms in a high demand situation.

 

The Results

Now that the facility has been in operation for over a year, the design team’s objectives have proven to be a success.  More accurate communication, lower stress levels, as well as reduced fatigue have contributed to a more efficient operation.  Comments from patients have been positive.  The increased space in the operating rooms gives the team more room for equipment.  The ability to keep the sterile field clear and space to move about the room freely has reduced stress.  The adjacency to the sub-sterile room and the use of positive air pressure with laminar flow HEPA filtration provides the cleanest possible environment.  Staff energies can now be better focused on the care of the patients and the surgical procedures, with the end result being decreased mistakes and improved patient outcomes.

 

St. Anthony Regional Hospital has gone beyond simply providing outstanding healthcare to being an integral part of the community.   Constantly looking for opportunities to connect with the community, they recently teamed up with a local community college to provide teaching lab facilities for nursing, including a high-tech simulation room that is an exact replica of their patient rooms.  This reflects the hospital’s attitude towards being a healthcare leader. The nursing education center provides a well-trained and qualified staff without having to recruit outside the region.  The education program is located on the fourth floor of the new surgery addition as a part of the hospital’s education/conference center.  The reason St. Anthony Regional Hospital is a healthcare leader is because they are in the forefront of constantly and consistently developing solutions to meet the needs of the region.

 

The motto for the St. Anthony Regional Hospital is to provide quality healthcare, close to home, at a good value.  Drawing its patients from a 75-mile radius, the hospital successfully competes with the larger urban hospitals in Des Moines and Omaha.  Feedback from patients and their families, and constantly increasing demand, demonstrates they are doing things right. There is a high level of patient satisfaction.  Patients report that they like the calm, pleasant atmosphere and the feeling of receiving high-quality care in a community atmosphere.  Surveys indicate they like the convenience of the hospital where they and their families do not have to navigate a maze of highways and a large urban medical campus to have their healthcare needs met.  Low staff turn-over indicates that staff enjoys this workplace.  St. Anthony’s recognition and reputation is reaching further than 75 miles.  The hospital has recently been recognized with a 2009-2010 Hospital Value Index TM:  Best-in-Value TM Award for achieving high marks in quality, affordability, efficiency, and patient satisfaction. 

 

As published in Healthcare Building Ideas

Author:

Sara Malin

Healthcare Planner | AIA