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Clarian's Cure
Hospitals' Designs
Aid in Healing Patients
by Elaine Schmidt
Indianapolis-based Clarian Health Partners Inc. is employing evidence-based design, a trend in hospital design, for two major projects under way in the central Indiana city.
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Evidence-based design, or EBD, seeks to improve patients'
health through design in part because of research showing
a link between recovery and the way a hospital is laid out.
Clarian is a partnership involving Indiana University, Riley
Hospital for Children and Methodist Hospital.
The projects include the 10-story, $235 million inpatient
tower under construction at Riley. The 288-bed facility, which
has a move-in date of late 2008, will house patient rooms,
operating rooms, pharmacy, labs, radiology department, food
services and an atrium.
Indianapolis-based Ratio Architects Inc. and Nashville-based
Earl Swensson Associates are the designers, and Indianapolis-based
Pepper Construction of Indiana is the construction manager.
The second is the six-story, $150 million IU Cancer Care Center.
It will provide cancer treatment facilities that bring research
and patient care together in a holistic environment. St. Louis-based
Cannon Design is the architect and Indianapolis office of
New York-based Turner Construction Co. is the general contractor.
Peter Woeste, project manager for Turner, says the structure
should be watertight by July and is scheduled to open in summer
2008.
Science and Simplicity
The principles of evidence-based design are scientific and
simple: Research shows that hospital stays are shorter and
have better outcomes when medical facilities address the emotional
and psychological needs of patients along with medical needs.
Doug Morris, vice president of operations and facilities for
Clarian, says reducing patient falls was one goal of using
EBD. Some patient falls were addressed through changes in
bed rail design and sensors that alert nurses when a patient
begins shifting in his or her bed.
"But patients often need to get out of their beds and
they often have things hooked to them or have some kind of
impairment that makes mobility difficult," Morris says.
Data indicated that many patient falls occurred in bathrooms
or in transfers from bed to bathroom.
The solution was simple. "We made the door openings larger,"
Morris adds.
"There was a pinch point at the door to the bathroom.
Caregivers' abilities to help the patient were limited when
they were both trying to get through that door."
Clarian's in-house tracking of patient falls in areas equipped
with larger door
openings has indicated fewer patient falls in those rooms.
Morris says that choosing design firms with experience in
EBD was critical in implementing the latest research.
"We rely on our design firms to bring what they are doing
at other locations to our projects," he says. "Our
relationships with those firms give us another source of information
so it's not just us reinventing the wheel."
In addition, Clarian has relied on outside sources, such as
the Concord, Calif.-based Center for Health Design. The research
organization seeks to transform health care settings into
healing environments.
"Clarian brought in some of the leading EBD guys in the
country for us to meet with," says Dave Doell, manager
of design and construction for Clarian. "We were pretty
intimidated by doing an all-day seminar with them."
Some of what the construction teams learned was that bright
lighting and high noise levels increase stress in patients.
High stress levels, in turn, slow the healing process and
increase the length of hospital stays.
The research concluded that decreasing light and noise levels
in patient rooms and giving patients some control over lighting
created more of a home-like environment, which reduced stress
and speeded healing.
"So we are installing more indirect lighting, like wall
sconces and bedside table lamps, instead of overhead lighting
in patient rooms," Doell says. "We are using carpeting
and acoustical ceiling tiles wherever we can.
"Patients feel less helpless when they are surrounded
by things that feel more like home. That gets them out of
there quicker."
A Hospital as Home
Creation of a home-like environment includes sheet vinyl flooring
that looks like hardwood, Corian counters and flat-screen televisions
placed at eye level.
"We are putting materials that are familiar to people within
the view or touch of the patients," Doell says.
Research has also shown that patients feel less stress and get
better quicker if they have family members around them as much
as possible while they are in the hospital.
In response to this finding, Clarian is creating larger patient
rooms.
"Ten years ago hospital rooms were built with no space
for anything except a chair beside a bed," Doell says.
"We are dedicating a lot more square footage now to family
space."
Furnishings include a couch or a couple of chairs. An apartment-sized
refrigerator stocks drinks and snacks that can be shared with
the visitors.
Showers and chairs or fold-away couches allow for overnight
stays and views of the TV.
Incorporating family spaces into rooms and patient areas does
raise construction costs over smaller, patient-only rooms.
"Retrofitting existing hospital spaces can be really tough
if you don't have the space to begin with," Doell says.
"If you are converting a semiprivate room to a private
room, it's a little easier."
Thinking Outside the Patient Room
Family space extends beyond patient rooms. Café tables
with outdoor views and palatable food have replaced the old
institutional commissary and provide family members with space
to decompress.
The needs of staff members have also been included in Clarian's
new facilities.
"Caregivers go through a lot of traumatic experiences,"
Doell says. "They are human beings and they need a place
to go to recharge their batteries."
Clarian's new construction is replacing traditional and noisy
staff lounges with quiet rooms for staff.
"There are smaller, carpeted rooms with no television that
nurses can sign up for to read a book or take a nap, or whatever
they want to do with their break," he says.
SIDEBAR
A Different Kind of Construction Crane
When one of the young patients at Riley Hospital for Children
in Indianapolis began leaving drawings and notes on his window
for the "Bob the Builders" working on the site,
an idea was born.
Every Monday since July, a large stuffed giraffe has been
placed somewhere on the site. Named Mason McGrafe the Construction
Giraffe, he wears a hard hat and safety vest. Children at
the hospital can get on the Riley Web site and use a Web cam
to locate Mason. They can also leave messages for the workers
through the site.
"Mason McGrafe has given the kids and the workers a way
to communicate and interact without having to enter each other's
environments," says Natalie Harter, communication coordinator
for Pasadena, Calif.-based Jacobs Facilities, the program
manager. "Some of these children are here for months
at a time."
The interaction is important at a place like Riley, where
erecting a building that abuts a busy children's hospital
presents big issues such as controlling dust, noise and vibrations-and
also sensitivity to the children. Harter says they are among
the most seriously ill children in the country.
Mason McGrafe can be viewed on the Web at www.clarian.org/portal/patients/Mason.
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