The University of Kansas Hospital

How to Build a Heart Center

Many people build a new home. When they do so, they decide what is important to them and what makes them comfortable. Design generally takes into account what the person or family enjoys or how time is spent. Many questions abound: How many bedrooms? How should we plan the living spaces? What about the kitchen, patio, den and so on? At The University of Kansas Hospital, we followed the same process in building the Center for Advanced Heart Care, a facility dedicated to heart care and heart surgery.

The process of designing and building any structure typically involves working with consultants, architects and construction teams. What made our project different were the careful consideration of each patient area and how they work together, as well as a focus on staff satisfaction and retention, patient comforts, and convenience and caring for both groups.

 

Only the Beginning

First, the process to determine the right size for the Center for Advanced Heart Care began. A consultant helped determine what would be best for our organization and our program. Our  Business and Strategic Development Department worked carefully to determine capacity projections for both the inpatient and outpatient areas, including the cardiovascular (CV) labs and cardiovascular operating rooms (CVORs).

The architectural firm RTKL, of Dallas, Texas, was chosen through a request for proposal process, as was the nationally recognized, local construction company J.E. Dunn. Owner’s Representative Services, Inc. joined the team to provide construction project management, and the design process was well on its way.

Thoughtful and Functional Design

Right away, the hospital’s clinical and administrative teams had to ask themselves: What is most important for our heart center and our heart program?

Of course, exceptional patient care and safety together are the top priorities. Following closely from an organizational point of view are family and visitor comforts and staff workflows, conveniences, efficiencies and comfort. The intention was to provide a great environment in which all staff is supported to provide exceptional patient care.

Design decisions were driven using the guidance of our organizational pillars of quality, service, people, cost and growth. Quality outcomes and care are most important, of course. Design that allowed for superior service, from curbside to bedside, and patient satisfaction were always taken into account. Satisfaction and retention of nursing staff, physicians and other support/ancillary staff were also considered in workflow designs. We determined that the facility should allow for program expansion and growth, so design decisions needed to be based on that. And, of course, we had to consider how design, flow and equipment selection could be cost efficient and long lasting.

Our internal clinical design team, composed of clinical staff, including nurses and physicians, began meeting with the RTKL architects in 2003. A general scheme had been developed; however, the clinical team provided essential information to create thoughtful and functional patient care areas. Throughout the process, the focus continued to be onpatient care and safety, along with efficiency of that care for both nursing staff and physicians.

From the beginning, we determined it was very important to provide staff respite areas/lounges with generous square footage, natural light and amenities. Staff lounges for five of the seven units in our heart center are located on the corner of the building, providing wonderfully big, beautiful, light-filled areas. All of the lounges contain many staff conveniences that offer some relaxation and rejuvenation as staff members continue to provide great care to patients. We also chose to make the staff areas calm and quiet, providing comfort to those who provide so much comfort to others.

Staff support was and remains an important aspect of the Center for Advanced Heart Care. Early in the process, space was set aside for physician and support staff work areas, and they were designed into each patient care area. These work areas provide computers, phones and storage space in quiet, private locations.

 

A Focus on Patient Care and Comfort

We paid considerable attention to all patient rooms. Clinical staff made significant contributions to the design, resulting in space that makes sense to staff as they provide care. Patient rooms also feature family areas or zones for family and visitor comfort. Small workspaces with computer access and in-room sleeper sofas are included. There are also six guest suites on the inpatient progressive care units. Suites include attached guest areas for greater privacy, as needed.

A beautifully planned education area for families and patients, located on the second floor, was included to serve as a significant learning and support resource for all patients and families.

Additionally, spaces were specifically planned for the display of art, adding to the building’s beautiful, healing atmosphere. The magnificently spacious entrance to the Center for Advanced Heart Care is filled with light and beauty; natural light and a hanging glass sculpture create a soothing, healing space.

Easy wayfinding also was incorporated into design. Specific colors identify each floor, and related art identifies space, such as waiting areas.

As the design process continued, patient care areas were painstakingly reviewed unit by unit. Another important consideration that upheld the guiding principle of patient safety was the consistency of units from floor to floor. Nurse work areas are similarly stocked and organized throughout the facility. Universal placement and design allow for safer and more consistent patient care. This concept also allows for physician efficiencies, reducing rounding time spent looking for forms, charts, etc.

An overall look at all areas ensured appropriate and efficient patient care and workflows between areas. All work- and patient flows were specifically detailed and diagramed to ensure that the intended designs would work in practice. These flow diagrams were also used extensively in orientation training for the facility.

Early in the planning, we decided that nursing and supportive care would be decentralized. This meant designing the nurse work areas so they are within steps of the patient beds, allowing nurses to easily see patients and stay close to keep them safe. Architects worked with the clinical team to draw sight lines from each patient’s room to various areas on the unit, ensuring visual lines of sight into each patient’s room from multiple points on the unit No patient rooms were tucked away out of a nurse’s or other care provider’s sight.

Another of our priorities was to eliminate unnecessary steps for staff to obtain supplies, medications and other patient care items. As a result, plans called for necessary supplies, materials and medicals records to be located at workstations just outside of each patient room. Computers, phones, medications and supplies are only a few steps away from patients. Close-by nutrition centers store the supplies that could not be kept at workstations, including clean supplies and additional medications.

 

Designing for Advanced Services

Other important aspects of most heart programs were taken into consideration. For example, door-to-balloon time, a performance improvement initiative, is closely monitored. To continue ensuring the ease and speed of care delivery, we carefully designed a plan for moving patients from ambulance, helicopter or the Emergency Department to the catheterization lab in reduced time. A new state-of-the-art Emergency Department was designed and built on the first level of the Center for Advanced Heart Care, allowing us to improve door-to-balloon times and quickly transport patients to our cardiac catheterization labs or to the chest pain center, when appropriate.

Also important to the design was the close proximity of patient care areas. For example, on the second level, which houses the cardiac catheterization and electrophysiology (EP) labs, the floor was laid out to include the labs, the Cardiovascular Treatment and Recovery (which is a prep and recovery area) and the Cardiac Intensive Care Unit. This permits the availability of RNs with a wide scope of competencies (ICU, recovery and procedural), immediate physician availability and ease of movement from one area to another. These efficiencies provide a service-orientation to physicians and patients, along with continued focus on patient care and safety. Help is never far away.

The same concept applies to the cardiothoracic surgery floor. The CVORs and the Cardiothoracic Surgery ICU are housed on a single floor, again providing access to critical care and surgical nurses and to surgeons and anesthesiologists. This floor also has a satellite pharmacy, which serves the CVORs and all ICUs in the heart center and prepares all stat medications for the entire facility.
Cardiac catheterization and EP labs and CVORs are challenging and innovative areas for design. The CV labs, which include the cardiac catheterization and EP labs and the CVORs are big, remarkable areas with state-of-the-art equipment and nurse-designed workstations. The layout was planned with significant physician and staff input. To minimize time spent running for an item, some supply storage is inside the CV labs, as well as a larger stock area.

 

Equipment selection, a tricky endeavor, could be described in an article of its own. Again, physician input is critical, as is having team members who are well versed or researched in the various equipment and options. It is also important to have someone who is very comfortable with negotiations and contracts. Many questions must be asked to make wise, cost-conscious decisions.

 

Opening the Heart Center

Design and construction soon were completed. The task of moving in, occupying and opening units, and making them operational soon became the focus of the clinical team. That successful accomplishment is also a story unto itself, for another day.

The University of Kansas Hospital’s Center for Advanced Heart Care opened in October 2006. The major project required the help of hundreds of people – design team, staff, community members, patients and families. We are very proud of our facility. It is a place where excellent, quality care continues to be delivered by a dedicated, committed and caring team. And the quality of care will remain at the heart of its existence.


Cardiology Inpatient Floor Plan

Cardiology Inpatient Floor Plan

Cath Lab Floor Plan

Cath Lab Floor Plan

The Foyer

The Foyer

The Foyer: The colourful hanging sculpture is called a PulseFlow composed of more than 300 pieces of blown glass.

The Foyer: The colourful hanging sculpture is called a PulseFlow composed of more than 300 pieces of blown glass.

Decentralized Nursing Stations: Allowing nurses to be only steps away from their patients. Names and titles from left to right: Mike Kaiser - PA, Shirley Verbenec - CV OR, Lynette Patocka - CV OR, Zann Roach - EP Lab, Chris Buckley - CTS ICU, Lynn Smith - Cath Lab, Annie Burger - CTS PCU, Kathy Carson - CTS ICU, Gail Schuman - CV Pre/Post, Kate Jones - CTS Nurse Clinician, Andy Hawthorne - CTS ICU, Anna Werner - CTS PCU

Decentralized Nursing Stations: Allowing nurses to be only steps away from their patients. Names and titles from left to right: Mike Kaiser - PA, Shirley Verbenec - CV OR, Lynette Patocka - CV OR, Zann Roach - EP Lab, Chris Buckley - CTS ICU, Lynn Smith - Cath Lab, Annie Burger - CTS PCU, Kathy Carson - CTS ICU, Gail Schuman - CV Pre/Post, Kate Jones - CTS Nurse Clinician, Andy Hawthorne - CTS ICU, Anna Werner - CTS PCU

The University of Kansas Hospital Center for Advanced Heart Care

The University of Kansas Hospital Center for Advanced Heart Care

Patient Rooms:  Every patient has a private room, and most have wireless internet access.

Patient Rooms: Every patient has a private room, and most have wireless internet access.


Author:

Elizabeth Clark
Clinical Director, Cardiovascular Services
The University of Kansas Hospital
Kansas City, KS
USA

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