The healthcare design and construction picture has been muddied by uncertainty over the new healthcare law. Hospital systems are in a bind, not knowing what levels of reimbursement to expect. Building Teams serving this sector will have to work even harder to meet growing client demands.

March 01, 2012

2. Design spaces to increase patient throughput and staff efficiency

Renovation Picture


Twenty-nine bay observation unit at Detroit Medical Center, a renovation of a 5,800-sf physiotherapy space. A customized headwall design using a modular, prefabricated solution with pre-installed medical gasses works anywhere in the space.

A renovation that created a short-term observation unit at Detroit Medical Center highlights another cost-saving trend. The 29-bed, 5,800-sf unit provides space for patients referred from the ER at Detroit Receiving Hospital, one of nine hospitals in the Detroit Medical Center. The center’s ER traffic has increased more than 60% in the last decade, from 68,000 patient visits in 2001 to 110,000 in 2011, according to Ruth Kremer, the DMC’s communications director.

The revamped space, previously dedicated to physical therapy, accommodates non-acute patients who need less than 24 hours of monitoring. The unit is staffed by nurse practitioners and skilled nurses; staff physicians make rounds and are on call, but are not assigned full time to the unit.

The new staffing strategy was prompted by changes in reimbursement. “Insurers are reimbursing [only] nominally for patients that just receive observation,” says Kremer. The new space is helping the hospital implement a lower-cost staffing solution for an increasingly costly function.

Another way to save money on space is to build less of it. Recent healthcare designs have pared back square footage on lobbies, dining areas, and other nonclinical functions. At Presbyterian Hospital, a new facility in Flower Mound, Texas, HKS Architects steered away from an expansive lobby and created a courtyard off a relatively modest lobby. “The courtyard is less expensive to maintain than an indoor area.” says Shannon Kraus, AIA, ACHA, LEED AP, an associate principal and senior vice president at HKS.

Scaling back nonessential space not only saves on initial costs, but also on long-term maintenance. According to healthcare consulting firm Kaufman Hall, each square foot of space costs $30-40 a year to heat, cool, insure, clean, and refurbish over a hospital’s lifetime.

Designs that allow healthcare facilities to operate more efficiently after the ribbon cutting can add significantly to value. At the new 286-bed Middle Tennessee Medical Center in Murfreesboro, Gresham, Smith and Partners laid out each floor on a 72-bed chassis, broken into four 18-bed pods that operate independently. “No patient room is more than 75 feet from a nursing station,” says Greg Gore, AIA, NCARB, Gresham’s principal-in-charge. This contrasts with traditional designs that had some patient rooms as far as 200 feet from a nursing station. Cutting down on unnecessary walking gives nurses more time to care for patients.


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