Local health systems improve efficiency with newest hospitals

When UPMC Pinnacle set out to design West Manchester Township-based, UPMC Memorial hospital, the system laid out its imaging and emergency departments next to one another, and operating rooms were expanded to leave room for advances in surgical equipment such as robotics.

The layout was similar in design to UPMC Pinnacle’s West Shore hospital, which opened in 2014. The designs of both allowed for quicker, more efficient medical care that older hospitals can’t always achieve even with extensions and renovations, said Paul Toburen, senior vice president of facilities and support services for UPMC Pinnacle.

“A lot of hospitals in the US have aging infrastructure,” he said. “As they continue to grow, they grab the available land around them and they renovate the space. When you are building a new hospital you have the ability to do it right the first time.”

Where aging hospitals may have departments that work together on different floors or wings, a new hospital gives architects the opportunity to put them together, improving efficiency and work flow.

At UPMC Memorial, two departments, such as imaging and emergency, that are generally used together, could now be neighbors.

“Most hospitals were built 50 years ago and every five years they add a new wing; they become little mazes that are hard to navigate and understand,” said Jim Albert, principal at Hord Coplan Macht, a Baltimore-based architecture and interior design firm.

Hord Coplan Macht’s health care team has designed for inpatient and outpatient hospitals across the country, including WellSpan Heart and Vascular Center in York.

What to improve on

Newer hospitals like UPMC’s West Shore and Memorial hospitals can increase efficiencies that may not warrant an entire renovation with changes such as decentralizing their nursing stations, said Toburen.

In a centralized nurse station, a hospital’s staff operates from one location for all of the patient rooms in their wing. Many new nurse stations have become decentralized with more than one work station for nurses and patient rooms with computers that allow them to complete charts from a patient’s room.

When Penn State Health built its new Lime Spring and Mechanicsburg outpatient facilities, it introduced self rooming capabilities meant to offer more privacy to patients.

With self rooming, a patient independently finds their own exam room in a designated wing. The provider then gives the check up from one location and the patient checks out in the same room before leaving the facility.

“We’ve changed the way we look at our offices and we try to build some efficiencies in,” said Dr. William Bird, a senior vice president with Penn State Health Medical Group. “Some of our offices like Mechanicsburg and Lime Spring have self rooming capabilities, so the patient can room themselves, which contributes to privacy.”

The mental health of hospital staff has also become a hot topic in hospital design. Good designs can reduce rates of clinical depression among health care providers.

Penn State Health’s most recent hospital, the Hampden Medical Center, projected to finish construction in Hampden Township, Cumberland County in 2021, includes natural light in staff break rooms with access to the outdoors.

“There needs to be an importance placed in making sure there are areas of respite for staff and that they get natural light and windows,” Albert said. “The way that hospitals build up over time can make that challenging.”

In its Lime Spring and Mechanicsburg outpatient facilities, Penn State Health offers lactation rooms for staff, and technology to have teleconferencing capabilities that allow staff to have meetings online.

The sometimes confusing layout of hospitals was something that both Penn State Health and UPMC Pinnacle have tried to combat with their newest facilities. The new hospitals use “wayfinding” techniques like clearer signage and patterned and color coded floor patterns.

“We really want navigation to be an easy part of the patient experience,” said Kent Eckerd, vice president of ambulatory development at Penn State Health. “We want wayfinding to be intuitive but we don’t assume it is.”

State regulations

Additions to a hospital to increase efficiency or comfort are at the discretion of the hospital system, but there is still state requirements for patient room size and privacy.

Pennsylvania’s hospitals are mandated by the state Department of Health to follow requirements that spell out standards every new hospital or renovation must follow.

“The guidelines are what the architect uses to get the basis of design when either renovating or starting from new,” said Toburen. “We have to get the minimum design to start with and from there you look at efficiency.”

To bridge the gap between what the firm’s staff is designing and the clinical needs of the system and its staff, Hord Coplan Macht keeps a registered nurse on staff.

As the architect’s work to find how they can make the staff’s jobs easier and more efficient, the nurse works with the hospital and its staff to help the architects understand how the space will actually be used when its finished.

Futureproofing

Current new hospitals boasting innovations in care will need to hold up over the next 50 years as new rules and regulations result in new extensions and renovations.

When designing health care facilities, Hord Coplan Macht does this by making space for future chillers and boilers and considering where future expansions could build from.

On the ambulatory side, Bird said he expects telemedicine to continue to expand, allowing for more facilities to be able to offer more specialty services electronically.

At UPMC Pinnacle, Toburen said the hospital system takes a piece by piece approach, trying to be both forward thinking and reactive when it comes to how it can update its hospitals.

“There are always little tweaks, the industry is constantly changing,” he said. “We are always taking the best of the best from UPMC’s hospitals and developing a better model.”