3 Key Department Information
Karlsberger Healthcare Consulting
Planning | Strategy | Operations | Programming
Stacking Diagrams
Karlsberger Healthcare Consulting
Planning | Strategy | Operations | Programming
1KARLSBERGER PROJECT NO. 30-0002AAMARCH 18, 2009
Parkland Health and Hospital System Operational Planning
LOWER LEVELBUILDING STACKING DIAGRAM
CENTRAL STERILE
LOADING / MECHANICAL
MORGUE
SERVICE ELEVATORS
VISITOR ELEVATORS
2KARLSBERGER PROJECT NO. 30-0002AAMARCH 18, 2009
Parkland Health and Hospital System Operational Planning
FIRST FLOOR at gradeBUILDING STACKING DIAGRAM
EMERGENCY SERVICES
IMAGING - RADIOLOGY
INMATE UNIT
ICC
LOBBY / SHARED
PSYCH ED
SERVICE ELEVATORS
VISITOR ELEVATORS
3KARLSBERGER PROJECT NO. 30-0002AAMARCH 18, 2009
Parkland Health and Hospital System Operational Planning
SECOND FLOOR at gradeBUILDING STACKING DIAGRAM
MEDICAL RECORDS
RESPIRATORY ADMIN
LOBBY
CAFETERIA / DIETARY
PUBLIC SERVICES
CHAPEL
BLOOD BANK
CLINICAL PATHOLOGY
ANATOMIC PATHOLOGY
PHARMACY
SERVICE ELEVATORS
VISITOR ELEVATORS
4KARLSBERGER PROJECT NO. 30-0002AAMARCH 18, 2009
Parkland Health and Hospital System Operational Planning
THIRD FLOORBUILDING STACKING DIAGRAM
PUBLIC
SURGERY / ANESTHESIOLOGY
ECU
OB TRIAGE / OBSERVATION
O.R.’s
SURGERY / GYN / C-SECTION
LABOR & DELIVERY
SERVICE ELEVATORS
VISITOR ELEVATORS
5KARLSBERGER PROJECT NO. 30-0002AAMARCH 18, 2009
Parkland Health and Hospital System Operational Planning
FOURTH FLOORBUILDING STACKING DIAGRAM
CCU / TLEMETRY UNIT
CATH and ENDO
NNICU
SERVICE ELEVATORS
VISITOR ELEVATORS
6KARLSBERGER PROJECT NO. 30-0002AAMARCH 18, 2009
Parkland Health and Hospital System Operational Planning
FIFTH FLOORBUILDING STACKING DIAGRAM
MECHANICAL
SERVICE ELEVATORS
VISITOR ELEVATORS
7KARLSBERGER PROJECT NO. 30-0002AAMARCH 18, 2009
Parkland Health and Hospital System Operational Planning
SIXTH FLOORBUILDING STACKING DIAGRAM
SICU
BURN UNIT
POSTPARTUM
ANTE PARTUM
SERVICE ELEVATORS
VISITOR ELEVATORS
MED SURG
8KARLSBERGER PROJECT NO. 30-0002AAMARCH 18, 2009
Parkland Health and Hospital System Operational Planning
SEVENTH FLOORBUILDING STACKING DIAGRAM
MICU
POSTPARTUM
SERVICE ELEVATORS
VISITOR ELEVATORS
APHERESIS / DIALYSIS
MED SURG
9KARLSBERGER PROJECT NO. 30-0002AAMARCH 18, 2009
Parkland Health and Hospital System Operational Planning
EIGHTH FLOORBUILDING STACKING DIAGRAM
PSYCH UNIT
MED SURG
REHAB
POSTPARTUM
SERVICE ELEVATORS
VISITOR ELEVATORS
10KARLSBERGER PROJECT NO. 30-0002AAMARCH 18, 2009
Parkland Health and Hospital System Operational Planning
NINTH FLOORBUILDING STACKING DIAGRAM
MED SURG
POSTPARTUM
GYN ONC
SERVICE ELEVATORS
VISITOR ELEVATORS
HEM-ONC
GCRC
11KARLSBERGER PROJECT NO. 30-0002AAMARCH 18, 2009
Parkland Health and Hospital System Operational Planning
ALL FLOORSBUILDING STACKING DIAGRAM
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Stacking Narrative
Karlsberger Healthcare Consulting
Planning | Strategy | Operations | Programming
Functional Stacking Narrative
The space program for the future Parkland Memorial Hospital is intended to provide
large fl exible spaces that will be timeless and allow for adaptability as technology,
science and clinical medicine change over time. All patient care rooms are
programmed to be universal and meet TAC for ICU which will provide maximal
fl exibility to adapt spaces for patient acuity, service line design or future changes to
operating models.
The hospital space program is one part of the larger campus vision, which in addition
to the hospital includes the future administrative building and the future clinic
building.
This narrative will discuss the vision for the replacement hospital fl oor by fl oor. It
will also point out the most critical adjacencies.
This stacking diagram presents a vision of 3 patient care towers: a woman’s and two
adult non-woman’s towers, organized with a service line or center of excellence
vision. It is envisioned that all towers will be connected horizontally.
Lower level:
The lower level of the hospital will house Central Sterile Processing and the Morgue.
Central Sterile Processing will be centralized in the new hospital and support all
sterile processing on the PHHS campus, for the hospital (except fl exible endo and
bronchoscopes), the clinic and outpatient areas. Vertical adjacencies via clean and
soiled elevators for the transportation of case carts and distribution of supplies and
instruments is required. As the clinic building is programmed additional vertical and
horizontal connections will need to be further studied.
The Morgue will need access to the outside via a dock for funeral homes to pick up
bodies.
Central Logistics is planned to be in the basement of the clinic building. Connections
for the effi cient distribution of supplies and equipment throughout the entire hospital
will need to be further analyzed during the design phase of this project.
First Floor:
The Emergency Department, ICC, Psych ED, Inmate Unit Treatment Center and
Imaging will be located on the fi rst fl oor of the hospital.
Coordination of drive-up, drop-off and parking will need careful attention. The lobby
entrance used for foot traffi c should be located away from EMS traffi c.
The circulation and fl ow of patients, EMS and staff during a crisis situation, requiring
decontamination, should also be considered and studied further during the next
phase of this project.
The ICC is intended to be adjacent to the main ED with a backstage connection for
woman who require emergent ED services. Elevators providing a vertical adjacency
to L&D are required.
The psych ED is programmed to have adjacent access to the sallyport for patients
who are brought in by police escort. The psych ED requires a backstage connection
to the ED to accommodate psych patients who require care services from the main
ED.
The inmate unit and treatment center will be directly adjacent to the sallyport. This
unit will have a priority adjacency to radiology as no imaging services are planned for
the inmate unit, other than portable imaging capabilities. An off-stage hall way is
requested to safely and securely transport prisoners, who require ED services, from
the inmate unit to the ED.
Sec3:12
A separate EMS entrance is envisioned. This entrance should be designed to provide immediate access to the resus rooms in the
main ED. An elevator providing a direct vertical adjacency to the OR and cath lab from this space is planned.
The radiology department will support all inpatient and outpatient imaging services. Adjacencies providing effi cient access to the
clinic building and inpatient areas is critical.
Second Floor:
Two distinct entrances and lobbies are planned; one for the main hospital and one for woman’s services. The Gift shop, patient
relations including interpreters, and the cafeteria are planned to be located off the main lobby in a highly visible location, with lots
of traffi c.
Clinical and anatomic labs are planned to be located on the second fl oor across the hall from each other. Backstage connections
are required to transport specimens between the two spaces. Organized, sophisticated connections via a pneumatic tube system
are essential. Off-stage vertical and horizontal connections to clinical care areas including the OR and ED are necessary for the
transport of specimens that cannot be transported via pneumatic tube.
Blood bank is planned to be either on the 2nd fl oor with vertical adjacencies to the OR and ED or within the OR suite with a
vertical adjacency to the ED.
ADT requires easy access to the patient care areas, the ED, discharge lounge and the observation unit.
The discharge unit requires easy access to the pharmacy so patients can pick up prescriptions while they wait for a ride home
after being discharged.
The eligibility center will service the entire hospital. Many outpatients are serviced here, so a close adjacency to the main lobby
would be preferred.
Third Floor:
The Consolidated OR suite, which includes: 23 OR’s, supporting spaces and recovery, intra-operative MRI, blood bank, frozen
section/grossing room, satellite pharmacy, is located on the 3rd fl oor adjacent to Labor and Delivery.
The OR and L&D require vertical adjacencies to sterile processing, the ED / ICC, patient care units, blood bank, and the
laboratories.
The general OR’s require vertical adjacency with designated elevators to transport patients from the ED, to and from the Burn
unit, and SICU. Vertical adjacencies to all patient care areas are important, but the ED, Burn and SICU require designated, clean
elevators that can be designated to stop only at specifi c fl oors for purposes of the emergency transportation of patients.
The labor fl oor requires a designated elevator to transport infants to the NNICU. Vertical direct access from the antepartum unit
to the labor fl oor is also essential.
The C- section OR’s, ECU and recovery spaces should all be contiguous to create maximal fl exibility and support anesthesia
cross coverage.
Fourth Floor:
The NNICU will be located on the fourth fl oor with a vertical adjacency to the labor fl oor. The NNICU is a self contained unit and
includes spaces for procedures, satellite pharmacy, formula room, storage, transport, child -life and therapists, family space and
staff support spaces A plan for the effi cient and emergent transport of a sick infant to Children’s Hospital needs to be further
discussed during the next phase of this project to ensure that the most effi cient vertical and horizontal offstage routes are
identifi ed.
The interventional unit which is comprised of non-invasive inpatient cardiac services, invasive cardiac services and the GI /
Bronch suite will be located on the 4th fl oor. A shared recovery space is planned to maximize effi ciency and anesthesia coverage.
A vertical adjacency to the ED is essential. Vertical adjacencies to the ICU’s (MICU) and patient care units is required.
Communications with anatomic lab, sterile processing and pharmacy are also important.
Functional Stacking Narrative
Sec3:13
Strategic Question: A 36 bed patient care unit is planned for this fl oor. The unit has been titled CCU and was envisioned to have
a combination of ICU beds (12) and acute care beds(24) and care for patients requiring medical and surgical cardiac care. It was
envisioned that the telemetry command center could be part of this unit. Depending on the confi guration of patient type vertical
adjacencies to the OR and ED are necessary as well as a horizontal adjacency to the cath lab. The future vision for cardiac and
cardiothoracic services is still being discussed among PHHS senior administrative and medical leadership.
Another thought: the cardiac population could be accommodated on other patient fl oors and this unit could become the
observation unit, where patients requiring less than 24 hour LOS would be managed. This unit is a standalone unit and doesn’t
offer future fl exibility afforded on the other fl oors where care units have horizontal adjacencies.
Fifth Floor:
Mechanical
Sixth Floor:
Womans:
This fl oor will house either (2) 36 bed Postpartum / Newborn Nursery or (1) 36 bed Antepartum (1) 36 bed Postpartum unit
Vertical adjacencies to L&D, NNICU are required.
Strategic Question: Could the antepartum unit be moved to the 9th fl oor with the GYN ONC unit. This would allow one less NBN
to be built (which was not programmed).
Adult non-woman’s: Surgical ICU, Burn Service and Subspecialty Service Lines / Trauma Institute
This fl oor is envisioned to be organized with surgical services. The 32 bed burn unit with all its’ required support spaces and a
36 bed SICU are envisioned to be in one tower. These units require a clean elevator, vertical adjacency to the OR and ED. Two
acute care 36 bed units are planned to be in the adjacent tower. In accordance with a service line or center of excellence
approach these units could accommodate surgical subspecialty and trauma patients. The Neuro surgical ICU could be
accommodated on one of these units (12 beds), covered by the neuro-intensivists. The adjacent acute care beds could
accommodate medical and surgical neuro / stroke patients. A vertical adjacency to radiology specifi cally CT and MRI are
required. The Epilepsy monitoring station could be part of this unit. The horizontal adjacency between these units will
accommodate programmatic growth and fl uctuation in census. The ICU satellite pharmacy will be located on this fl oor or the 7th
fl oor.
Seventh Floor:
Woman’s:
Woman’s (2) 36 Bed Postpartum / NBN. Vertical adjacencies to L&D, NNICU are required.
Adult non-woman’s: Medical ICU and Subspecialty Service Lines
This fl oor is envisioned to be organized with medical services. The 36 bed MICU, which requires vertical adjacencies to the ED,
GI/Cath lab are required.
It is envisioned that the adjacent acute care unit will manage patients with end stage renal disease (ESRD), renal transplant and
other nephrology patients. This unit will either be 24 or 36 beds the apheresis / dialysis unit will be adjacent to this space. This
will provide the requested horizontal adjacency between the nephrology unit and dialysis and the MICU and dialysis. The
additional (2) 36 bed acute care units on this fl oor can support patients with other medical conditions: IDDM, pulmonary,
infectious disease, etc. A vertical adjacencies to the GI/Cath lab, imaging- specifi cally MRI and CT are required. The ICU satellite
pharmacy will be located on this fl oor or the 6th fl oor.
Eighth Floor:
Woman’s
Woman’s (2) 36 Bed Postpartum / NBN. Vertical adjacencies to L&D, NNICU are required.
Functional Stacking Narrative
Sec3:14
Eighth Floor cont.
Adult non-woman’s: Rehab. / Trauma Institute
It is envisioned that the 24 bed psych unit will be part of this fl oor. This unit requires a vertical adjacency to the psych ED.
The 24 bed Rehab unit with support space is envisioned to be adjacent to (2) 36 bed acute care med/surg units. It is envisioned
that these adjacent units could provide fl exibility for PMR overfl ow and in the future support an expanded vision (60 beds) for
PMR. It is envisioned that patients who require some level of rehabilitation, such as stable post trauma or stroke, orthopedic,
gerontology, patients will be cared for on the units adjacent to the rehab unit. The satellite PT/OT gym should be located in the
core between these units to provide effi cient care and maximum fl exibility.
Ninth Floor : Hematology/Oncology Service Line or Cancer Center of Excellence
Woman’s:
This fl oor will house either (1) 36 bed Postpartum / Newborn Nursery or (1) 36 bed Antepartum and the 28 bed GYN-ONC unit
and infusion center.
Vertical adjacencies to L&D, NNICU are required.
Strategic Question: Could the antepartum unit be moved to the 9th fl oor with the GYN ONC unit. This would allow one less NBN
to be built (which was not programmed).
Adult non-woman’s: Hematology/Oncology:
Four, 36 bed med/surg units are planned for this fl oor. All hem/onc medical and surgical patients would be admitted to these
fl oors. Twelve beds on one of the units would be dedicated to the GCRC. Vertical adjacencies to the OR, imaging and apheresis
are required. A vertical adjacency to pathology is requested. Safe and effi cient access to radiation therapy will need to be
further discussed during the next phase of this project. Currently radiation therapy is programmed to be on the fi rst fl oor of the
clinic building. The oncology satellite pharmacy, which mixes all chemotherapy will be located in the clinic building. Transport
of chemotherapy to the inpatient heme/onc and GYN-ONC units needs to be further discussed.
Functional Stacking Narrative
Sec3:15
Functional Narratives
Karlsberger Healthcare Consulting
Planning | Strategy | Operations | Programming
Functional Narratives are the operational narratives that defi ne the space. Each
narrative contains the following information:
SCOPE OF SERVICES AND OPERATING PARAMETERS•
- Background / Current State Information
PLANNING CONSIDERATIONS •
- Model of Care
- Space Program
- Utilization
- Staffi ng
ORGANIZATIONAL AND KEY ADJACENCIES•
- Adjacency Diagrams (see the key below)
FUTURE FLEXIBILITY•
Adjacency Diagram Key
Functional Narrative Introduction
Sec3:16
Bubble Example Bubble Description
Department in question.
Very Close / Critical Adjacency
Close adjacency
Easy access
Interactions impact workflow and adjacencies or easy access should be considered.
Example
Example
Example
Example
Example
THIS FUNCTIONAL NARRATIVE IS ASSOCIATED WITH THESE SPACE PROGRAMS:
Critical Care Units•
Patient Care Unit Floor Core (ICU)•
Med/Surg Unit•
Patient Care Unit Floor Core (Med/Surg)•
PLANNING WAS INFORMED BY THE FOLLOWING:
Proven Evidence Based Design•
Identifi ed Best Practices•
Completed Staff Questioners•
User Group Discussions•
PWC- PHHS Strategic Planning Document •
SCOPE OF SERVICES AND OPERATING PARAMETERS:
Currently Parkland Hospital has a complement of 24 acute care units and 5 •
ICU’s
Nurse patient ratios vary based on acuity•
Sizing of care units needs to support fl exibility in staffi ng ratios. Should be •
divisible by 2 -4 and 6.
The current inpatient acute care groupings are:
Medical/Hospitalist•
Hematology/Oncology•
Neurology•
Acute Stoke-step down•
Epilepsy monitoring•
Telemetry•
Rehabilitation•
Trauma•
Diabetes•
Pulmonary•
General Surgery•
Surgical Oncology•
Burn•
Miscellaneous surgery, Urology, Oral Ophthalmology, ENT•
Neurosurgery•
Orthopedics•
Functional Narrative - Inpatient Care
Units (Acute Care/Critical Care)
Sec3:17
The current inpatient ICU groupings are:
• CCU
• MICU
• BICU
• SICU
Background / Current-State:
The current units vary in size from 11 beds to 26 beds and are comprised of mostly semi-private rooms. •
The small size of the current rooms, do not accommodate families and make it diffi cult to integrate families into a patient’s •
care.
Presently units are organized according to service line, physician staffi ng guidelines and patient acuity.•
Supplies and medication dispensing machines are centrally located on the units requiring nurses to go to a central location •
when they need supplies.
The current medical record and order entry system is manual which creates delays in care delivery and is prone to human •
error. This system also takes nurses away from the bedside to a central location to chart, obtain orders and make changes
to the patient’s plan of care.
There is limited space on or adjacent to the units for physicians to hold work and teaching rounds, as a result they are forced •
to seek spaces away from the unit, which does not enhance a multidisciplinary or collaborative practice model of care.
PLANNING CONSIDERATIONS:
Model of Care:
Inpatient services will be provided on units of 36 and 24 private patient rooms. •
There will be two (2) 36 bed units per fl oor or (1) 36 bed and (1) 24 bed unit per fl oor in the replacement hospital. The new •
hospital will be programmed with 10 acute care medical surgical units, 3 ICU, 1 inmate (see inmate program), 1
rehabilitation unit (see rehab program), one integrated burn unit, which accommodates all levels of care, (see burn
program).
Patients requiring acute and step-down medical and surgical level of care will be managed on the acute care units. •
It is anticipated that in the future patients will be grouped on units according to disease state/service line and physician •
staffi ng for coverage. Units will be programmed to be generic but will be designed to cater to the unique features of specifi c
patient populations.
The building stacking should be arranged to support service line grouping and maximal fl exibility between adjacent care •
units.
The unit groupings take into consideration the following strategic visions: a trauma institute, cardiothoracic surgery •
returning to Parkland, expansion strategy for PMR, inmate strategy, oncology growth strategy, Parkland’s academic mission,
and future multidisciplinary operating models of care delivery.
The Epilepsy Monitoring station will be located within one of the acute care units. Twelve beds will be allocated to Epilepsy •
Monitoring; however more could be added if future patient volumes increase. There will be an electronic adjacency between
the Epilepsy Monitoring station and the neurodiagnostics center. 2 rooms on this unit will be dedicated to inpatient EEG
testing and should be designed with acoustics to reduce artifact that will interfere with EEG testing.
The Central Telemetry Monitoring station will be located within one of the acute care units. This space should be located in •
close proximity to the telemetry unit, however all patients who are on telemetry will be monitored remotely in this space.
A 320 NSF OT/PT satellite gym is planned to accommodate the therapy needs of those patients who are not on the rehab unit, •
but who require dedicated gym space for therapy. This gym should be located on the unit or in the core of the unit where
orthopedic, stroke, recovering trauma patients are hospitalized.
The optimal unit lay out will foster a decentralized operating model of care. •
Functional Narrative - Inpatient Care Units (Acute Care/ICU)
Sec3:18
Care will be organized at the patient’s bedside rather than in a central location. •
The unit should be designed to promote maximal visibility, special relationships and a lean approach to care delivery. All •
equipment, supplies and documentation tools will be within a nurse work zone. This will promote effi ciency by reducing
travel distances. The “sweet spot” for effi ciency and walking distance is 241 - 289 NSF.
All rooms with be private with bathrooms and showers.•
All critical care rooms will be telemetry capable, all acute care rooms will be wired for telemetry. •
All critical care rooms will be plumbed for dialysis. •
Consideration of lifts to assist in moving patients should be widely implemented.•
25% (9-per unit) of acute care rooms will be equipped as bariatric rooms will be plumbed for dialysis. •
Isolation (negative pressure): it is planned that 25% of the MICU beds (9) will be negative pressure, and 10% of the remaining •
beds will be negative pressure. ICRA to be done to validate the number of isolation rooms.
-36 of the negative pressure rooms should be collocated on one unit. This strategy will infectious patients to be
cohorted on one unit.
At a minimum an additional 36 bed acute care unit will be programmed to be easily converted to negative pressure in the •
event of a pandemic situation. This space should be designed in such a way that it could be quarantined from the remaining
hospital space. Parkland leadership will continue to work with infectious disease physicians and clinicians to develop a
response plan for a pandemic situation. The details of this plan will be further fl ushed out with the architect and engineer
during the design phase of the project.
The design of horizontal pathways and vertical transporting systems to reduce the physical demand on personnel servicing •
multiple units and departments should be employed in the design. Separate onstage and offstage functions will support
patient, public and logistics traffi c, both vertically and horizontally.
Nursing Model of Care:• Will remain primary with 1 nurse and patient care assistant to a designated number of patients.
Medical Model :• Parkland will continue its mission of teaching residents and medical students. Changes in CMS guidelines,
physician shortages and the increasing acuity of hospitalized patients are driving the development of hospitalist programs,
increased use of midlevel providers, and more on-service time for existing attending physicians. The new space needs to
accommodate these clinicians 24/7. Provisions for designated available space for educational activities, offi ces and call
rooms will be allocated.
Grouping and Size of IP Care Units
Functional Narrative - Inpatient Care Units (Acute Care/ICU)
Sec3:19
Critical Care Patient Units Notes/ Comments # of Rms
Board Approved DGSF 11/4/08
KHC 2/22/09 Revised 3/4/09
KHC SHELL 2/22/09Revised 3/4/09
Critical Care Units 3 units of 36 beds + a burn unit.
Critical Care Units 3 units of 36 beds each = 108 critical care non-women’s beds
108 76,500 82,491
Burn Unit 32 beds (20 acute and 12 ICU): Urgent Care, OR/Procedure Room, Outpatient Burn
32 45,000 30,299
Patient Care Unit Floor Core
4 units total require 2 cores at 6,593 DGSF 0 12,701
Med/Surg Patient Units 9 med/surg units, 2 shell, 1 rehab unit, 1 psych unit, and 1 inmate unit
Med /Surg Unit 9 units of 36 beds each: 324 beds 324 216,000 245,687
Med/Surg Rehab Unit 1 unit of 24 beds 24 26,135
Psych Bed Unit 1 unit of 24 beds 24 27,000 24,306
Inmate Unit and Treatment Center
1 unit of 12 beds; Urgent Tx and Exam Rooms (incl. core functions)
12 16,799
Patient Care Unit Floor Core
6 cores total – one core per floor serves two units (each core is 6,593 DGSF)
38,102
Apheresis/Dialysis Unit Locate on the same floor as nephrology beds 8,274
Satellite PT/OT Gym Locate in the Floor Core on the Ortho Floor (or wherever the team feels is appropriate
320
Epilepsy Monitoring (see M/S unit program note at end
Epilepsy monitoring room thatneeds to be located on one med/surg unit
360
EEG/Sleep Move to clinic 4,400
Central Telemetry Monitoring (See M/S unit program note at end)
Telemetry monitoring rooms that need to be located on one med/surg unit
360
SHELLED M/S Unit 2 unit of 36 beds 72 54,597
SHELLED Core to go with Unit
1 core 6,350
Source: Kaufman Hall 2006 data (9months annualized), Price Waterhouse Coopers(PWC) Volume Capacity, Projections. Master Facility Plan, June 2007.
Patient Arrival
• Unit Transfer• Bed Assigned• Equipment
ordered/delivered to room
• Electronic report sent to receiving RN
Patient Arrives
Bedside registration completed, if necessary
Patient care assignment made
Initiation of Care
Care Delivery
Patient assessment performed
Orders initiated electronically
Monitoring:Hardwire, invasive,
telemetry
Medication System• Pyxis modules located
near patient rooms at ratio of 1 set per 18 patients
• Clinical pharmacists available for discussion
• Special items provided via P. Tube.
Supplies• Patient specific items
added to in-room supply cart
Equipment• Available on the unit or
from Distribution or Biomed
Food Services• Meals ordered
electronically• Room Service Model• Nutritional services• Coordinates with
nursing for feeding.
Documentation• Done at bedside,
decentralized areas, or work room.
• As many systems as possible are electronically integrated into the EMR.
Lab• Specimens drawn at
bedside• Testing utilizes POC: in
room, in surgery• P. tube used for
specimen transport• Results electronically
produced.
Surgical Intervention/ Procedures
• Transport to Surgery/Procedure area
• Emergencies may require in room intervention for some procedures
• Patient returned from Recovery Area or directly from Surgery/Procedure area
Therapies• Bedside administration
• Respiratory• PT/OT/ST• EKG• EEG
• Department administration• PT/OT/ST• Cardio Diagnostics• Neuro Diagnostics
Imaging• Provided with portable
equipment at bedside or transported to Imaging Department
• All imaging is digital and viewed in PACS.
• Some key Imaging services located on IP Units (CT)
Discharge Process
• Starts on Admission• Case Manager/Social
Worker assigned at admission
• Team conferences case review occurs on regular schedule
Appropriate placement arranged
Discharge orders received.
Patient transferred or discharged.
Future State Process Flow
Functional Narrative - Inpatient Care Units (Acute Care/ICU)
Space Program:
Unit Size:• Future confi gurations will be standardized and should allow nurse patient ratios to be divisible by 2-4-6. A
standardized 36 private-bed unit is planned to provide operational fl exibility.
Unit Sub-divided: Units• can be subdivided into smaller pods or groupings. These smaller areas could be grouped to
accommodate staffi ng and care for specifi c patient populations. ICU’s could be sub-divided into four i.e. Neurosurgical ICU.
Unit Layout:• The use of single patient rooms will increase the footprint size of the patient care units, thus the space design
must maximize visibility, spatial relationships and reduce travel distances. In addition staff to staff communication via
advanced technology will be essential.
Electronic Environment• : It is envisioned that the new hospital will be completely electronic. It is presumed that all
documentation, order entry, monitoring, etc. will take place at or in close proximity to the patient’s bedside.
Transportation:• Horizontal pathways and vertical transportation systems will be programmed. They must reduce the
physical demand on personnel servicing multiple units and departments. A sophisticated pneumatic tube system is planned
as a critical component to the medication/supply/specimen delivery system. Medication delivery will utilize automated
dispensing machines (Pyxis) with medication stocking by pharmacy. Specialty or emergency delivery of products will be
accomplished by pneumatic tube.
Reception / Family Waiting: • Space will be programmed to accommodate patient’s families. Integration of family centered
care principles will be paramount in the new hospital.
Sec3:20
Patient Room: • The rooms will feature 3 distinct zones: family, patient and staff. Family centered care will be a cornerstone
of the new facility. Distinct spaces and amenities that reach-out to and foster the inclusion of families in patient care area
planned.
-Room Standardization: Rooms will be standardized with regard to the location of medical gases, systems and supplies.
This concept will enable providers to experience an identical environment in each patient room.
-All rooms with be private with outboard bathrooms and roll in showers.
-All ICU rooms will be plumbed for dialysis.
-All rooms will be private, universal and wired for telemetry. This will provide fl exibility with changes in patient census
and acuity.
-Isolation rooms will be distributed through-out the specifi cs to be determined by ID/IC plan.
-Future Flexibility: A Universal Room Concept will be utilized to provide a fl exible, physical environment that supports
varying acuity of patients and avoids multiple transfers. Blocks or modules of rooms can be designated for specifi c
acuity levels or disease populations.
Medication Administration:• Each unit will have a secure med room at a 1:18 ratio. This room will provide space for
medication storage and supplies for dispensing medications. In addition each patient room will be designed with a nurse
server. A system which utilizes medication distribution to a patient specifi c space reduces medication errors.
Team Work Space:• Spaces will be programmed to support both unit and visiting professional staff.
- The new space will feature decentralized work spaces at the patient bedside. Alcove work stations with computers
will be programmed at a ratio of 1 for every patient room.
- Clinical Support Team Workroom: Centralized “touchdown” space for staff collaboration and work space for visiting
staff will be programmed on each unit.
- Support Space: Separate onstage and offstage functions and patient, public and logistics traffi c (both horizontal and
vertical) will be programmed. Larger spaces can accommodates teaming, planned meetings and educational
programs.
Provider Spaces: • Each unit has designated provider workrooms to accommodate provider rounds and workspace. In
addition each unit core has a Resident Learning Center (LRC) and offi ce space to support 2 fellows (Fellow LRC).
Specialized Service Flexibility:• In the future the acute care units will have the fl exibility to provide specialized common
treatment modalities and monitoring that they have not had the ability to provide because of space constraints. Provision of
this care will afford future fl exibility to respond to patient clinical needs, acuity, fl uctuating census and staffi ng, for example:
- Telemetry monitoring - future state all rooms will be wired
- Flexibility to manage step-down patients in the acute care units including those on ventilators
- Increased number of patients with complex co-morbidities whose care will require increased task, education and
patient/ family collaboration.
- Increasing infection control concerns and regulatory policy constraints
- Increased volume of bariatric like patients will increase the physical demands placed on staff
- Increased number of cognitively challenged patients: aging population, borderline psychiatric population.
Specialized Population Specifi c Space:• Flexible space will be built into the unit core which will provide future ability to have
specialized equipment i.e. satellite therapy gym on or in close proximity to patients requiring rehab therapy but are not on the
rehab unit.
Functional Narrative - Inpatient Care Units (Acute Care/ICU)
Sec3:21
Functional Narrative - Inpatient Care Units (Acute Care/ICU)
Sec3:22
Reception / Waiting Patient Rooms/ Clinical Care (Space:Pt)
Unit Core (1:18) Unit Support Vertical Transportation
Reception / Information and Control (1:72)
Patient Room 36 regular;Isolation per ID/IC
Storage Equipment,General
Communication Center (1:36)
Support Elevators – 1 bank of multiple elevators per 36 patients
Waiting / Family Lounge,Library (1:72)
Decentralized staff workstation (1:1)
Stretcher / Wheelchair Storage
Respiratory Therapy (1:72)
Patient elevators – 1 bank of multiple elevators per 72 patients
Family Consult Room (1:72)
Provider work rooms1:9 vs. 1:18
Public Trash & Recycling Pantry Staging Patient Elevators – 1 bank of multiple elevators per 72 patients
Clinical Support Team 1:36 Soiled Holding Staff Lounge and Locker Room (1:72)
Pointof Care Testing 1:18 Linen MD Hoteling Office (2:72)
Medication Room 1:18 Clean Supplies Unit Manager Office 1:36
Galley / Staff Nutrition 1:18 EVS Shared Office (4:72)
Family Nutrition 1:18 Staff Bathroom Fellow Office (LRC)(1:72)
Emergency Equipment Alcove 1:9 Conference Room (one lg. one small:72)
Pneumatic Tubes 2:36
Source: Kaufman Hall 2006 data (9months annualized), Price Waterhouse Coopers(PWC) Volume Capacity, Projections. Master Facility Plan, June 2007.
Utilization / Hours of Operation:
24 hours a day- 7 days a week •
- Most admissions occur between 3 PM - 11 PM
- Most discharges occur between 12 PM – 4 PM
Staffi ng:
Staffi ng ratios may vary by unit, new space should support fl exible ratios and be divisible by 2-4-6. HUC, PAC future roles •
will change with decentralized units and EMR- need further discussion.
Staff work 8 hour shifts on the acute care units and 12 hour shifts in the ICU’s •
There are between 16 - 20 members of the nursing staff on the unit at any one time.•
There are between 4 - 15 staff (allied health, attending physicians, students, etc.) on the unit at any given time.•
ORGANIZATIONAL AND KEY ADJACENCIES:
The inpatient acute care units should be easily accessible to staff, materials management, visitors, the operating rooms and •
the emergency department.
Designated elevators for staff, patients, visitors and supplies to decrease travel time, improve effi ciency and patient safety •
will be programmed.
In the future state operating model staff from cross-disciplines will be dedicated to specifi c units, hoteling space will be •
provided.
The new space will accommodate phlebotomy staff and direct access to clinical lab, via pneumatic tubes. •
ICU rooms and a percent of acute care rooms will be plumbed for dialysis. •
Therapists will have space for supplies to accommodate unit based therapy. •
Consideration should be given to the following intuitive adjacencies when the building is stacked:•
- Placement of Hematology/Oncology and Surgical Oncology patient populations
- Medical / Surgical Oncology and GYN Oncology
- Medical / Surgical Acute Care patients requiring therapy services adjacent to Acute Care Rehab. Unit
- Medical Acute Care Unit caring for nephrology patients adjacent to Dialysis Unit
- Dialysis Unit Vertical adjacency to ICU
- SICU with vertical adjacency to the OR
- GCRC and Oncology
- ICU’s with vertical adjacency to OR and ED
- CCU and telemetry vertical adjacency to OR and Invasive / Non-invasive cardiology
- Clinical lab, blood bank, and pharmacy adjacency needs will be met with pneumatic tubes.
- Potable imaging, ECHO, EEG will be available bedside in the ICU’s and on the acute care units as necessary
- Neuro ICU adjacency consideration to CT
Functional Narrative - Inpatient Care Units (Acute Care/ICU)
Sec3:23
Adjacency Diagrams
FUTURE FLEXIBILITY:
All inpatient rooms will be universal and sized to meet Texas Administrative Code – ICU requirements, to provide a fl exible,
physical environment that supports the varying acuity of patients and avoids multiple transfers. Blocks or modules of rooms can
be designated for specifi c acuity levels or disease populations.
The plan for how the units are confi gured in the new building should allow for fl exibility across units to accommodate
programmatic growth, changes in science, technology and disease management and fl uctuation in patient census.
Functional Narrative - Inpatient Care Units (Acute Care/ICU)
OR
Imaging
Pharmacy
Pathology
Clinical Lab
ED
MRI
PM&R
ICU ICU
Imaging
Dialysis
ED
Sec3:24
THIS FUNCTIONAL NARRATIVE IS ASSOCIATED WITH THESE SPACE PROGRAMS:
Burn Unit with Specialty Procedure Space•
Patient Unit Floor Core•
PLANNING WAS INFORMED BY THE FOLLOWING:
Proven Evidence Based Design•
Identifi ed Best Practices•
Completed Staff Questioners•
User Group Discussions•
PWC- PHHS Strategic Planning Document •
SCOPE OF SERVICES AND OPERATING PARAMETERS:
Background / Current-State:
The Regional Burn Program at PHHS is accredited by the American Burn •
Association, ABA. The center has received verifi cation by the ABA and the
American College of Surgeons.
Burn center verifi cation is a mark of distinction and indicates to government, •
third party payors, patients, and accreditation organizations that the center
provides the highest quality care and meets the rigorous qualifi cations outlined
by the ABA for accreditation.
The program at Parkland cares for patients of all ages. Over the last year the •
burn program has noticed increased volumes. It is hypothesized that volumes
have increased as a result of hurricane Katarina and the closing of burn centers
in nearby regions. However, the exact source and sustainability of the volume
increase has not been further studied. Additionally, there are patients with skin
sloughing disorders that could benefi t from the services provided by the
Parkland burn program.
The current burn program is divided into two units (acute care unit and ICU), •
located on two different fl oors.
There is a burn urgent care center located adjacent to the burn unit. This center •
is staffed by nurses and treats patients with minor burns; outpatient dressing
changes and wound care. The wound care space is ineffi cient and too small to
service the growing number of burn patients who seek this outpatient service.
Currently there are 2 physicians who manage the burn service (ICU, acute care •
units, surgical procedures, ambulatory clinics, teaching and research) 24/7.
Because of the demanding workload, acuity of patients and manpower it is
imperative that all burn services be co-located or in very close proximity to each
other.
The current burn ICU is 9 beds and the current acute care unit is 16 beds. Nurse •
patient ratios on the acute care unit are 1:4-6. Patient care assistants also care
for patients, this staffi ng ratio varies depending on patient need. The ICU is
staffed with ratios of 1:1 or 1:2 depending on the acuity of the patient.
Currently supplies and medication dispensing machines are centrally located on •
the units requiring nurses to go to a central location when they need supplies.
Functional Narrative - Burn Unit with Speciality Procedure
Spaces
Sec3:25
The current medical record and order entry system is manual which creates delays in care delivery and is prone to human •
error. This system also takes nurses away from the bedside to a central location to chart, obtain orders and changes to the
patient’s plan of care.
There is limited space on or adjacent to the units for physicians to hold work and teaching rounds, thus they are forced to •
seek spaces away from the unit, which does not enhance a multidisciplinary or collaborative practice model of care.
PLANNING CONSIDERATIONS:
Model of Care:
The Burn Program will continue to serve patients with burns who are referred from within the region and nearby regions. •
Due to the recent closing of Shriners Burn Center it is expected that Parkland’s burn center will begin to see an increase in •
pediatric patients.
It is imperative that the program continue to be accredited by the ABA.•
The future burn space is programmed to accommodate all burn services in one geographical location. This space will •
include the acute care beds, ICU beds, hydrotherapy, therapy gym and burn urgent care exam space. In the future burn
services will be provided on a 32 bed unit, comprised of 20 acute care beds and 12 ICU level care beds. A protective
environment is planned.
Burn patients are especially susceptible to infections, a protective environment is requested. Consideration should be given •
to having isolation room (s) available. Further discussion with ID/IC is required.
Two scrub sinks will be located at the entrance to the unit to be used by all staff and visitors who enter the unit. The sinks •
should be designed to be inviting and unavoidable to ensure that hand washing and gowning is practiced by every individual
who enters the unit.
Nursing Model of Care:• Will remain primary with 1 nurse and patient care assistant to a designated number of patients.
Medical Model: • Currently there are 2 physicians who manage the burn service (ICU, acute care units, surgical procedures,
ambulatory clinics, teaching and research) 24/7. Because of the demanding workload, acuity of patients and manpower it is
imperative that all burn services be co-located or in very close proximity to each other. It is thought that this situation may
not change in the future. Parkland will continue its mission of teaching residents and medical students. Changes in CMS
guidelines, physician shortages and the increasing acuity of hospitalized patients are driving the development of hospitalist
programs, increased use of midlevel providers, and more on-service time for existing attending physicians. The new space
needs to accommodate these clinicians 24/7. Provisions for designated available space for educational activities, offi ces and
call rooms will be allocated.
Functional Narrative -Burn Unit with Speciality Procedure Spaces
Sec3:26
Functional Narrative -Burn Unit with Speciality Procedure Spaces
Sec3:27
Space Program:
Unit Size: • Future confi gurations will be standardized and should allow nurse patient ratios to be divisible by 4.
Patient Care Unit Layout: • The use of single patient rooms will increase the footprint size of the patient care units, thus the
space design must maximize visibility, spatial relationships and reduce travel distances. In addition staff to staff
communication via advanced technology will be essential.
Electronic Environment:• It is envisioned that the new hospital will be electronic. It is presumed that all documentation,
order entry, monitoring, etc. will take place at or in close proximity to the patient’s bedside.
Transportation:• Horizontal pathways and vertical transportation systems will be programmed. They must reduce the
physical demand on personnel servicing multiple units and departments. Sophisticated pneumatic tube system is planned
as a critical component to the medication/supply/specimen delivery system. Medication delivery will utilize automated
dispensing machines (Pyxis) with medication stocking by pharmacy. Specialty or emergency delivery of products will be
accomplished by pneumatic tube.
Reception / Family Waiting: • Space will be programmed to accommodate patient’s families. Integration of family centered
care principles will be paramount in the new hospital.
Patient Room: • The rooms will feature 3 distinct zones: family, patient and staff. Family centered care will be a cornerstone
of the new facility. Distinct spaces and amenities that reach-out to and foster the inclusion of families in patient care area
planned.
-Room Standardization: Rooms will be standardized with regard to the location of medical gases, systems and supplies.
This concept will enable providers to experience an identical environment in each patient room.
-All rooms with be private with outboard bathrooms and roll in showers.
-All ICU rooms will be plumbed for dialysis.
-The unit will be protective environment. The location of patients requiring negative pressure isolation needs further
discussion.
-All rooms will be private, universal and wired for telemetry. This will provide fl exibility with changes in patient census
and acuity.
-Future Flexibility: A Universal Room Concept will be utilized to provide a fl exible, physical environment that supports
varying acuity of patients and avoids multiple transfers. Blocks or modules of rooms can be designated for specifi c
acuity levels or disease populations.
Medication Administration: • Each unit will have a secure med room at a 1:20 ratio for acute care beds and 1:12 ratio for the
ICU. This room will provide space for medication storage and supplies for dispensing medications. In addition each patient
room will be designed with a nurse server. A system which utilizes medication distribution to a patient specifi c space
reduces medication errors.
Code Carts:• A pediatric emergency cart with pediatric and infant defi brillator will be located in each unit.
Team Work Space:• Spaces will be programmed to support both unit and visiting professional staff.
- The new space will feature decentralized work spaces at the patient bedside. Alcove work stations with computers
will be programmed at a ratio of 1 for every patient room.
- Clinical Support Team Workroom: Centralized “touchdown” space for staff collaboration and work space for visiting
staff will be programmed on each unit.
- Support Space: Separate onstage and offstage functions and patient, public and logistics traffi c (both horizontal and
vertical) will be programmed. Larger spaces can accommodates teaming, planned meetings and educational
programs.
Provider Spaces: • Each unit has designated provider workrooms to accommodate provider rounds and workspace. In
addition each unit core has a Resident Learning Center (LRC) and offi ce space to support 2 fellows (Fellow LRC).
Specialized Service Flexibility: • In the future the acute care units will have the fl exibility to provide specialized common
treatment modalities and monitoring that they have not had the ability to provide because of space constraints. Provision of
this care will afford future fl exibility to respond to patient clinical needs, acuity, fl uctuating census and staffi ng, for example:
-Telemetry monitoring- future state all rooms will be wired
-Flexibility to manage step-down patients in the acute care units including those on ventilators
-Increased number of patients with complex co-morbidities whose care will require increased task, education and
patient/ family collaboration.
-Increasing infection control concerns and regulatory policy constraints
Specialized Population Specifi c Space: •
-Hydrotherapy tanks, therapy gym, wound care treatment/exam rooms will be programmed as part of the unit.
-Age appropriate recreation/therapeutic space will be programmed: playroom, teen-room, adult day room.
Functional Narrative -Burn Unit with Speciality Procedure Spaces
Sec3:28
Utilization / Hours of Operation:
24 hours a day- 7 days a week •
-The average daily census is 19.9 which is a 86% occupancy.
-The average length of stay is 14 days.
-Most admissions occur around 5pm
-Most discharges occur around 11am
Staffi ng:
Staffi ng ratios may vary by unit based on acuity. The new space needs to be divisible by 2-4-6. HUC, PAC future roles will •
change with decentralized units and EMR- need further discussion.
Staff work 8 hour shifts on the acute care units and 12 hour shifts in the ICU•
Functional Narrative -Burn Unit with Speciality Procedure Spaces
Sec3:29
Reception / WaitingIn Core
Patient Rooms/ Clinical Care (Space:Pt)
Unit Core Unit Support / Floor Core
Vertical Transportation
Reception / Information and Control in core
Total Patient Rooms: 3220 acute care, 12 ICU*All protective
Storage Equipment, General
Communication Center 1:32
Support Elevators – 1 bank of multiple elevators per 68 patients
Waiting / Family Lounge,Library
Decentralized staff workstation 1:1
Stretcher / Wheelchair Storage
Respiratory Therapy(1:68)
Patient elevators – 1 bank of multiple elevators per ?? Patients
Family Consult Room Provider work rooms 3:32(1:ICU; 2:Acute Care)
Public Trash & Recycling Pantry Staging Patient Elevators – 1 bank of multiple elevators per 68 patients
Patient Elevators Direct to OR 1:32
Specialty Spaces Clinical Support Team 1:32 Soiled Holding Staff Lounge and Locker Room
PT/OT Point of Care Testing 2:32(1:ICU; 1:Acute Care)
Linen MD Hoteling Office (2:68)
Playroom/School Young Children
Medication Room 2:32(1:ICU; 1:Acute Care)
Clean Supplies Unit Manager Office (1:32)
Teen Room/SchoolAdult Day Room
Gallery / Staff Nutrition 2:32(1:ICU; 1:Acute Care)
EVS Shared Office (4:68)
Burn Urgent CareOutpatient Space
Family Nutrition 2:32(1:ICU; 1:Acute Care)
Staff Bathroom Fellow Office LRC(1:68)
Wound Care: Hydrotherapy and Debridement Shower
Emergency Equipment Alcove1:12 ICU Adult1:12 ICU Pediatric1:10 Acute Care Adult1:20 Acute Care Pediatric
Conference Room (one large and one small 1:68)
Pneumatic Tubes 2:32(1:ICU; 1:Acute Care)
Source: Kaufman Hall 2006 data (9months annualized), Price Waterhouse Coopers(PWC) Volume Capacity, Projections. Master Facility Plan, June 2007.
Imaging
Pharmacy
ED
OR MRD
Pathology
Therapy / Hydro-therapy Wound
Care / Urgent Care
Acute ICU Burn
ORGANIZATIONAL AND KEY ADJACENCIES:
Vertical adjacency to the operating room is essential. Burn patients require multiple trips to the operating room. There •
should be a clean elevator dedicated to transporting burn patient between the inpatient care unit and the operating suite.
Vertical adjacency to the ED is planned.•
The burn unit acute should be easily accessible to staff, materials management, visitors, the operating rooms and the •
emergency department.
Designated elevators for staff, patients, visitors and supplies to decrease travel time, improve effi ciency and patient safety •
will be programmed.
It is planned that the burn unit will be located adjacent to the SICU to allow for patient overfl ow into that unit if the burn •
volume continues to grow.
Adjacency Diagram
FUTURE FLEXIBILITY:
Universal rooms will offer staff the ability to fl ex care up and down as a patient’s clinical condition. •
Universal rooms offer staff the ability to fl ex rooms in response to patient acuity and census.•
The burn unit should be located with a horizontal adjacencies to the SICU and acute care unit to accommodate an increased •
census.
Functional Narrative -Burn Unit with Speciality Procedure Spaces
Sec3:30
THIS FUNCTIONAL NARRATIVE IS ASSOCIATED WITH THESE SPACE PROGRAMS:
Med/Surg Rehab Unit•
PLANNING WAS INFORMED BY THE FOLLOWING:
Proven Evidence Based Design•
Texas Administrative Code•
CARF•
Identifi ed Best Practices•
Completed Staff Questioners•
User Group Discussions•
PWC- PHHS Strategic Planning Document •
SCOPE OF SERVICES AND OPERATING PARAMETERS:
Currently Parkland Hospital has a 17 bed inpatient acute care rehab unit which •
services mainly patients requiring rehabilitation services after suffering from
traumatic brain injury or spinal cord injury.
Background / Current-State:
The current unit is made up of small semiprivate rooms that not only do not •
accommodate a patient’s family, but are so small that it is diffi cult to
accommodate and maneuver patients. The bathrooms are small making it
diffi cult for patients in wheel chairs and those needing assistance to use. There
are no showers in the bathrooms.
There is minimal space for storage of patient equipment.•
Staff works as a team to care for patients. The patient care team consists of •
physicians, nurses, therapists, social workers, case managers, dietitians and
family members.
Nurse patient ratios are 1:4. Patient care assistants also care for patients, this •
staffi ng ratio varies depending on patient need. Currently supplies and
medication dispensing machines are centrally located on the units requiring
nurses to go to a central location when they need supplies.
The current medical record and order entry system is manual which creates •
delays in care delivery and is prone to human error. This system also takes
nurses away from the bedside to a central location to chart, obtain orders and
changes to the patient’s plan of care.
There is limited space on or adjacent to the units for physicians to hold work and •
teaching rounds, thus they are forced to seek spaces away from the unit, which
does not enhance a multidisciplinary or collaborative practice model of care.
The ability to care for patients in a multidisciplinary model is essential for
patients on the rehabilitation unit.
There is always a waiting list for a bed on the rehab unit. Because of• Parkland’s
mission to fi rst serve the indigent patients most of the funded patients go to
other facilities for rehab services.
Functional Narrative -Rehab Unit
Sec3:31
Space Program:
Unit Size: • Future confi gurations will be standardized and should allow nurse patient ratios to be divisible by 2-4-6. A
standardized 24 private-bed unit is planned to provide operational fl exibility.
Nursing Unit Layout:• The use of single patient rooms will increase the footprint size of the patient care units, thus the space
design must maximize visibility, spatial relationships and reduce travel distances. In addition staff to staff communication via
advanced technology will be essential.
Security: • Electronic surveillance or electronic access to the unit is requested as a patient safety measure to ensure patients
who might wonder off the unit are not able to do so.
Electronic Environment: • It is envisioned that the new hospital will be electronic. It is presumed that all documentation,
order entry, monitoring, etc. will take place at or in close proximity to the patient’s bedside.
Transportation:• Horizontal pathways and vertical transportation systems will be programmed. They must reduce the
physical demand on personnel servicing multiple units and departments. Sophisticated pneumatic tube system is planned
as a critical component to the medication/supply/specimen delivery system. Medication delivery will utilize automated
dispensing machines (Pyxis) with medication stocking by pharmacy. Specialty or emergency delivery of products will be
accomplished by pneumatic tube where applicable.
Reception / Family Waiting: • Space will be programmed to accommodate patient’s families. Integration of family centered
care principles will be paramount in the new hospital.
Patient Room:• The rooms will feature 3 distinct zones: family, patient and staff. All rooms will have outboard private
bathrooms with roll in showers. Ceiling lifts should be considered.
-Patient rooms will be approximately 300 SF.
-Each room will have a private ADA sized bathroom with a roll in shower.
-Some rooms will be equipped with patient lifts in the ceiling.
-Rooms will be standardized with regard to the location of medical gases, systems and supplies.
-This concept will enable providers to experience an identical environment in each patient room.
Medication Administration: • Each unit will have a secure med room at a 1:20 ratio for acute care beds and 1:12 ratio for the
ICU. This room will provide space for medication storage and supplies for dispensing medications. In addition each patient
room will be designed with a nurse server. A system which utilizes medication distribution to a patient specifi c space
reduces medication errors.
Therapy Spaces:• A therapy work station with 15 work stations and 4 computers has been programmed. This space should be
open to the gym space.
-Physical Therapy: A 2,000 NSF gym has been programmed. Patients on the rehab. unit require intensive therapy for
several hours a day. This space accommodates specialized equipment and the ability to treat 8 patients simultaneously.
-Occupational Therapy: A 720 NSF OT treatment space has been programmed. In addition a ADL Kitchen at 160 NSF,
ADL Bed Area, ADL Bathroom Area at 100 NSF and Laundry at 100 NSF has been programmed as therapy space.
Functional Narrative -Rehab Unit
Sec3:32
-Speech Therapy: Three speech therapy treatment spaces at 143 NSF (consider increasing size to 196 SF) are
programmed.
-Private Treatment Space: Private treatment space to be used by OT and ST for working with patients in a low
stimulation environment. This room should reduce sound and distracting external stimulation. Recreation/ Dining
Dining Room: • A dining / recreation room is planned.
Team Work Space:• Spaces will be programmed to support both unit and visiting professional staff.
-The new space will feature decentralized work spaces at the patient bedside. Alcove work stations with computers
will be programmed at a ratio of 1 for every patient room.
-Clinical Support Team Workroom: Centralized “touchdown” space for staff collaboration and work space for visiting
staff will be programmed on each unit.
-Support Space: Separate onstage and offstage functions and patient, public and logistics traffi c (both horizontal and
vertical) will be programmed. Larger spaces can accommodates teaming, planned meetings and educational
programs.
Provider Spaces: • Each unit has designated provider workrooms to accommodate provider rounds and workspace. In
addition each unit core has a Resident Learning Center (LRC) and offi ce space to support 2 fellows (Fellow LRC).
Specialized Service Flexibility: • In the future the acute care units will have the fl exibility to provide specialized common
treatment modalities and monitoring that they have not had the ability to provide because of space constraints. Provision of
this care will afford future fl exibility to respond to patient clinical needs, acuity, fl uctuating census and staffi ng, for example:
-Telemetry monitoring- future state all rooms will be wired
-Flexibility to manage step-down patients in the acute care units including those on ventilators
-Increased number of patients with complex co-morbidities whose care will require increased task, education and
patient/ family collaboration.
-Increasing infection control concerns and regulatory policy constraints
-Increased volume of bariatric like patients will increase the physical demands placed on staff
-Increased number of cognitively challenged patients: aging population, borderline psychiatric population.
Specialized Population Specifi c Space: • Flexible space will be built into the fl oor core which will provide future ability to have
specialized equipment i.e. satellite therapy gym on or in close proximity to patients requiring rehab. therapy but are not on
the rehab unit.
Functional Narrative -Rehab Unit
Sec3:33
Utilization / Hours of Operation:
24 hours a day- 7 days a week •
Staffi ng:
Staffi ng ratios vary based on acuity. HUC, PAC future roles will change with decentralized units and EMR - need further •
discussion.
Staff work 8 hour shifts •
There are between 16 - 20 members of the nursing staff on the unit at any one time.•
There are between 4 - 15 staff (allied health, physician, students, etc.) on the unit at any given time.•
Sec3:34
Functional Narrative -Rehab Unit
Reception / Waiting Patient Rooms/ Clinical Care (Space:Pt)
Unit Core (1:24) Unit Support / Floor Core
Vertical Transportation
Reception / Information and Control 1:24
Patient Rooms: 24 Storage Equipment, General
Communication Center (1:24)
Support Elevators – 1 bank of multiple elevators per 24 patients
Waiting / Family Lounge,Library 1:24
Decentralized staff workstation 1:1
Stretcher / Wheelchair Storage
Respiratory Therapy (1:60)
Patient elevators – 1 bank of multiple elevators per 60 Patients
Family Consult Room 2:24 Provider work rooms 1:8 Public Trash & Recycling
Pantry Staging Patient Elevators – 1 bank of multiple elevators per 60 patients
Specialty Spaces Clinical Support Team 1:24 Soiled Holding Staff Lounge and Locker Room (1:60)
OT Spaces Point of Care Testing 1:!2 Linen MD Hoteling Office (2:60)
PT Spaces Medication Room 1:12 Clean Supplies Unit Manager Office (1:24)
Speech Therapy Spaces Gallery / Staff Nutrition 1:12 EVS Shared Office (4:72)
Recreation / Dining Room Family Nutrition 1:12 Staff Bathroom Fellow Office (LRC) (1:72)
Emergency Equipment Alcove1:12
Conference Room (one lg. one small 1:60)
Pneumatic Tubes 2:24
Source: Kaufman Hall 2006 data (9months annualized), Price Waterhouse Coopers(PWC) Volume Capacity, Projections. Master Facility Plan, June 2007.
PLANNING CONSIDERATIONS:
Model of Care:
The new rehabilitation unit will be 24 beds. •
This unit will continue to provide services to patients with spinal cord injuries and traumatic brain injury. •
This unit will be self contained and provide all the spaces to accommodate a multidisciplinary care team. •
Stable patients with tracheotomies requiring acute rehab and mechanical ventilation will be able to be safely cared for in the •
new space. A percentage of the rooms will also have video capabilities as a safety measure to monitor patients with new
traumatic brain injury.
Spaces are programmed in accordance with Texas Administrative Code which meets CARF guidelines for self contained •
rehab unit which provides spaces for therapy services, social support services and spaces which allow and foster inclusion
of families in patient care.
Nursing Model of Care: • Will remain primary with 1 nurse and patient care assistant to a designated number of patients.
Medical Model: • Parkland will continue its mission of teaching residents and medical students. Changes in CMS guidelines,
physician shortages and the increasing acuity of hospitalized patients are driving the development of hospitalist programs,
increased use of midlevel providers, and more on-service time for existing attending physicians. The new space needs to
accommodate these clinicians 24/7. Provisions for designated available space for educational activities, offi ces and call
rooms will be allocated.
Future State
Functional Narrative -Rehab Unit
Rehabilitation / PM&RInpatient 17 bedsOut patient – OT, PT, STAlways full, waiting listTrauma and spinal cord injury
• Staf f• 24 Residents (10 at Parkland at any given time
• Wound care team: plastic surgeon, RN, PM&R
Services:• Inpatient acute rehab• Therapy in and out patient• Wound care-hydrotherapy
SNF if no be available patient may go there to wait
Transfer from inpatient unitReferred from:• Inpatient service:
Med/Surg / trauma• Acute rehab service-
consult from PM&R
Inpatient units, ICU’s
LTCF
SNF
Home
Shelter
While on the unit the following come to patient
While on unit patient may go to:• EEG• MRI/ imaging• Dialysis• Aphaeresis• Hydrotherapy• Clinic for procedure clearance• OR• Clinic• ICU• Medsurg unit
• Consulting MD• Chaplin• Students • Lawyers• Court officers• Health
department• Sheriff• Research RN• Biomed• Engineering• D/C RN for
medicine• Police• Jail Health• Volunteers• Family / visitors
• WCS• OT/PT/ST• SW• D/C planning• Rx.• Psych• Psychology• MRD• Dialysis• Radiology• Phlebotomy• Financial
counseling• Interpreter• Outside facility
liaison• School
Entry Points End Points
Transfer from inpatient unit
Sec3:35
ORGANIZATIONAL AND KEY ADJACENCIES:
The inpatient acute care rehab unit should be easily accessible to staff, materials management, visitors. •
Designated elevators for staff, patients, visitors and supplies to decrease travel time, improve effi ciency and patient safety •
will be programmed.
In the future state operating model many staff will be dedicated to specifi c units. Some adjacencies will be programmed into •
the new unit space.
The new space will accommodate phlebotomy and direct access to clinical lab and pharmacy via pneumatic tubes. Care •
coordinators and social workers will have space on the care units.
Consideration should be given to the following intuitive adjacencies when the building is stacked:•
-Medical / Surgical Acute Care patients requiring therapy services adjacent to Acute Care Rehab. Unit
-Clinical lab, blood bank, and pharmacy adjacency needs will be met with pneumatic tubes.
-Potable imaging, ECHO, EEG will be available bedside in the ICU’s and on the acute care units as necessary
Adjacency Diagram
FUTURE FLEXIBILITY:
A Universal Room Concept will be utilized to provide a fl exible, physical environment that supports varying acuity of patients •
and avoids multiple transfers.
Blocks or modules of rooms can be designated for specifi c acuity levels or disease populations. •
In the new hospital the rehab unit will be located adjacent to a medical surgical acute care unit that will allow the rehab unit •
to fl ex into the adjacent space.
It is envisioned that the rehab unit in the future may increase to 60 beds. •
The concept of a trauma institute is being considered. Organizing trauma services, from acute ICU to PMR as one organized •
service is being discussed.
Placement of the satellite gym in the unit core adjacent to the rehab unit will allow patients with rehab goals to be treated in •
one geographic area.
Functional Narrative -Rehab Unit
Sec3:36
Imaging
Pharmacy
Therapy / Hydro-therapy
OR
PT, OT, ST
InpatientRehab MRD
THIS FUNCTIONAL NARRATIVE IS ASSOCIATED WITH THIS SPACE PROGRAM:
Psychiatric Inpatient Unit•
PLANNING WAS INFORMED BY THE FOLLOWING:
Proven Evidence Based Design•
Identifi ed Best Practices•
Completed Staff Questioners•
User Group Discussions•
PWC- PHHS Strategic Planning Document •
SCOPE OF SERVICES AND OPERATING PARAMETERS:
Provide inpatient psychiatric care.•
Detox should be separate service.•
It is projected that PHHS psych inpatient unit will need to accommodate 6500 in •
patient days over the next 5 years.
It is anticipated that Northstar-managed medicade will increase referrals over •
the next years.
Background / Current-State:
Currently the psych unit at PHHS accommodates 575 admissions annually. •
ALOS for patients is 9 days for a total of approximately 5000 inpatient days.
The average occupancy on the unit is 78%.•
The majority of the admissions are referred from the psych ED or the outpatient •
psych clinic.
All admissions are involuntary.•
The current psych unit is small and outdated. In a recent mock JCHAO it was •
identifi ed that the bathrooms were not compliant.
On the current unit there is a lack of visualization of patients.•
There is a lack of safety features in patient rooms.•
There is poor medication room set-up.•
There is a lack of AV monitoring for patients in seclusion.•
PLANNING CONSIDERATIONS:
Model of Care:
All admissions will continue to be involuntary. •
There is need to separate detox from general psych.•
Functional Narrative - Psychiatric Inpatient Unit
Sec3:37
Space Program:
Unit Size: • Future confi gurations will be standardized and should allow nurse patient ratios to be divisible by 2-4-6. A
standardized 24 private-bed unit is planned to provide operational fl exibility.
Nursing Unit Layout:• The use of single patient rooms will increase the footprint size of the patient care units, thus the space
design must maximize visibility, spatial relationships and reduce travel distances. In addition staff to staff communication via
advanced technology will be essential.
Security: • Electronic surveillance or electronic access to the unit is requested as a patient safety measure. This is a locked
unit.
Electronic Environment: • It is envisioned that the new hospital will be electronic. It is presumed that all documentation,
order entry, monitoring, etc. will take place at or in close proximity to the patient’s bedside.
Transportation:• Horizontal pathways and vertical transportation systems will be programmed. They must reduce the
physical demand on personnel servicing multiple units and departments. Sophisticated pneumatic tube system is planned
as a critical component to the medication/supply/specimen delivery system. Medication delivery will utilize automated
dispensing machines (Pyxis) with medication stocking by pharmacy. Specialty or emergency delivery of products will be
accomplished by pneumatic tube where applicable.
Reception / Family Waiting: • Space will be programmed to accommodate patient’s families. Integration of family centered
care principles will be paramount in the new hospital.
Inpatient rooms: • All rooms will be private with bathrooms and roll in showers. A % of the rooms will have AV monitoring
capabilities for patient safety. All rooms will have locked space for patient belongings. All patient rooms will have bathrooms
with roll in showers. Isolation rooms: 2 are planned on the unit per request of PHHS staff.
Medication Administration:• Each unit will have a secure med room at a 1:18 ratio. This room will provide space for
medication storage and supplies for dispensing medications. In addition each patient room will be designed with a nurse
server. A system which utilizes medication distribution to a patient specifi c space reduces medication errors.
Team Work Space:• Spaces will be programmed to support both unit and visiting professional staff.
- The new space will feature decentralized work spaces at the patient bedside. Alcove work stations with computers
will be programmed at a ratio of 1 for every patient room.
- Clinical Support Team Workroom: Centralized “touchdown” space for staff collaboration and work space for visiting
staff will be programmed on each unit.
- Support Space: Separate onstage and offstage functions and patient, public and logistics traffi c (both horizontal and
vertical) will be programmed. Larger spaces can accommodates teaming, planned meetings and educational
programs.
Provider Spaces: • Each unit has designated provider workrooms to accommodate provider rounds and workspace. In
addition each unit core has a Resident Learning Center (LRC) and offi ce space to support 2 fellows (Fellow LRC).
Functional Narrative - Psychiatric Inpatient Unit
Sec3:38
Specialized Spaces:
Recreation / Dining: • A 720 NSF space is planned to accommodate seating for 30.
Dayroom / Lounge/ Quiet Room:• 320 NSF is planned this space will accommodate 10 seats.
OT Arts/Crafts: • This space is provided at 14 NSF per bed per TAC.
Psych Eval Exam Room:• (2) private exam rooms are planned.
Seclusion Rooms:• (4) seclusion rooms with video capabilities for patient safety are planned.
ETC: • 240 NSF are planned to accommodate ETC procedures. This space includes prep and treatment space.
Logistical and staff support spaces• for respiratory therapy, nutrition, phlebotomy are also programmed on the unit.
Utilization / Hours of Operation:
24 hours a day- 7 days a week •
- Most admissions occur between 7pm
- Most discharges occur between 2pm
Staffi ng:
Staffi ng ratios may vary by unit the space should be divisible by 2-4-6.•
ORGANIZATIONAL AND KEY ADJACENCIES:
The Psych ED is the most important adjacency. A vertical adjacency is planned.•
It is envisioned that the psych unit will be located on the same horizontal fl oor as PMR and units caring for patients with •
rehab/therapy needs. This will provide easy and effi cient access for therapy staff to care for many of their patients on one
horizontal plane.
FUTURE FLEXIBILITY:
The increased number of beds 24 will accommodate anticipated future growth related to changes in the Northstar program.•
All inpatient rooms will be universal and sized to meet Texas Administrative Code – ICU requirements, to provide a fl exible, •
physical environment that supports the varying acuity of patients and avoids multiple transfers. Blocks or modules of
rooms can be designated for specifi c acuity levels or disease populations.
The plan for how the units are confi gured in the new building should allow for fl exibility across units to accommodate •
programmatic growth, changes in science, technology and disease management and fl uctuation in patient census.
Functional Narrative - Psychiatric Inpatient Unit
Sec3:39
THIS FUNCTIONAL NARRATIVE IS ASSOCIATED WITH THESE SPACE PROGRAMS:
Inmate Unit Treatment Center•
PLANNING WAS INFORMED BY THE FOLLOWING:
Proven Evidence Based Design•
Identifi ed Best Practices•
Completed Staff Questioners•
User Group Discussions•
PWC- PHHS Strategic Planning Document •
SCOPE OF SERVICES AND OPERATING PARAMETERS:
The Dallas County Commissioners Court placed the responsibility for the health of •
the Dallas County Jail inmates on Parkland in March of 2006. State regulation
requires TB screening, medical, dental, mental health and the pharmacy components
for the care of inmates.1
Background / Current State:
•Currently inmates are cared for in the same spaces as the general population. •
•Although efforts are taken to segregate the inmates from other patients many •
times they are intermixed with the general patient population.
•This poses, both a security concern and a public relations issue, as patients •
feel uncomfortable being intermixed with inmates.
Parkland is working closely with the county jail to provide complementary •
services to inmates that cannot be provided on site at the jail.
The jail infi rmary and medical staff are simultaneously working to increase both •
the numbers and types of medical services provided at the jail to reduce
unnecessary transports of inmates to Parkland Hospital.
1 Parkland Hospital Website Jail Health. www.parklandhospital.com
Functional Narrative - Inmate Unit Treatment Center
Sec3:40
PLANNING CONSIDERATIONS:
Model of Care:
The Inmate Treatment Center will provide a secure and segregated environment where inmates can receive acute care •
hospitalization, outpatient subspecialty care or urgent care that cannot be provided at the prison.
The inpatient part of the unit will be designed to accommodate patients who are too acutely ill to be cared for at the prison •
infi rmary, but who do not require ICU level care.
Patients who require ICU level care, obstetrical services or emergency care (levels 1-3) will have services provided in the •
main hospital.
It is envisioned that inmates will arrive through a Vehicular Sally Port. A secure holding area is planned to securely manage •
inmates who are waiting for an exam room to become available.
The unit should be located in close proximity to radiology as the unit will not have imaging capabilities.•
The unit should be designed with the same level of security as a prison. Individual patient rooms should be designed as •
cells, to safely secure patients and staff.
Space Program:
Security spaces•
-Vehicular Sallyport: A vehicular sallyport that can support 2 vehicles at a time is planned.
-Security / Control Station: This space is programmed to be 100NSF and should be located adjacent to the sallyport.
-Police workroom: This space is programmed at 252 NSF and will accommodate 4 computer workstations.
-Gun Lock-Up Room: This should be a secure space with internal secure gun lockers.
-Video Arraignment: A separate room with video communication is planned. This room is programmed at 80NSF and
should be designed to accommodate security personnel to be in the room, but not on video.
Prisoner Holding: • An open area providing full vision to all holding is planned.
Seclusion Room/ Detainee Holding: • Two (2) holding spaces one male and one female are planned. These spaces should be
minimally furnished and have bulletproof glass windows to enable inmate observation. Theses rooms should have audio and
video monitoring equipment and should be sound proof. These spaces should also be negative pressure.
Inpatient rooms:• The unit will include 12 secure acute care patient rooms. AV monitoring is requested for safety and
security.
Isolation rooms:• Eight (8) of the rooms will be negative pressure, to accommodate the large number of inmates with TB or
TB exposure.
Exam rooms• : The space will also include 14 general treatment exam rooms to accommodate outpatient examinations and
urgent care. It is planned that medical and surgical subspecialists will come to the inmate unit to see inmates rather than
have inmates travel to medical and surgical clinic locations.
Functional Narrative - Inmate Unit Treatment Center
Sec3:41
ORGANIZATIONAL AND KEY ADJACENCIES:
The Inmate Unit and Treatment Center should be in close proximity to the ED and imaging. •
Direct access to the outside vehicular Sallyport is necessary. •
Adjacency Diagram
FUTURE FLEXIBILITY:
Parkland Hospital leadership will continue to work collaboratively with the leadership and medical staff of the county jail to
continue to provide appropriate quality care to inmates.
Functional Narrative - Inmate Unit Treatment Center
Imaging
EDICU
OR
Inmate Treatment
Center
Obstetrics
Sec3:42
THIS FUNCTIONAL NARRATIVE IS ASSOCIATED WITH THESE SPACE PROGRAMS:
Apheresis / Central Dialysis Unit•
PLANNING WAS INFORMED BY THE FOLLOWING:
Proven Evidence Based Design•
Identifi ed Best Practices•
Completed Staff Questioners•
User Group Discussions•
PWC- PHHS Strategic Planning Document •
SCOPE OF SERVICES AND OPERATING PARAMETERS:
The Dialysis and Apheresis Programs at Parkland provides acute inpatient •
hemodialysis and apheresis to patients. Currently these services are provided in
two separate locations.
The Acute Dialysis Unit provides hemodialysis for stable inpatients. •
70% of the dialysis patients are scheduled and are hospitalized patients with •
end stage renal disease.
30% of the dialysis patients who require emergent hemodialysis treatments and •
enter the hospital through the ED.
Portable hemodialysis is provided bedside in the intensive care units. •
Background / Current-State:
Currently there are 8 dialysis stations including one isolation room on the unit. •
The Apheresis unit at Parkland currently has 5 stations and at the present time •
maintains a low census.
Functional Narrative - Apheresis / Central Dialysis Unit
Sec3:43
Model of Care:
The ESRD population treated at Parkland is projected to continue to grow. •
The program will continue to be an inpatient acute dialysis program. •
Outpatients will be treated only on an emergency basis. •
The acuity of the patients who are dialyzed is extremely high. •
In many cases patients are too ill to be accommodated in a dialysis chair, thus the stations were programmed at 143 NSF to •
accommodate beds or stretchers rather than dialysis chairs.
All ICU rooms and a percentage of acute care rooms will be plumbed for dialysis, in order to accommodate patients who •
cannot be moved.
Space Program:
A Combined Apheresis Central Dialysis unit is planned for the new facility. •
Stations: • The unit will have a total of 18 stations, each is programmed at 143 NSF.
Isolation: • Four of these stations will be isolation rooms, and will accommodate patients with Hepatitis B-, per Texas
Administrative Code. These rooms do not require negative pressure or anterooms.
-Patients with tuberculosis, or another air borne pathogen, requiring negative pressure, will be dialyzed in an
isolation room on an inpatient unit.
-All ICU rooms and a percentage of acute care rooms will be plumbed for dialysis, in order to accommodate patients
who cannot be moved.
PLANNING CONSIDERATIONS:
Service 2006 2012 2017 KHC Request -Inpatient Hospital
Dialysis Stations (including Bedside) 8 14 15 14 (10 regular, 4 isolation)
Apheresis 4
Dialysis Statistics 2006 2012 2017
Total Outpatient Maintenance Treatments/Initiations ** 2,334 3,315 4,239
Total Inpatient Treatments/Initiations (Main Department) 3,836 3,728 7,460
Total Treatments 6,170 7,043 7,460
Annual Treatment/Initiations per Station 771 503 497
Daily Treatments/Initiations per Station 3.1 2.0 2.0
** through 2006 outpatient treatments provided on an emergent basis only
Functional Narrative - Apheresis / Central Dialysis Units
Sec3:44
Utilization / Hours of Operation:
The unit is open 7 days a week and provides dialysis services from 6:00 AM until 4:¬00 PM, Monday through Friday and 8:00 •
AM until 4:30 PM on the weekends.
ORGANIZATIONAL AND KEY ADJACENCIES:
The dialysis / apheresis unit will be part of the inpatient hospital. •
The dialysis / apheresis unit should be located with a horizontal adjacency to the acute care inpatient unit where the majority •
of the nephrology patients are hospitalized.
This will allow a quick and safe transport of patients to and from the dialysis unit. •
The unit should also be in close proximity to the ICU to provide effi cient movement of staff and equipment between the •
dialysis unit and the ICU.
It is not infrequent that the code team is called to the dialysis unit, so close proximity to the ICU is preferred. •
30% of the patients dialyzed are emergent and present in the emergency department effi cient access to the ED is requested.•
Patient Acute Care
Unit
Dialysis / Apheresis
Patient ICUUnit
Patient goes from the acute care unit to the Dialysis unit for treatment
Trained staff provide service at the bedside in the ICU
Patient ED
Patient who meets emergent hemodialysiscriteria is emergently sent to the Dialysis unit. Depending on the patients status post –dialysis:•Returns to the ED and is discharged home•Admitted
Dialysis Future State
Functional Narrative - Apheresis / Central Dialysis Units
Sec3:45
Adjacency Diagram
FUTURE FLEXIBILITY:
In the new hospital Apheresis and Dialysis will be combined for maximum fl exibility.
Functional Narrative - Apheresis / Central Dialysis Units
Sec3:46
Acute Care Units - ESRD,
Neph.
EDICU Dialysis & Apheresis
Hemat-ology
THIS FUNCTIONAL NARRATIVE IS ASSOCIATED WITH THESE SPACE PROGRAMS:
Antepartum/Postpartum - 36 Bed Units•
Postpartum/Antepartum Core - 72 Beds•
Newborn Nursery – 24 Bassinets per Floor•
Women’s Offi ces - relevant to other women and infant services and programs, •
also.
PLANNING WAS INFORMED BY THE FOLLOWING:
Proven evidence-based design for inpatient units.•
Best practices for mother/baby couplet care, holding nurseries and high risk •
antepartum units.
Completed staff questionnaires that provided input on current and projected •
status.
Series of PHHS user group discussions resulting in recommendations and •
general consensus.
PWC- PHHS strategic planning documents that provided the quantity of patient •
rooms and supporting projections for patient care space.
SCOPE OF SERVICES AND OPERATING PARAMETERS:
Inpatient care of antepartum and postpartum women with obstetric acuities •
ranging from routine postpartum care to pregnant patients at risk of pre-term
labor with complicating factors such as diabetes, hypertension or substance
abuse.
Care of relatively healthy babies who are generally stable, near-term and term •
babies of gestational age ≥ 35 weeks and birth weights > 2,100 grams.
Discharge and breastfeeding classes provided in Spanish and other languages •
by educators; population is largely Hispanic.
Infant services range from routine care, tests including hearing assessments, •
procedures such as circumcisions, newborn pictures, if family requests them,
and follow-up care among other services.
March of Dimes Family support program and the Child Life Specialists provide •
classes about baby care and meet other educational needs.
Long-term antepartum patients are offered opportunities to participate in •
activities to offset the boredom and depression of hospitalization.
Teaching service that includes education of nurses, medical students, residents •
and many others through a variety of formal and informal programs.
Functional Narrative - Postpartum/
Antepartum and Newborn Nursery
Sec3:47
Background / Current State:
PHHS providers: • renown for utilization of midlevel providers and residents in the provision of care. Providers include
almost 80 employed obstetric/gynecology faculty along with a strong core of nurses and many other multidisciplinary staff
who provide care to a large volume of patients. Most of the providers are organized by whether they care for the baby or
mother and by acuity.
Lack of privacy:• inventory of 164 postpartum and 55 antepartum / postpartum beds is in multi-bed rooms mostly. A
two-bed room equates to four-bed ward when two babies and two mothers are in the same room. The newborn nurseries
are reported to accommodate 88 bassinets, excluding the nurseries designated for continuing care. The care is provided on
third, fourth and fi fth fl oors.
Varying unit sizes:• most inpatient units are sized between 26-29 beds each and rooms are a variety of sizes. Room sizes and
locations were identifi ed as bigger issues than unit sizes. Some of the postpartum beds are located remotely from the
newborn nurseries.
Complex patient placement practices: • mothers are placed on high risk versus low risk units for postpartum care, which is
driven by rotating residents and assigning different types of practitioners. In recent years, PHHS has made changes to help
smooth the placement so that poor utilization of some units and over-utilization of other units is less of a problem. A central
“bed czar” directs patient placement. Antepartum patients are clustered into a high risk unit and use other rooms fl exibly
when needed.
Admission process separates babies and moms:• most healthy babies born in labor and delivery go to the admission nursery
for the fi rst 3 hours (admitted, weighted, bathed, eye ointment, Vitamin K, Hep B vaccine). Then the baby goes to the
postpartum room to stay with mom or to be fed. The opportunity to keep mom and baby together during this time is limited
by facility and processes, and is a rare occurrence according to staff. When labor and delivery is very busy, PHHS reports
that baby admissions are delayed and the admission process is often extended or occurs ahead of the completion of complete
data entry required to set up medical records.
Discharge process impacts bed availability: • PHHS reports that discharges are sometimes delayed because pediatric nurse
practitioners (PNPs) are waiting for lab results, patients have not been seen by the Birth Certifi cate offi ce or fi nancial
services or patients are awaiting transport couriers. Delayed patient pick-up by family or friends creates back-ups in some
cases.
PLANNING CONSIDERATIONS:
Model of Care:
Parkland made a commitment to move from a “hybrid” mother-baby couplet care to a full continuum in the new facility. This •
objective was confi rmed in user group meetings and is included as a premise in the previous PHHS operational plan. The
model was summarized in the planning meetings as:
- One nurse providing care to a mother and her baby and a philosophy that states we should not separate them unless it
is due to mother’s preference or clinically indicated… Not really only about babies always being in mom’s room, which
is another concept known as rooming-in.
Research indicates that mother/baby couplet care :•
- Supports continuity of care and infant development1
1 Alleva, E., A. Berry, and F. Cirulli. (2003) Early disruption of the mother-infant relationship: Effects on brain plasticity and implications for
psychopathology. Neuroscience and Biobehavioral Reviews 27: 73-82.
Functional Narrative - Postpartum/Antepartum and Newborn Nursery
Sec3:48
- Helps reduce communication errors between nursery and postpartum nurse (same nurse for mother & baby
- Enhances patient teaching / nurse, resident and PNP communication with patient; opportunity to teach while talking
and observe the family
- Promotes maternal-infant bonding
- Supports family-centered care and family satisfaction
- Improves lactation initiation and breastfeeding
- Enhances nursing and medical staff communication
Operational processes will be developed for babies to be with their mothers rather than returned to a nursery for routine •
care. When assessments cannot or should not occur in the same room with the mother, then the nursery will be available.
The challenge of this model will be changing the process where the provider goes to the patients individually rather than •
having the patients come to the providers. In addition to supporting the mother/baby relationship, targeted goals could
increase competence with the opportunity to be present for more of the care and fewer questions later.
Parkland will continue its mission of teaching residents and students and has long been ahead of many facilities in its use of •
midlevel providers. The continuation of this approach is assumed in light of potential CMS changes in resident coverage.
Provisions will be made for designated available space for educational activities, offi ces and call rooms.
Future Model of Care for Antepartum/Postpartum Units and Newborn Nursery
Functional Narrative - Postpartum/Antepartum and Newborn Nursery
Sec3:49
Space Program:
Patient Rooms: 252 private patient rooms for antepartum and postpartum care:
Private, standardized universal rooms appropriately sized for all acuities to:•
-Support reductions in hospital acquired infection rates
-Improve privacy- HIPAA compliance
-Target the “sweet spot” for effi ciency and walking distance
Four distinct zones: mom, infant assessment, staff and family for postpartum rooms, although these areas may overlap. •
Antepartum rooms will be sized identically to postpartum rooms, even though they will not be set up for infant assessment. •
Ample number of gas and electrical outlets for both patients and work space with computer access in or just outside the •
room.
Handwashing sink for caregiver.•
Private bathrooms with showers, handheld shower hoses and shower seats (ADA). •
Windows on exterior wall with view of outside from each room. No viewing windows into patient rooms from corridor work •
stations for privacy reasons. These patients are usually not sick and requiring observation as with critical care units.
Family support space that includes daybeds or equivalent sleeping space, television, wireless internet access and lockable •
personal item storage.
Individually controlled lighting and temperature in patient rooms.•
Isolation rooms with different air handling and ante rooms, but with equivalent room confi gurations. An adequate number of •
negative pressure rooms with ante rooms will be designed per infection control recommendations and Texas codes. They
can be used for non-isolation patients, when appropriate.
Patient rooms designed with consideration of bariatric patients. Nationally, approximately one million (33%) of pregnant •
women are categorized as obese1. The percentage that would benefi t from lifts is to be determined. The hospital is
considering putting lifts in 25% of patient rooms in the new hospital.
Reception and Control
Each unit will include a concierge area at the main unit entry. For staffi ng effi ciency, this person might serve multiple roles •
including a greeter who will direct staff and visitors and oversee access to the unit.
Proximity to the clinical team area and the Health Unit Coordinator will be important. With the roll-out of the EMR the role of •
Health Unit Coordinators is likely to change in the future. The exact job description is still yet to be determined but could
include a variety of control and communication functions.
While control and security are critical issues, the plan is not to station a uniformed security offi cer at this location routinely. •
The intention is a design that supports safety as a priority and a fi rst impression of warmth and friendliness.
Public and Family Space:
Patient rooms will be large enough to accommodate family and visitors comfortably and will include a place for a family •
member or other designated support person to recline / sleep.
Waiting areas will be programmed on each unit to provide a space for family to wait if they are asked to leave a patient room. •
Quiet, active and child zones will be planned in each waiting area.
A small consultation room on each unit will serve as private places for members of the healthcare team to meet with •
families or patients away from the bedside.
1 S. Y. Chu et al, Association between Obesity during Pregnancy and Increased Use of Health Care, The New England Journal of Medicine,
April 3, 2008
Functional Narrative - Postpartum/Antepartum and Newborn Nursery
Sec3:50
Patient Unit Layout (including holding nurseries)
Inpatient postpartum and antepartum services will be provided on seven 36-bed units, totaling 252 beds plus a 28 bed •
gynecological unit.
Optimal unit layout includes:•
- Less centralization
- Moves staff areas to patients
- Moves support areas to patients
- Reduces walking distance due to increased geography of larger private patient rooms
One of the 36-bed units will be dedicated to antepartum care and does not require a holding nursery, unless the unit is built •
for future fl exibility to accommodate postpartum patients.
When Parkland’s antepartum needs exceed the capacity of one unit, a second 36-bed unit of mixed antepartum/postpartum •
rooms will be provided for fl exibility. Ideally, patient placement would result in clustering antepartum patients together and
away from the postpartum mothers and nursery. The dedicated antepartum unit could share a fl oor with the gynecology
inpatient unit or share with a mixed antepartum / postpartum unit.
Assuming one antepartum and one fl exible ante/postpartum unit, the remaining fi ve 36-bed units will function primarily for •
postpartum and newborn care and will be considered “mother/baby” units with a central holding nursery located in the core
between them.
Each set of two units on a fl oor will have common family and public support space and will share some staff support areas •
such as conference space.
PHHS plans to continue organizing patient placement by acuity, but will have the fl exibility to place any patient in any room •
since all rooms will be standardized. The exception will be isolation rooms that will have different air handling, ante rooms
and other features. An adequate number of negative pressure rooms with ante rooms will be designed per infection control
recommendations and Texas codes.
Holding nurseries will contain a total of 72 bassinets divided into 24 bassinets per fl oor in adjacent rooms of twelve •
bassinets, depending upon layout and approval by the state agency.
Texas Administrative Code (TAC) stipulates that a service must have holding nursery bassinets at a minimum ratio of 50% of •
postpartum beds and each nursery shall not have more than 16 bassinets per room.
Bassinet space is planned in every postpartum room in addition to the holding nursery. •
While the nursery ratio does not apply to antepartum beds, a holding nursery will be required for any fl oor with a mix of •
antepartum and postpartum beds.
Codes are not followed in the program because PHHS determined that 50% of postpartum beds results in excessive nursery •
space due to the combined percentage of 24 hour rooming-in and NNICU babies. Two nurseries with 12 bassinets each is
programmed per fl oor (approximately 33% of 216 postpartum beds). A PHHS study will be needed to support an application
for variance or exception from TAC.
“Sick nursery” services will be consolidated with the NNICU and included in the total NNICU bed count for Level II and III •
care.
Team Work Stations/Charting:
Assumption that electronic medical records will be implemented when this facility opens. •
Computers will be provided with a decentralized approach in locations outside the patient room and dispersed throughout •
the unit.
Going live with electronic medical records will result in bedside or near bedside charting of certain information such as •
admission assessment and vital signs. Using the computer for all of the charting will be a signifi cant change for current
staff, but could provide an opportunity to further support mother/baby couplet care prior to moving into the building.
Functional Narrative - Postpartum/Antepartum and Newborn Nursery
Sec3:51
Provider Rooms:
Two workrooms will be provided on each 36-bed unit with one for providers caring for moms and one for providers caring for •
babies. In addition, multi-purpose midlevel practitioner rooms will be provided where appropriate.
General Support Space:
Separate onstage and offstage functions and patient, public and logistics traffi c (both horizontal and vertical). •
Space to support “green” practices such as recycling.•
Equipment, supplies, and documentation tools will be located to promote effi ciency by reducing travel distances within the •
units.
Horizontal pathways and vertical transporting systems designed to reduce the physical demand on personnel servicing •
multiple units and departments.
Separate onstage and offstage functions to support patient, public, and logistics traffi c.•
Medication Administration:
A secure medication room will be provided at a ratio of 1:18 beds. This room will provide space for medication storage and •
supplies for dispensing medications. Pharmacy will be reducing the quantity of satellite pharmacies, including the labor and
delivery satellite, which will be replaced by direct service from the Main Pharmacy. Medication delivery will utilize
automated dispensing machines (Pyxis) with medication stocking by pharmacy. Specialty or emergency delivery of products
will be accomplished by pneumatic tube. From a best practice perspective, a system which utilizes medication distribution to
a patient specifi c space reduces medication errors.
Disaster Preparedness:
Design should support ability to accommodate disaster preparedness.•
Equipment:
Supply and medication rooms will be standardized and conveniently located on each fl oor.•
There will be an adequate number of Pyxis machines conveniently located to patient care areas.•
Locked space within the patient care area for patient specifi c supplies and medications (TBD).•
Central Logistics staffed 24/7 will accommodate equipment that can be obtained within a 60 minute window. (Planned at •
10sq foot per patient. Additional storage space at 10sq foot per patient will be on the fl oor).
Lockers, Lounges, Offi ce and Conference Space
Suffi cient space is provided for allied health, MD, students and other caregivers on each unit. Providing adequate space and •
making PHHS attractive to nursing students, physicians and other is an important consideration for future success.
Conference space is provided in the core between two units and could be provided on every other fl oor if required.•
Utilization / Hours of Operation:
24 hours a day- 7 days a week•
Functional Narrative - Postpartum/Antepartum and Newborn Nursery
Sec3:52
PHHS Utilization / Volumes:
The PWC data indicated that approximately 19,400 antepartum and postpartum discharges were projected for 2017, given 17,654
deliveries. The PWC projections indicated a need for 243 beds for postpartum and antepartum and rounded the beds to 7 units of
36 beds (252 beds). PWC projections assumed a 65% average occupancy rate and used a normative model for prediction.
Staffi ng:
Primary nursing care model with 1 nurse to 4 couplets generally (RN with PCA) plus nursery staff.•
Nurses back each other up and each nurse “reports off” to another nurse. •
Charge nurse has assignment.•
RNs do not usually leave the unit due to “no time” and 7a-7p cafeteria is closed.•
Techs handle supplies with supply and medical Pyxis on each fl oor.•
PNPs work in the newborn nurseries, all postpartum units, attend deliveries and perform circumcisions.•
Almost 40% of postpartum nurses have 10 or more years of experience and may not have had the opportunity to work in •
other environments with this model of care. Transition, orientation, dealing with fears and change management will be
critical for success.
Service FY03 FY04 FY05 FY06 Annual Change 03-06
Total Change 06-12
FY12 Total Change12-17
FY17
Antepartum
Discharges 300 254 288 325 1.7% 1.9% 341 1.0% 348
Days 8,818 9,706 9,477 9,068 .6% 9,660 11,146
Average Daily Census 24.2 26.6 26.0 24.8 .6% 26.5 30.5
ALOS 29.4 38.2 32.9 27.9 -1.0% 1.5% 28.3 2.8% 32.0
Postpartum
Discharges 17,252 17,385 17,433 17,766 .6% 1.9% 18,647 1.0% 19,021
Days 38,998 38,042 36,729 37,773 -.6% 40,240 46,430
Average Daily Census 106.8 104.2 100.6 103.5 -.6% 110.2 127.2
ALOS 2.3 2.2 2.1 2.1 -1.2% 1.5% 2.2 2.8% 2.441
Women’s and Infants’ Specialty Hospital Services (PWC)
Source: Kaufman Hall 2006 data (9months annualized), Price Waterhouse Coopers(PWC) Volume Capacity, Projections. Master Facility Plan, June 2007.
Functional Narrative - Postpartum/Antepartum and Newborn Nursery
Sec3:53
ORGANIZATIONAL AND KEY ADJACENCIES:
Postpartum rooms and newborn holding nurseries will be on the same fl oor resulting in a “mother/baby” unit.•
Postpartum and antepartum units should be easily accessible to staff, materials management and families. Designated •
elevators for staff, patients, families, visitors and supplies to decrease travel time, improve effi ciency and patient safety will
be designed.
Most patients will arrive on these units from the Labor and Delivery fl oor, requiring attention to designing “off-stage” paths •
among these units.
Midlevel provider rooms should be convenient to these patient units.•
Adjacency Diagram
ICU
Transport after delivery other than
in L&D
Labor and Delivery
Home
Other: (ICU, Transport, Jail, Morgue)
Patient flow from AP/PP unit:
Newborn Nursery
Admin and Staff Support (eg, call rooms, offices, lounges, conference,
lockers)
Clinical Support, Family Support and Ancillary
Services
Antepartum or Postpartum Inpatient Unit
Antepartum/Postpartum Unit and Newborn Nursery Internal Functional Adjacencies and Flow
Infant & Lactation Follow-up
FUTURE FLEXIBILITY
Projected growth is expected to be gradual, resulting in the consideration of shelling thirty-six rooms of the 252 rooms. •
Functional Narrative - Postpartum/Antepartum and Newborn Nursery
Sec3:54
THIS FUNCTIONAL NARRATIVE IS ASSOCIATED WITH THESE SPACE PROGRAMS:
GYN - GYN/ONC - URO/GYN Patient Care Unit - 28 beds•
GYN - GYN/ONC - URO/GYN Patient Care Unit Core•
GYN Chemotherapy / Infusion Therapy •
PLANNING WAS INFORMED BY THE FOLLOWING:
Proven evidence-based design and best practices for inpatient units.•
Completed staff questionnaires that provided input on current and projected •
status.
Series of PHHS user group discussions resulting in recommendations and •
general consensus.
PWC- PHHS strategic planning documents that provided the quantity of patient •
rooms and supporting projections for patient care space.
SCOPE OF SERVICES AND OPERATING PARAMETERS:
Inpatient gynecology services for general gynecology, uro-gynecology and •
gynecology/oncology.
Adjacent chemotherapy/infusion unit accommodates patients who require these •
therapies, most of whom were gynecology/oncology patients in the inpatient
unit.
Wide range of acuity from overnight uro-gynecology care to seriously ill cancer •
patients.
Patients with fetal losses who do not want to be on the postpartum or •
antepartum units.
Women with brachytherapy such as thyroid cancer patients (lead lined rooms).•
Participation in research projects in concert with University of Texas •
Southwestern Medical School.
Teaching service that includes education of nurses, medical students, residents •
and many others through a variety of formal and informal programs.
- In total during their training, residents spend 16 months on the Parkland
Hospital Gynecology Service and some of their time is spent on this unit in
addition to clinics and surgery.
Background / Current state:
Current inpatient unit includes approximately 22 beds on 4 West. One patient •
room was converted to space for patient / families.
Lead lined for radiation therapy shielding – occasionally male, but mostly female •
(estimate less than 150 per year).
General consensus in women’s services that 4 West works well and patient •
satisfaction is noted for its consistently high ratings; perception of a collegial
culture of multi-disciplinary providers and other staff.
PHHS gynecological service ranks in the top 15 in US News and World Report •
consistently.
Bed availability has not been a frequent issue due to a typical census of 12 to 16 •
patients, recently.
Functional Narrative - Gynecology and Chemotherapy/Infusion
Therapy Units
Sec3:55
Central team workstation is a feature reported as valued by the GYN user group.•
Chemo/infusion clinic is undersized and converted patient rooms that do not lend themselves to optimal function: crowded •
and do not support confi dentiality.
Care is provided by multi-disciplinary team of providers to support the diversity of diagnoses and acuities.•
Staff are cross-trained for 4 North and 4 West, excluding gyn-oncology.•
PLANNING CONSIDERATIONS:
Model of Care:
Twenty –eight room inpatient unit and a fi ve bed therapy unit will be provided for gynecological care in the new facility. •
Model will continue to be based on a multi-disciplinary and highly collaborative environment for the delivery of care.•
Focus will include a continuum of care for patients, which is especially important to cancer patients and their families.•
Space Program:
Patient Rooms
Private, standardized universal rooms appropriately sized for all acuities that:•
- Support reductions in hospital acquired infection rates
- Improves privacy- HIPAA compliance
-Targets the “sweet spot” for effi ciency and walking distance
- Space for patient, staff and family, though these areas may overlap. (Antepartum, postpartum and gynecology rooms
sized uniformly).
Ample number of gas and electrical outlets for both patients and work space with computer access in or just outside the •
room.
Handwashing sink for caregiver.•
Private bathrooms with showers, handheld shower hoses and shower seats (ADA). •
Windows on exterior wall with view of outside from each room. No viewing windows into patient rooms from corridor work •
stations for privacy reasons. These patients are usually not sick and requiring observation as with critical care units.
Family support space that includes daybeds or equivalent sleeping space, television, wireless internet access and lockable •
personal item storage.
Individually controlled lighting and temperature in patient rooms.•
Isolation rooms with different air handling and ante rooms, but with equivalent room confi gurations. An adequate number of •
negative pressure rooms with ante rooms will be designed per infection control recommendations and Texas codes. They
can be used for non-isolation patients, when appropriate.
Chemotherapy/Infusion Therapy Unit
4 treatment / observation rooms plus one isolation treatment room.•
Point of care testing on unit and staff work and support space separate from the inpatient unit.•
Space for secured patient/family belongings needs to be located in each bay and in the private infusion room.•
Internet access at each station.•
Natural light would be benefi cial to patients.•
Functional Narrative - Gynecology and Chemotherapy/Infusion Therapy Units
Sec3:56
Patient Unit Layout
By locating the gynecology inpatient services and the chemotherapy/infusion therapy next to each other, staff, space and •
operational effi ciencies will be realized. In addition, the proximity is considered a strong patient satisfi er because of the
culture and familiarity that has been created in these units.
Would like a distinct way to identify and locate women’s services and include this space as part of the comprehensive •
services for women offered by PHHS.
Reception and Control
Concierge area at the main unit entry. For staffi ng effi ciency, this person might serve multiple roles including a greeter who •
will direct staff and visitors and oversee access to the unit.
Proximity to the clinical team area and the Health Unit Coordinator will be important. With the roll-out of the EMR the role of •
Health Unit Coordinators is likely to change in the future. The exact job description is still yet to be determined but could
include a variety of control and communication functions.
While control and security are critical issues, the plan is not to station a uniformed security offi cer at this location routinely. •
The intention is a design that supports safety as a priority and a fi rst impression of warmth and friendliness.
Public and Family Space:
Patient rooms will be large enough to accommodate family and visitors comfortably and will include a place for a family •
member or other designated support person to recline / sleep.
Waiting area will provide a space for family to wait if they are asked to leave a patient room. Quiet, active and child zones will •
be planned in the waiting area.
Consultation room will serve as private place for members of the healthcare team to meet with families or patients away •
from the bedside.
Patient Education Room / Therapies / Activities Room for long term patient activities; located within GYN unit core and not •
fl oor core unless remainder of fl oor becomes GYN (separate room eliminated and function to occur in conference room or in
waiting area).
Family consultation room for private meetings away from the patient’s room.•
Team Work Stations/Charting:
Assumption that electronic medical records will be implemented when this facility opens. •
Computers will be provided with a decentralized approach in locations outside the patient room and dispersed throughout •
the unit.
- Multidisciplinary provider space for attendings, consultants, fellows, residents and other providers could be combined
or co-located with team room and zoned.
General Support Space:
Separate onstage and offstage functions and patient, public and logistics traffi c (both horizontal and vertical) will be
programmed.
Space to support “green” practices such as recycling.•
Equipment, supplies, and documentation tools will be located to promote effi ciency by reducing travel distances within the •
units.
Horizontal pathways and vertical transporting systems designed to reduce the physical demand on personnel servicing •
multiple units and departments.
Functional Narrative - Gynecology and Chemotherapy/Infusion Therapy Units
Sec3:57
Medication Administration:
Two secure medication rooms will be provided (ratio of 1:14 beds). This room will provide space for medication storage and •
supplies for dispensing medications. Medication delivery will utilize automated dispensing machines (Pyxis) with medication
stocking by pharmacy. Specialty or emergency delivery of products will be accomplished by pneumatic tube. From a best
practice perspective, a system which utilizes medication distribution to a patient specifi c space reduces medication errors
and is being considered.
Disaster Preparedness:
Design should support ability to accommodate disaster preparedness.•
Equipment
Supply and medication rooms will be standardized and conveniently located on each fl oor.•
There will be an adequate number of Pyxis machines conveniently located to patient care areas.•
Locked space within the patient care area for patient specifi c supplies and medications.•
A Central Storage Garage staffed 24/7 will mange equipment that can be obtained within a 60 minute window. This will be •
sized at 10 square feet per patient. Additional storage space at 10 square feet per patient will be planned on the fl oor.
Lockers, Lounges, Offi ce and Conference Space
Suffi cient space is provided for allied health, MD, students and other caregivers on each unit.•
Conference space is provided in the core between two units and could be provided on every other fl oor if required.•
Utilization / Hours of Operation:
24 hours a day- 7 days a week•
Majority of gyn surgeries are scheduled •
Utilization / Volumes:
Functional Narrative - Gynecology and Chemotherapy/Infusion Therapy Units
Service FY03 FY04 FY05 FY06 Annual Change 03-06
Total Change 06-12
FY12 Total Change12-17
FY17
GYN and GYN Oncology
Discharges 1,502 1,625 1,583 1,627 1.7% 1.9% 1,658 1.0% 1,674
Days 4,883 4,983 5,244 5,331 1.8% 5,329 4,520
Average Daily Census 13.4 13.7 14.4 14.6 1.8% 14.6 12.4
ALOS 3.3 3.1 3.3 3.3 .2% -1.9% 3.2 -3.8% 2.7
Women’s and Infants’ Specialty Hospital Services (PWC)
Source: Kaufman Hall 2006 data (9months annualized), Price Waterhouse Coopers(PWC) Volume Capacity, Projections. Master Facility Plan, June 2007.
Staffi ng:
Varying levels of acuity and associated staffi ng ratios, typically 1 nurse to 4 patients on the inpatient unit.•
Sec3:58
ORGANIZATIONAL AND KEY ADJACENCIES:
The following diagram depicts internal functional adjacencies and future fl ow. The diagram is distinguished from the graphic
analysis of the program (GAP), which identifi ed the specifi c rooms and areas included in the program.
Key functional adjacency requirements include:
Adjacency between the chemo/infusion therapy unit and inpatient unit.•
Receive patients from surgery in a convenient path.•
Co-located with other women’s services for identity and continuity of care.•
Consider relationship with other oncology services, preferably adjacency, if medical/surgical tower is connected to women’s •
tower.
Adjacency Diagram
FUTURE FLEXIBILITY:
The proposed 28 bed unit will provide additional capacity beyond recent 65 – 70% occupancy of the 21-22 available beds. •
Should future strategic planning result in a successful campaign that signifi cantly increases patient needs beyond the 28 •
beds, then ideas for additional expansion include: 1) expanding into the adjacent 36 bed women’s unit, which will be
potentially shelled space in the short-term although it is intended for birth service expansion at this time; and 2) converting
the chemo/infusion area to rooms resulting in up to a 36 bed unit.
As with many hospitals, PHHS gynecological services are a sliver of the total inpatient services but have higher potential •
growth for same day surgery and outpatient services.
Future fl exibility to increase outpatient and same day gynecology services is being planned at hospitals and ambulatory •
surgery centers throughout the US and is another consideration for PHHS. The Advisory Board Company report on women’s
health identifi ed a latent demand in the US for uro-gynecology services and an expected steep escalation in the future,
especially for minimally invasive procedures 1.
1 Health Care Advisory Board Innovations Center Staff, Future of Women’s Services: Strategic Forecast and Investment Blueprint The Advi-
sory Board Company • Washington, D.C. 2005
Functional Narrative - Gynecology and Chemotherapy/Infusion Therapy Units
Surgery
ICC/ Clinic/ MoncriefReferral/ED
Other Medical Admission or ICU
L&D(eg, fetal demise)
GYN Inpatient Unit Internal Functional Adjacencies and Flow
Home
Other: (ICU, Transport, Jail, Morgue)
Patient flow from GYN unit:GYN Chemo/Infusion Unit
Admin and Staff Support (eg, call rooms, offices, lounges, conference,
lockers)
Clinical Support, Family Support and Ancillary
Services
GYN Inpatient Unit
Sec3:59
THIS FUNCTIONAL NARRATIVE IS ASSOCIATED WITH THESE SPACE PROGRAMS:
Labor and Delivery Unit•
Labor and Delivery Administration•
Obstetric Triage•
Women’s Offi ces - relevant to other women and infant services and programs, •
also.
PLANNING WAS INFORMED BY THE FOLLOWING:
Proven evidence-based design for universal labor/delivery/recovery (LDR) •
model; elimination of traditional delivery rooms; and appropriately sized patient
rooms and support space.
Identifi ed best practices related to mother/baby recovery, triage process •
integrated with “labor and delivery”; bolstered identity for the service line;
standardized support spaces when appropriate; and streamlined operations.
Completed staff questionnaires that provided input on current and projected •
status.
Series of PHHS user group discussions resulting in recommendations and •
general consensus.
PWC- PHHS Strategic Planning Documents that provided the quantity of patient •
rooms and supporting projections for patient care space.
SCOPE OF SERVICES AND OPERATING PARAMETERS:
“Labor and Delivery” includes triage, obstetric observation, vaginal and •
Cesarean births, extended high risk obstetric care and elective obstetric
surgeries.
Generally, patients in “labor and delivery” are pregnant women and their babies •
greater than 24 weeks gestational age who reside in the region, with some
women from the hospital’s 30 county referral area.
Obstetric services extend beyond birth to outpatient obstetric observation; •
elective and non-elective obstetric procedures: tubals, cerclage, placenta
retention, chronic and short-term antepartum care and terminations for genetic
issues and other reasons.
PHHS provides a comprehensive scope of perinatal services and is a national •
leader in this fi eld. The service is further described as:
Second largest volume birth service in the country.•
Largest volume public hospital birth service. •
Strong academic mission for obstetrics including:•
- Approximately 75 - 80 OB/GYN residents and maternal fetal medicine
fellows.
- Known for team of physicians with strong ties to Parkland who update the
premier textbooks on obstetrics and gynecology, Williams Obstetrics and
Williams Gynecology.
- School of nurse midwifery.
- Nurse extern program.
Functional Narrative - Labor and Delivery Unit
Sec3:60
- Support of many other teaching initiatives from high school students to maternal-fetal medicine fellowships.
Research and studies including recently documented success of Parkland in reducing the preterm birth rate consistently •
during the past 15 years in contrast to a national climb. PHHS has both a lower overall rate and decreased disparity in
preterm birth rates between white women and racial ethnic/minorities in comparison to national norms.1
Background / Current State:
Organization of services: • birth services are divided into three distinct units that support different levels of medical acuity
and provider coverage:
- Highest acuity labor and delivery unit is staffed by faculty and residents (L&D West).
- Two lower acuity units are staffed by certifi ed midwives, residents and faculty (L&D East and 4 South-South).
- Cesarean / operating rooms are not centralized and are located on two of the three units.
- Grouping obstetric patients by acuity is a common practice in regional perinatal centers with high birth volume in their
labor and delivery units and seems to work well with appropriate design.
Obsolete facilities and ineffi cient patient fl ow: • current labor and delivery facilities do not meet today’s minimum local and
national norms and facilities are in need of full replacement. The model requires an assembly-line approach and greater
movement of obstetric patients from room to room than experienced at many other hospitals. An insuffi cient number of
LDRs and the relative isolation of the three units results in patient placement practices that are sometimes based on
creative “work arounds”, especially when census is high or low.
Minimal fl exibility and standardization of rooms: • patient beds are located in rooms of various sizes and capacities with
minimal standardization. The complement of rooms includes but is not limited to 20 beds for labor and induction, 14 LDRs, 4
traditional delivery rooms and 7 Cesarean operating rooms.
Family-centered care impeded:• many of the patient rooms are not sized to keep mother and infant together when
appropriate nor do they provide suffi cient space for other family members - two basic premises of family-centered care. All
rooms are not private. Family waiting space and toilets are limited, also.
Perceived disproportionate clustering of rooms:• a centralized, traditional nurses’ station on the highest risk labor and
delivery unit was observed to be noisy and crowded on several occasions. The lowest risk unit was observed to be quiet and
served fewer patients. Staff confi rmed that these situations were not unusual. Average occupancy of the individual units
was perceived to be disproportionate, but data were not analyzed to confi rm the frequency of this situation.
Undersized staff support space: • staff spaces are undersized from break rooms to the number of staff toilets, computer
work areas and the size of locker rooms. The location of space was an issue for staff, also. On one of the units, staff had
converted what appeared to be a closet to a break room near the nurses’ station. A larger lounge was nearby, but some staff
preferred to take a break in the tiny room rather than walk a few more yards to the lounge. This preference was explained
anecdotally as a social preference and the desire to stay as close as possible to the nurses’ station. During tours, areas for
physicians including the anesthesia ready room were observed to be crowded.
1 Leveno et al, Decreased Pre-term Births in an Inner City Public Hospital, Obstetrics and Gynecology, ACOG, VOL. 113, NO. 3, MARCH 2009,
578-584.
Functional Narrative - Labor and Delivery Unit
Sec3:61
PLANNING CONSIDERATIONS:
Model of Care:
Care models will continue to range from minimal intervention with certifi ed nurse midwifery based care for a low risk •
population to a medical model for high risk obstetric patients.
Family-centered care is emphasized as a basic guiding principle for all care.•
Parkland will continue its mission of teaching residents and medical students and has long been ahead of many facilities in •
its use of midlevel providers. The continuation of this approach is assumed in light of potential CMS changes in resident
coverage. Provisions will be made for designated available space for educational activities, offi ces and call rooms.
Space Program:
PHHS will continue to serve obstetric patients and their families in an expanded facility that addresses the defi cits described •
as the current state. The facility will support a model of care that results in less patient movement through utilization of
LDRs for most vaginal births, less physical segregation of units and more appropriately sized operating rooms. Features
include:
Reception and Control
Concierge/control area at the main unit entry. •
For staffi ng effi ciency, this position may be staffed by someone serving multiple roles including a greeter who will direct staff •
and visitors and oversee access to the unit. Proximity to the clinical team area and the Health Unit Coordinator will be
important. With the roll-out of the EMR the role of Health Unit Coordinators is likely to change in the future. The exact job
description is yet to be determined, but could include a variety of control and communication functions.
Public and Family Space:
Waiting areas on each unit will provide a space for family to wait if they are asked or want to leave a patient room. •
Patient rooms are sized large enough to accommodate family and visitors comfortably and should help decrease waiting •
rooms needs.
Small consultation rooms on each unit, which serve as private places for members of the healthcare team to meet with •
families or patients away from the bedside.
Patient Rooms
Forty-Three (43) Labor/Delivery/Recovery (LDR) Rooms: •
- More than triple the current number of LDRS (from 14 to 43 or 48 with ECU beds) and appropriate space for
practitioners, supplies, equipment and maneuvering.
- Twelve-bed clusters of LDRs connected to each other and the Cesarean ORs. Could be sub-divided into groupings of
six LDRs (e.g., Northside Hospital example reviewed).
- All private, standardized universal rooms appropriately sized for varying acuities of vaginal births to replace
semiprivate and multi-patient labor rooms.
- Four distinct zones: mom, infant, staff and family. Patient space includes dedicated space for infant resuscitation/
stabilization in the room, in addition to a resuscitation space located near the suite for babies too unstable to be
transported to the NNICU or Children’s Hospital immediately after birth. More LDR space is planned for
practitioners, patients, families, equipment and supplies.
- Ample number of appropriately placed gas and electrical outlets and work space with computer access.
- Handwashing sink for caregiver in each room.
Functional Narrative - Labor and Delivery Unit
Sec3:62
- Private bathrooms with showers, handheld shower hoses and shower seats (ADA).
- Windows on external wall with view from each room.
- Family support space that includes daybeds or equivalent, wireless internet access and lockable personal item
storage.
- Individually controlled lighting and temperature in patient rooms.
- LDR model is the prevalent design for non-operative, vaginal births and replaces traditional individual labor and
delivery rooms.
Five (5) Extended Care Rooms•
- Sized the same as LDRs for fl exibility and contiguous with both the LDRs and the post-anesthesia recovery area.
- For high acuity patients needing more direct observation and proximity to a higher level of care and resources than
available in antepartum and postpartum (e.g., post HELLP syndrome).
- Operates similarly to a high level “obstetrics ICU step-down” except for patients needing intubation or other services
that are better provided in an adult ICU.
No Traditional Delivery and Labor Rooms: •
- Program replaces traditional delivery room design since hospitals in the US have been phasing them out during the
past 30 years for new construction.
- Most hospitals use either a Cesarean operating room or the LDR equipped for high risk vaginal births instead of an
“in-between” traditional delivery room that does not quite meet the standards of either of these other options. Texas
requires a minimum of one delivery room, and an LDR is interpreted as meeting this requirement typically, although
code language is unclear on this point. Codes clearly indicate that LDRs may be substituted for the requirement of
traditional labor rooms and recovery rooms.
- Health Facility Guidelines being proposed for 2010 and used or referenced by 40+ state regulatory agencies (Texas has
its own) are moving toward elimination of facility guidelines for traditional delivery and labor rooms in new
construction.
- This “best practice” was highly recommended and became a planning assumption, although not without some
concerns and questions from user group members about converting to this approach.
Nine (9) Cesarean/Obstetric Operating Rooms: •
- Large, central Cesarean/Obstetric OR suite will be positioned for convenient access from all LDR clusters and the pre
and post operative areas to work effectively and safely.
- Cesarean/OR rooms are programmed at uniform size of 624 net square feet, which is consistent with standard
operating rooms in the main OR.
- Cesarean birth rooms will allocate dedicated infant resuscitation space within the room.
- Separate infant resuscitation room for special cases will be provided separately.
- Large clean core will be provided in this suite; ORs will be served by central sterile with provision for stat needs rather
than maintaining a sterile processing satellite.
Functional Narrative - Labor and Delivery Unit
Sec3:63
Eight (8) Pre-Operative and Ten Post-Operative Rooms•
- Eight pre-op rooms for simultaneously scheduled patients assuming at least one of the nine ORs will be available for
stat Cesareans. Pre-op areas could be three hard walls or a room similar to recovery for fl exibility.
- The pre and post operative rooms will be located adjacent to the operating rooms and will be within the Labor and
Delivery Unit. The Obstetric OR suite will be separate from the Main OR, but will be located conveniently on the same
fl oor as the Main OR, which includes GYN ORs.
- Rooms will be sized for mother/baby recovery in the same room as an option when appropriate, for the following
reasons.
- Promotes breastfeeding and bonding
- Supports reductions in hospital acquired infection rates by eliminating multiple bed rooms
- Improves confi dentiality-HIPAA compliance
- Supports privacy for sensitive situations such as fetal demise, terminations or women who want privacy for
bonding. Use of glass and curtains provide privacy options while maintaining staff line of sight.
Eight (8) Observation Rooms•
- The eight observation rooms will be sized for easy conversion to four LDR’s, if needed. Observation rooms are
programmed at 180 nsf and LDR’s at 360 nsf.
- Observation will occur in private rather than open multi-patient rooms (bays) for fl exibility and family-centered care.
- Observation rooms are being considered in the PHHS strategy to shell some rooms initially.
- Obstetric observation rooms should be in close proximity to LDRs and other areas within Labor and Delivery.
Other Patient Room Considerations
Isolation Rooms •
- An adequate number of negative pressure rooms with ante rooms will be designed per infection control
recommendations and Texas codes. They can be used for non-isolation patients, when appropriate.
- Exceptions to standardized LDRs due to different air handling and ante rooms, but with equivalent room
confi gurations. Isolation rooms are included in the LDR count.
Bariatrics•
- Patient rooms must be designed with consideration of bariatric patients. Nationally, approximately 33% of
pregnant women are categorized as obese. Lifts are being planned in 25% of patient rooms in the new
hospital and are recommended in this area.
Patient Unit Layout:
Units confi gured to maximize visibility, spatial relationships and support a “lean” approach to care delivery. Larger •
and more patient rooms will increase the footprint size of the units so that layout will need to support reduced travel
distances.
Less isolated confi guration than the current segregation of the three obstetric delivery units. Operational planning and •
further studies need to be completed regarding the assignment of patients and staff to specifi c LDR clusters based on
provider teams, acuity, projected volumes and other factors. Flexibility in design will support the fact that these
variables tend to fl uctuate over time. Centralized ORs will increase fl exibility as opposed to the current split into two
separate suites in different locations.
The functions of the current Women’s Elective Surgery Unit (WESU) will be incorporated into separate track for pre-op •
fl ow for scheduled Cesareans and other elective procedures.
Functional Narrative - Labor and Delivery Unit
Sec3:64
Team Work Stations/Charting:
Assumption that electronic medical records will be implemented when this facility opens. •
Computers will be provided with a decentralized approach and dispersed throughout the unit.•
Hybrid approach to work space that includes both centralized and decentralized work stations. •
- Moves staff areas to patients
- Moves support areas to patients and materials to staff
- Helps address walking distance due to increased geography of larger footprint:
- Targets the “sweet spot” for effi ciency and walking distance:
- Decentralized nursing stations with touchdown places for team collaboration
- Staff support areas less than 20 feet in distance from nurse work area
- Physician workrooms and teaching spaces
- Peer line of site-teaming
- Fosters effi ciency and way-fi nding
- Design of horizontal pathways and vertical transporting systems reduce physical demand on personnel
servicing multiple units and departments.
Support of staff to staff communication via advanced technology. •
General Support Space:
Separate onstage and offstage functions and patient, public and logistics traffi c (both horizontal and vertical) will be •
required.
Space to support “green” practices such as recycling.•
Equipment, supplies, and documentation tools will be located to promote effi ciency by reducing travel distances within the •
units.
Horizontal pathways and vertical transporting systems designed to reduce the physical demand on personnel servicing •
multiple units and departments.
Medication Rooms:
LDRs and the OR suite will have secure medication rooms. These rooms will provide space for medication storage and •
supplies for dispensing medications. Pharmacy will be reducing the quantity of satellite pharmacies, including the labor and
delivery satellite, which will be replaced by direct service from the Main Pharmacy and the satellite pharmacy in the Main OR
suite. Medication delivery will utilize automated dispensing machines (Pyxis) with medication stocking by pharmacy.
Specialty or emergency delivery of products will be accomplished by pneumatic tube.
Disaster Preparedness:
Design should support ability to accommodate disaster preparedness.•
Equipment and Supply Storage:
Supply and medication rooms will be standardized and conveniently located on each fl oor.•
Adequate number of Pyxis machines conveniently located to patient care areas.•
Locked space within the patient care area for patient specifi c supplies and medications.•
Central Storage Garage staffed 24/7 will mange equipment that can be obtained within a 60 minute window. This will be sized •
at 10 sq foot per patient. Additional storage space at 10 sq foot per patient will be planned on the fl oor.
Functional Narrative - Labor and Delivery Unit
Sec3:65
Staff Support:
Lockers, Lounges, Staff Toilets and On-Call Rooms will be provided on this fl oor. Provider rooms, offi ces and Learning Resource
Center will be provided for women and infants’ services; location to be determined during design.
Utilization / Hours of Operation:
24 hours a day- 7 days a week•
Scheduled procedures peak on Monday, Tuesday, Thursday and Friday mornings. Most patients arrive between 6 and 7 am, •
and scheduled procedures are not staggered throughout the days. Inductions are typically scheduled to start at 8 am and 8
pm.
Utilization/Volume:
To see if the projections are on track to achieving projected volume so far, the recent twelve months of utilization data were
reviewed. The deliveries appear to be tracking lower than projected for the 2006 Master Facility Plan, although there may be
slight variation when comparing fi scal and calendar years and straight-line growth is usually unrealistic. FY 2008 volume was
estimated to be 16,787 with this model and actual volume was 15,528 deliveries for CY 2008.
In addition to these volumes, PHHS reported that for every inpatient in “labor and delivery” there is slightly more than one
outpatient who has a labor assessment, short term observation or other need, but is not admitted. These patients would use the
triage or observation rooms.
Parkland Health & Hospital System
WISH Division
CY 2008 Statistics
CY 2008
Deliveries 15,528 •
NICU Admits 1,381 •
Antepartum Admissions 2,680 •
Provided by Paula Turicchi, Sr VP, Women & Infants Specialty Health 1/2009
Functional Narrative - Labor and Delivery Unit
Service FY03 FY04 FY05 FY06 Annual Change 03-06
Total Change 06-12
FY12 Total Change12-17
FY17
Labor & Delivery
Deliveries 15,796 15,726 15,811 16,489 .9% 1.9% 17,306 1.0% 17,654
C Section Rate 25% 26% 26% 26% .8% 15.4% 30% NA 30%
L&D Triage 21,293 21,403 20,992 21,140 -.1% -2.5% 20,612 -1.5% 20,302
Elective Surgery
Total Procedures 2,632 2,794 2,939 30.6% 1.9% 2,995 0.3% 3,004
Women’s and Infants’ Specialty Hospital Services (PWC)
Source: Kaufman Hall 2006 data (9months annualized), Price Waterhouse Coopers(PWC) Volume Capacity, Projections. Master Facility Plan, June 2007.
Sec3:66
Functional Narrative - Labor and Delivery Unit
Staffi ng:
Currently there are approximately 130 RNs and 18 LVNs plus aids, coordinators and other employees in L & D (50 FTEs per •
day shift), according to a questionnaire completed by PHHS.
Staffi ng ratios vary widely based on acuity from 1 nurse:1 patient for delivery, 1:2 for inductions and up to 1:4 for other •
activities.
ORGANIZATIONAL AND KEY ADJACENCIES:
The following diagram is intended to serve as a tool to clarify internal functional adjacencies and future fl ow for “Labor and
Delivery”. The diagram is distinguished from the graphic analysis of the program (GAP), which identifi ed the specifi c rooms and
areas included in the program.
The diagram assumes the fl ow of an “established patient” who has seen a practitioner for prenatal care one or more times •
and has been informed about how to access Parkland’s “Labor and Delivery” unit.
Majority of established OB patients will be expected to enter through the street level birth service entrance, although •
exceptions are expected. Some women will arrive in the ED if they were in accidents or arrived by ambulance or helicopter.
Some pregnant pts may be referred from clinics or ICC directly to L and D. Patients will be directed to one of two places
upon entry: triage or pre-op for scheduled procedures. Some patients may pass through triage directly to an LDR or
Cesarean room because they are on the verge of delivering.
Adjacency Diagram
Birth Service Entry(Street Level
24 Hours )
Established OB Patient
OB Triage Unit(reception and
perinatal evaluation)
Cesarean / Obstetric Operating Rooms
Clinical Support and Ancillary
Services
Pre-operative Prep(scheduled pts)
Extended Care Unit
(ECU)
Mother/Baby Recovery
(PACU)
Postpartum Room
Antepartum RoomHome
Other: (ICU, Transport, Jail, Morgue)
Admin and Staff Support (eg, call rooms, offices, lounges, conference,
lockers)
Obstetric Observation LDR Unit
Clinical Support and Ancillary
Services
OB Patient Flow from L & D to:
“Labor and Delivery” Internal Functional Adjacencies and Flow
“Labor and Delivery Unit”
Sec3:67
Key Functional Adjacency Requirements include:
Labor and delivery should be easily accessible to the NNICU, materials management, families, GYN operating rooms, ICC •
and emergency department among other requirements.
GYN ORs and pre/post operative care will be on the same fl oor as L&D for convenient access and safety.•
- Obstetric triage should be accessible without walking through other patient care areas.
- Many patients will be transported from this fl oor to an inpatient unit for postpartum and antepartum care.
Designated elevators are planned for staff, patients including NNICU babies, visitors and supplies to decrease travel
time, improve effi ciency and patient safety.
- Path from entry into the hospital building to this fl oor should be convenient and easy to access with short term parking
for women in active labor.
FUTURE FLEXIBILITY
Expectations for projected growth was described by PHHS as gradual, resulting in the consideration of shelling eight •
observation rooms that would be considered soft space for future growth. The original 48 LDRs were consolidated with the 5
ECU rooms assuming fl exibility.
Several benchmarks and comments about utilization were requested by and provided to PHHS, although recommendations •
about the quantity of rooms were not part of this project. The following information was provided regarding fl exibility and
benchmarks.
Other large volume birth services analyzed the implications of changes in Cesarean rates, induction rates, academic •
requirements and many other factors as they embarked on new facilities. A common objective was to achieve better
utilization of Cesarean operating rooms, one of the higher cost rooms to newly construct and operate in the hospital. For
example, three large birth volume hospitals streamlined their Cesarean operating room utilization as follows:
- Prentice Women’s Hospital, affi liated with Northwestern University’s academic teaching program and located in inner
city Chicago has 4 Cesarean ORs for 13,600 annual births and a 30% Cesarean rate. Elective OB and GYN surgeries
do not occur in these 4 rooms routinely, other than elective Cesareans. Management indicated that they would like to
have had a 5th OR for growth, but are managing the volume for now.
- Northside Women’s Center at Northside Hospital in Atlanta has 5 Cesarean ORs with 18,000 annual deliveries and a
39% Cesarean rate last year. Many of the Cesareans are scheduled and they moved to a more staggered and effi cient
scheduling process to accommodate the high volume.
- Women’s Hospital of Baton Rouge in Louisiana implemented a patient itinerary where patients are given a checklist
and asked to help monitor the activities needed to occur from admission to discharge (e.g., baby photo at 11 am).
Positive results include better room turnover, increased patient satisfaction, reduced length of stay, and decreased
workload for the nursing staff. They implemented this improvement in advance of planning 6 Cesarean ORs, 13 pre/
post-op rooms and 28-32 LDRS for their new campus. They had approximately 8,500 births in 2007, but projected
growth is unknown. The project is on hold pending fi nancing at the time this report was written.
Functional Narrative - Labor and Delivery Unit
Sec3:68
THIS FUNCTIONAL NARRATIVE IS ASSOCIATED WITH THESE SPACE PROGRAMS:
Neonatal Intensive Care Unit - 120 Beds•
Neonatal Intensive Care Unit Core + Administration•
Neonatal Intensive Care Unit Satellite Pharmacy •
PLANNING WAS INFORMED BY THE FOLLOWING:
Proven evidence-based design related to the benefi ts of controlling the •
neonate’s environment from sound to lighting and stimulation.
Identifi ed best practices for implementation of an expanded, universal single •
family room model and family centered newborn intensive care; appropriately
sizes of patient rooms, ancillary space and staff support space such as on-call
room ratios and staff lockers; standardized support spaces when appropriate
and streamlined operations.
Completed staff questionnaires that provided input on current and projected •
status.
Series of PHHS user group discussions resulting in recommendations and •
general consensus.
PWC- PHHS strategic planning documents that provided the quantity of patient •
rooms and supporting projections for patient care space.
SCOPE OF SERVICES AND OPERATING PARAMETERS:
Parkland’s Neonatal Intensive Care Unit (NNICU) provides a full spectrum of •
care to the most critically ill and premature newborns. Parkland often refers to
this unit as the NNICU, which is used interchangeably with “NICU” in this report.
Established in 1968, the NNICU was the fi rst and largest neonatal intensive care •
unit in north Texas. The scope of services includes:
Comprehensive, multi-disciplinary medical and surgical services from birth to •
discharge.
Infant resuscitation and stabilization for the Parkland delivery service.•
Guidance and follow-up for parents of neonates.•
Education of nurses, medical students, residents and fellows. •
Excludes major cardiac surgery, specialized imaging and ECMO (extra corporeal •
membrane oxygenation) that are provided at nearby Children’s Medical Center.
Background / Current State:
Limited fl exibility: multiple levels of services and locations exist and are divided •
by medical acuity and provider coverage, ranging from the lower acuity
continuing care to acute and intensive care (Level III) in almost 100 beds
currently. Services are physically separated. Continuing care patients are
accommodated in a distinct unit separate from acute and intensive care.
Step-down nursery is where babies and their families prepare for discharge.
Six beds are designed for developmental needs: a gift from the Crystal Charities •
Ball enabled the provision of a 6-bed area in the NNICU concentrating on the
developmental care of infants in 2001.
Functional Narrative - Neonatal Intensive Care Unit
Sec3:69
Neonatal mortality is on par or better than national norms: mortality rates are better than average, according to a report in •
the agenda for the Quality and Risk Management Committee of the Board of Managers at PHHS on August 26, 2008, although
some of the sickest babies are transported to Children’s .1
- National mortality rate is 6.78 per 1,000 and PHHS rate is 3.4 per 1,000 (National Perinatal Information Center - NPIC).
Multi-disciplinary staff: staff include RNs, pediatric and neonatal nurse practitioners, neonatology faculty from the •
University of Texas Southwestern and many multidisciplinary employees ranging from respiratory therapists to nutritionists.
Compact, crowded facilities and limited ability to control the environment: current facilities average far less than today’s •
minimum standard of 120 clear square feet per baby excluding aisles. Efforts are being made to manage light, stimulation,
air fl ow and noise, but the small, open rooms are not conducive to controlling the physical environment or fully support
individualized, developmental care objectives. Efforts consist of “quiet time” with dimmed lights and softer voices in the
more crowded rooms and a few additional environmental controls are offered in the 6 bed developmental care room.
Family-centered care is not supported by facilities: infant care spaces are not conducive to keeping parent and infant •
together when appropriate. The tight quarters do not allow parents the option of more privacy and confi dentiality from other
families when desired. Parents may be asked to leave their infants’ bedsides during rounds or if something is happening
with the neighboring babies that would make it uncomfortable or inappropriate to observe. Privacy panels are used when
feasible for skin-to-skin contact and other times when privacy is ideal, but the small size of spaces and the inability to reduce
sound and full visual blocking make this challenging.
Small entry: a bank of institutional scrub sinks creates a stark entry to the unit. Continuing into the unit, this view is •
softened by photos that feature graduates and a small desk to the side that is staffed for the reception and control functions.
Limited staff support space: While the emerging trend is to provide options for parents to share in nurse reports and •
physician rounds related to their individual babies, there are no private bedside spaces for this practice currently. Staff do
not have a place for shift report if they would like to communicate with each other off-line. Locker, lounge and work spaces
are undersized and appear to be squeezed into areas not intended for these functions.
Ancillary, technology and other challenges: Pyxis fi lls are done 2-3 times daily from MRD and in-unit storage is limited. •
Pediatric radiology services such as MRIs and even the capability to perform ECHOs at the bedside on any patient result in
some patients being transported to Children’s. Complex surgical cases for babies who are too unstable to move present
challenges.
1 Source: www.parklandhospital.com/media/pdf/BOM_082608.pdf with references to Drs. Alexander and Bloom and Miriam Sibley.
Functional Narrative - Neonatal Intensive Care Unit
Sec3:70
PLANNING CONSIDERATIONS:
Model of Care:
The future design will support a model of care for the 120 bed NNICU requested by PHHS with these six primary •
considerations:
- Suffi cient space for patient, staff, family, teaching and research functions.
- Avoid noxious noise, light and stimuli from adjacent beds that impede care and development.
- Support the right to privacy and confi dentiality.
- Enhance safety (e.g., through design supporting reduced risk of infection).
- Support family accommodations, communication and involvement in care.
- Provide sustainable and effi cient facilities.
NNICU program includes all levels of newborn inpatient care except for newborn nursery care. •
NNICU user group recommended that the program include suffi cient space to accommodate an all single family room (SFR) •
design, while continuing to work toward consensus about the model of care and operational plan. PHHS Steering Committee
supported the SFR recommendation.
SFR design is fast becoming the prevailing design model to support evolving models of care for new construction of NICUs. •
More than 40 NICUs have converted to this design during new construction or major renovation in the US since the 1990s and
many more are in the planning stages. (TAC requires a minimum of one single family room for every six beds).
First recorded SFR was built in Brest, France, and was implemented to improve infection control in 1985, which was achieved •
successfully. Other units have evolved to this design because it strongly supports the premise of providing individualized
environments for the neurological and other sensory development of premature infants. Others base their rationale on many
of the same reasons that adult rooms are being converted to private rooms – for confi dentiality, privacy and control. Family-
centered care has been one of the key drivers, also.
Space Program:
Patient Rooms
Individual, standardized universal rooms programmed for all levels of acuity within a consolidated NNICU, including ICN, •
ACN, CCN and the “K Nursery” (maximum fl exibility).
Flexibility to cluster patients within the design by acuity or for other reasons, but without restriction because of room size.•
Space within each room for patient(s), equipment, supplies, staff work area with handwashing sink, family with daybed or •
sleeper, chair for skin to skin care, family personal storage, acoustical considerations, controlled lighting and individual
thermostat, among other features.
Patient Unit Layout
Single fl oor recommended with ten groupings of twelve rooms.•
Controlled reception and entries that support security. •
Perimeter windows and access to natural light would be provided based on data that supports benefi ts of natural lighting for •
adults (staff and families). Natural lighting as specifi cally benefi cial to premature babies would not be the driver for this
feature, since premature babies do not have the neurological maturity of a term baby.
Functional Narrative - Neonatal Intensive Care Unit
Sec3:71
Consistent model of care. Combination of multiple design models such as 50% pinwheel and 50% single family room is not •
recommended. Leadership from the Children’s Hospital of Denver built 30 single family room and 30 open pinwheel beds.
The NNICU director and staff reported at a national conference on Jan 22, 2009, that the mix of rooms was a signifi cant
family and staff dissatisfi er, based on their surveys. A poll showed that an overwhelming majority of staff would go with all
SFR in hindsight. Similar fi ndings have been experienced at several other hospitals with mixed models such as Providence in
Anchorage and Phoenix Children’s during a past interim construction project.
Procedure Room
Accommodates surgical light and other appropriate equipment for procedures.•
Cleanable surfaces and appropriate ventilation.•
Neonatologists are increasingly providing bedside procedures and procedures outside of traditional operating rooms. •
Observation of trends and a literature search on neonatal bedside procedures substantiate the practice. Examples of studies
that support bringing the surgeon to the bedside for certain procedures include:
- Article by Arbell et al in IMAH, Vol 9, December 2007, titled “Bedside Laparotomy in the Extremely Low Birth Weight
Baby: A Plea to Bring the Surgeon to the Baby”.
- Article by John et al titled “Improving the management and delivery of bedside patent ductus arteriosus ligation” in the
August 2007, AORN Journal:
“ ...if surgical intervention is the required method of treatment, often the procedure needs to be performed in the NICU
at the patient’s bedside. Keeping the patient in the NICU can be safer than bringing him or her to the OR. Patients with
PDA are most often critically ill, premature infants who are intubated and on mechanical ventilation. According to
Gould et al, (2) transfer of these premature patients has been associated with hemodynamic instability, inability to
maintain optimal ventilation and oxygenation, hypothermia, dislodging of the endotracheal tube, and loss of indwelling
lines causing interruption of continuous infusions. In addition to not moving a patient with a critical airway to the OR,
performing a PDA ligation in the NICU has advantages ...”
Satellite Pharmacy
Distinctive satellite NNICU pharmacy in or adjacent to the NNICU - based on best practices.•
High volume user of medications that are specialized for infants and detrimental if confused with adult dosages, as evidenced •
by recent and widely publicized cases of neonatal medication mix-ups at Christus Spohn Hospital in Corpus Christi, Texas,
Cedars Sinai in Los Angeles and Methodist in Indianapolis.
Proposed pharmacy includes:•
- Order processing and pick-up with a walk-up window serving clinicians fi lling patient orders
- Storage and staging space
- Compounding and packaging
- Specialty cart and tray staging/storage
Lactation Areas:
Centralized “formula” room as required by TAC and needed in the unit.•
Three additional lactation rooms that could be used to support breastfeeding supplies, pump storage and other needs. •
Expect most breastpumping in single family rooms but allow option based on experience at other hospitals where some
women are more comfortable in separate room without NNICU staff in this space caring for the infant. At other NICUs, the
culture is to use breastpumping as a means for mothers’ socialization and the space is shared with curtains.
Refrigerator/freezers for breastmilk provided in each of ten clusters of rooms. PHHS did not want individual refrigerators in •
patient rooms for breastmilk. This feature is common in new single family room NICUs to minimize breastmilk mix-ups.
When utilized, requirements include quiet refrigerators without freezer shelves, protocols for cleaning and electronic
temperature regulation/alarms.
Functional Narrative - Neonatal Intensive Care Unit
Sec3:72
Simulation Lab
Practice lab for staff required as part of the unit for “on the job” teaching for all nursery levels of care. •
PHHS determined that is needs to include future capacity for two simulation babies.•
Staff Support Space
While decentralized work stations are requested near the patients to reduce walking distances and improve effi ciency, four •
hubs (communication centers) with one designed as a central command center for 4-5 people simultaneously will support
staffi ng needs. PHHS expressed strong support for “hubs” rather than total decentralization of work stations resulting in a
hybrid model.
Utilization / Hours of Operation:
24 hours a day- 7 days a week•
Utilization/Volume
PHHS leadership analyzed several potential scenarios related to NNICU bed need, resulting in the conclusion that 120 beds •
would be the appropriate projection.
Since previous documents had different conclusions about bed needs, the next few key points are summarized to help trace •
and document the steps.
When reviewing the strategic planning volumes that are shown in the following table, the projected need was 96 beds, but •
appeared to exclude the “K” or “Sick Nursery”, level II beds.
PHHS approved budget for the NNICU (2008) was associated with the square feet in an HKS space program for 77 Level III •
beds, and appeared to inadvertently exclude the program numbers for intermediate and sick nursery needs. These 77 beds
were part of 128 total beds programmed initially for a separate women and infants’ hospital (2004).
Women and Infants leadership reviewed these documents, recent trends and projections and provided a revised projection of •
120 beds.
Service FY03 FY04 FY05 FY06 Annual Change 03-06
Total Change 06-12
FY12 Total Change12-17
FY17
Nurseries
ICN Patient Days 6,191 5,898 6,399 5,736 -1.5% 1.9% 5,845 1.0% 5,903
Average Daily Census 17.0 16.2 17.5 15.7 -1.5% 16.0 16.2
ACN Patient Days 9,794 11,313 11,184 10,975 2.4% 1.9% 11,184 1.0% 11,295
Average Daily Census 26.8 31.0 30.6 30.1 2.4% 30.6 30.9
CCN Patient Days 5,282 5,300 6,151 6,810 5.8% 1.9% 6,939 1.0% 7,009
Average Daily Census 14.5 14.5 16.9 18.7 5.8% 19.0 19,2
Women’s and Infants’ Specialty Hospital Services (PWC)
Source: Kaufman Hall 2006 data (9months annualized), Price Waterhouse Coopers(PWC) Volume Capacity, Projections. Master Facility Plan, June 2007.
Functional Narrative - Neonatal Intensive Care Unit
Sec3:73
Staffi ng:
Current nurse to patient staffi ng ratios range from 1:1 to 1:4, generally. •
Research from existing facilities has shown that nurse staffi ng ratios and nurse caseloads remained unchanged in the •
single family room model in comparison to open bay models. (Sources: Boekelheide NICU at Sanford Children’s Hospital –
staffi ng analysis was part of a 3 year investigation of differences in NICU environments; Children’s Hospital, St. Paul, MN,
and St. Luke’s Hospital, Cedar Rapids, IA). Some hospitals reported an increase in technical support, unit secretaries and
aids due to spreading out in more space than previous units.
ORGANIZATIONAL AND KEY ADJACENCIES:
The following diagram depicts the internal functional relationships and fl ow. Examples of clinical support and ancillary services
included in the green oval are the satellite pharmacy, MRI and other imaging services and a variety of therapies and many staff
support areas from work stations to child life storage, nutrition and social work.
Adjacency Diagram
Neonatal Intensive Care Unit Internal Functional Adjacencies and Flow
In-born (Labor and Delivery, ICU
or Trauma)
Clinical Support, Family Support and Ancillary
Services
Transport/Transfer: ED, Ambulance, Air
Newborn Nursery
Children’s or other hospital
Neonatal Intensive Care Unit
Home, Morgue, Transport
Admin and Staff Support (eg, call rooms, offices, lounges, conference,
lockers)
Satellite Pharmacy
Key Functional Adjacency Requirements include:
NNICU and labor and delivery must be readily accessible.•
Patients will be transported to this fl oor resulting in designated elevators for staff, patients, families, visitors and supplies to •
decrease travel time, improve effi ciency and safety. These elevators should be controllable for patient transport.
Clear path from emergency transport and receiving area.•
The NNICU should be designed to avoid cross traffi c from other units.•
Strategically positioned stairwells for staff and others who prefer stairs.•
Convenient access to materials management, garage storage, labs and ancillaries.•
Functional Narrative - Neonatal Intensive Care Unit
Sec3:74
FUTURE FLEXIBILITY
Universal rooms will allow better accommodation of fl uctuating acuities and census than if spaces were designed only for •
specifi c levels of care.
Other opportunities for increased fl exibility and growth in census are achieved in some NNICU by providing suffi cient gases, •
outlets and space to co-bed siblings in the same room, keeping low level II babies with moms on the postpartum unit (e.g.,
moderate feeding issues, antibiotics, phototherapy) and reducing average length of stay due to the ability to better prepare
parents for discharge in an environment that encourages “rehearsals” in the private patient room before taking the baby
home.
Some hospitals add space for “phantom” beds in each room for rare surges, resulting in a design with headwalls for two •
patients in a single patient room.
During the design phase, PHHS is expected to consider evaluating these and other options for fl exibility.•
Because this proposed change in the model of care and design is expected to require one of the most signifi cant transitions •
in the new facility, this document includes additional details that are beyond the usual supporting documentation in this
report. The following material was discussed in the user group meetings related to best practices, future needs and
outstanding issues.
NICU Examples:
A few examples of teaching hospitals that have or are implementing the single family room model include:
Vanderbilt Monroe Carell, Jr., Children’s Hospital at Vanderbilt, 60 beds (2004)•
Sioux Valley Hospital USD Medical Center; Sanford Children’s Hospital, 58 beds – 46 single plus triplet and twin rooms at •
Boekelheide NICU (2006)
Nebraska Medical Center, Omaha , 34 beds (2005)•
Children’s Hospitals and Clinics of St. Paul, started with 50 bed with expansion being planned (2003)•
Virginia Commonwealth University Medical Center, Richmond, VA , 40 beds( 2008)•
University Hospital’s Rainbow Babies and Children’s Hospital, Cleveland, affi liated with Case Western Reserve University •
(had a portion of SFR since 1999 and evolving to all single room – under construction , 82 beds (1999/2010)
St. Louis Children’s Hospital, Missouri (75 beds being phase in over time)•
Rhode Island Women and Infants / Brown University – 80 beds (2010)•
Johns Hopkins Medical Center, Baltimore, 46 beds (under construction)•
Recent construction with other design models includes:•
Morgan Stanley Children’s Hospital, New York, NY, 50+ semi-private patient pods with family support at bedside (2003)•
Prentice Women’s Hospital , Chicago, IL - 86 bays with sliding doors for extra space; sized at approximately 120 nsf; do not •
allow parents to stay at the bedside overnight; two mother/baby suites with double beds for parents and one or two
additional overnight parent rooms (2008)
Winnie Palmer Hospital for Women and Babies, Orlando, FL - semi-private rooms, 112 beds (2006)•
University of Iowa Hospitals and Clinics, replaced 46 bed NICU with combination of single and multi-bed rooms (2004)•
Functional Narrative - Neonatal Intensive Care Unit
Sec3:75
CHER Study1
A 2005 study of 11 NICUs by researchers from Texas A&M , USF and Memorial South Bend, included the following fi ndings:
“Based on the results of this preliminary study, single family room NICU design provides solutions for increasing parent privacy and
presence, supporting HIPAA compliance, minimizing the number of undesirable beds, increasing staff and parent satisfaction, and
reducing nursing staff stress. Potential limitations of the SFR design are reduced parent-to-parent social contact and isolation of both
parents and staff. In the projects reviewed in this study, construction cost was not infl uenced by design confi guration; therefore, the
decision to provide SFR units should not be infl uenced by fi nancial implications. The primary motivation for employing SFR design should
be the provision of an environment that supports quality care for infants and that offers a supportive experience for parents and nursing
staff.”
Several outstanding issues identifi ed by the user groups as requiring future resolution are documented in this report and include:
Resolve Children’s Medical Center and PHHS proximity issues: develop plan to address the implications of the increased 1.
distance required for transport of babies between Children’s and Parkland; continues to be a serious concern at the time of
this documentation. A separate study of this topic for hospitals from across the country was conducted and provided to
PHHS as an additional report for this project.
Confi rm a common vision: a common vision is a good anchor for design. Physician and PHHS leadership were working 2.
toward confi rming a common vision on some priorities for the project including translating care priorities into a preferred
design model
1 Harris, White, Shepley et al, NICU Environmental Design Research: The Impact of Single Family Rooms on Patients, Families, and Health-
care Staff, CHER, Nov 2005.
Functional Narrative - Neonatal Intensive Care Unit
Sec3:76
THIS FUNCTIONAL NARRATIVE IS ASSOCIATED WITH THIS SPACE PROGRAM:
Intermediate Care Center (ICC)•
PLANNING WAS INFORMED BY THE FOLLOWING:
Proven evidence-based design related to size and confi guration of •
patient exam rooms and functional adjacencies for similar services.
Identifi ed best practices for urgent/immediate care •
centers for obstetrics and gynecology.
Completed staff questionnaires.•
Series of PHHS user group discussions resulting in •
recommendations and general consensus.
PWC- PHHS strategic planning documents that provided the quantity of exam •
and other patient rooms and supporting projections for patient care space.
SCOPE OF SERVICES AND OPERATING PARAMETERS:
Mostly urgent to emergent care for obstetric and gynecological problems, •
but not a trauma unit (e.g., vaginal bleeding, pelvic pain, problems
associated with gyn/oncology, obstetric patients usually up to 24 weeks
gestational age). Some non-urgent outpatients are seen in the ICC.
Alleged criminal assault patient services.•
Prisoner obstetric/gynecology services.•
ICC is not equivalent to other hospitals’ use of “Obstetric Intermediate Care •
Unit” that denotes an inpatient or observation unit for high risk patients,
usually in regional perinatal centers. This other use of the term refers to
the care of the highest risk obstetric inpatients by obstetricians to result
in fewer transfers to medical/surgical intensive care units. PHHS uses
the ECU for this level of care and the antepartum/postpartum units, once
the patient is more stable. ICC is similar to what a few hospitals refer
to as an “Immediate Care Center” for obstetrics and gynecology.
Background / Current State:
Generally “walk-in” patients although some women may arrive by •
ambulance and be screened by the emergency department.
Care begins with triage upon entering the ICC; from triage, •
patients are directed to the appropriate treatment.
Some patients are sent to the emergency department, labor and delivery, •
GYN surgery or other locations when they arrive at the Intermediate
Care Center (ICC) with problems that should be treated elsewhere.
Large, usually crowded waiting area without separation •
of obstetric and gynecological patients.
OB patients are seen fi rst, unless it is a GYN emergency. •
Patients seen quicker because is a dissatisfi er when patients
with long dwell times see others “jump” ahead of them.
Functional Narrative - Intermediate Care Center (ICC)
Sec3:77
Additional defi ciencies in current spare are described as “not enough exam rooms and counseling areas, observation beds •
without privacy; limited work area for staff starting IV’s and drawing blood; lack of space for visitors; limited lab space and
lack of confi dentiality in registration areas”.
Sonography services are provided in the ICC.•
One negative air pressure provided for isolation currently.•
PLANNING CONSIDERATIONS:
Model of Care:
Model of care is based on the provision of midlevel providers who screen patients to determine the emergent needs and then •
direct them to receive the appropriate test, treatment, counsel or observation either by the ICC providers or referral to other
providers.
Future model is that the ICC will continue to treat the patients with non life-threatening obstetrics and gynecology conditions. •
The ICC will serve the community needs 24 hours and contribute to PHHS’ safety net service, with no appointment required.
Space Program:
Entry / Reception
ICC should have an entry that is ground level and in proximity to emergency departments. •
Large number of “tags”, also referred to as entourages and chaperones, accompany patients creating need for ample waiting •
space.
Triage and Registration
PHHS prefers separate paths for gynecology and obstetric patients with separate waiting; as processes become more •
streamlined and ideally most patients go directly into rooms for exam and treatment, the waiting area would be less of an
issue; future considerations for streamlining ICC fl ow include:
- Use of new technology to improve patient experience and effi ciency.
- Non-urgent care diversions; reduce unnecessary bottlenecks.
Patient Care and Other Key Rooms
Proposed rooms include: 4 triage, 12 exam/treatment, 6 observation + 2 special rooms, totaling 24 rooms for patient care.•
Four registration/interview areas will be provided as a front end function of the center.•
Resuscitation room is needed for safety in the event patients cannot make it to other locations for unexpected emergencies.•
Alleged criminal assault area should be in secure, discrete part of the center with access to a toilet, clothing closet and •
subwaiting for an offi cer or support person.
Ancillary Services
Suffi cient space for lab (two point of care testing stations), pneumatic tubes, medication, sonography and other ancillary •
space is programmed with the intent to improve the current defi ciencies identifi ed regarding ancillary and clinical team
space.
Functional Narrative - Intermediate Care Center (ICC)
Sec3:78
General Layout
Decided not to combine obstetric triage (Labor and Delivery) and obstetric ICC, based on volume, processes and the reality •
that all of the obstetric services and ICC are unlikely to fi t on one fl oor, and remain in proximity to the emergency
department.
Determined that the path into the ICC should be designed to avoid congestion of ambulatory and other ICC patients with other •
high volume areas and to provide appropriate security for this 24 hour operation.
Utilization / Hours of Operation:
24 hours a day- 7 days a week•
Peak operating hours are 1:00 pm to 12:00 am•
Utilization / Volumes:
ICC is predicted to continue to grow and serve as a women’s urgent care center. Projected volume provided for this project is •
shown in the following table:
Staffi ng:
Current staffi ng includes 11 to 14 full-time equivalents (FTEs) with the highest number during the day shift. •
Key staff include: 3 managers, 1 RN charge nurse, 1 RN triage, 1 RN fl oat, 1 RN observation, 1 med director, 2 physicians •
and 3 midlevel practitioners.
Functional Narrative - Intermediate Care Center (ICC)
Service FY03 FY04 FY05 FY06 Annual Change 03-06
Total Change 06-12
FY12 Total Change12-17
FY17
ICC 21,293 20,837 19,319 20,792 -.5% 4.9% 21,811 9.7% 23,926
Women’s and Infants’ Specialty Hospital Services (PWC)
Source: Kaufman Hall 2006 data (9months annualized), Price Waterhouse Coopers(PWC) Volume Capacity, Projections. Master Facility Plan, June 2007.
Sec3:79
ORGANIZATIONAL AND KEY ADJACENCIES:
Adjacency Diagram
Direct / Hospital Entry
ACC/Clinics/Family Planning/Jail
Emergency Department
Admin and Staff Support (eg,,offices, lounges, conference, lockers)
Clinical Support, Family Support and Ancillary
Services
Intermediate Care Center
Intermediate Care Center (ICC) Internal Functional Adjacencies and Flow
Sonography/Imaging
ICC Triage
OB GYN
Home, Jail, L&D, Postpartum, Antepartum, GYN, OR, ED, Med/surg,
Morgue, Clinic
Functional Narrative - Intermediate Care Center (ICC)
Key Adjacencies include:
Emergency department – some cross fl ow of patients expected.•
Access to imaging/radiology.•
Close to OB Complications Clinic/Genetics/Sonography/GYN Clinics.•
Elevator access to Labor and Delivery triage, assuming on another fl oor.•
- Pregnant women greater than 22-24 weeks gestational age with complaints of decreased fetal movement may be at
risk for fetal demise. For this reason, if these women arrive at the ICC instead of the L&D unit, the design and process
should support swift transport to L&D without waiting time in the ICC. Long distances to L&D or “Keeping a pregnant
woman sitting in a waiting area or waiting to be evaluated for a long period of time is a prescription for liability”. 1
FUTURE FLEXIBILITY:
Triage, observation and exam/treatment rooms are sized uniformly for fl exible use should needs change regarding the •
allocation of each of these types of spaces.
Discussion and planning about how the emergency department triage and the ICC triage will interface optimally is expected •
to continue and could impact future operations. Initial discussions identifi ed relationships between the ICC and ED regarding
security and ICC patients’ entry to the building, but not shared exam and treatment rooms since each service had high
volume.
Recent and future emergency department protocol changes could have relevancy for the ICC, too.•
1 Mahlmeister L, Van Mullem C. The process of triage in perinatal settings: Clinical and legal issues. J Perinat Neonatal Nurs 2000;13:13–
30.
Sec3:80
THIS FUNCTIONAL NARRATIVE IS ASSOCIATED WITH THESE SPACE PROGRAMS:
Emergency Services•
Shared ED Admin•
Psych ED•
PLANNING WAS INFORMED BY THE FOLLOWING:
Proven Evidence Based Design•
Identifi ed Best Practices•
Completed Staff Questioners•
User Group Discussions•
PWC- PHHS Strategic Planning Document •
SCOPE OF SERVICES AND OPERATING PARAMETERS:
The emergency room at Parkland hospital is one of the busiest in the country.•
In 2006 there were 87,315 visits to the Main ED.•
This volume is expected to grow to over 100,000 by 2017• 1
Parkland is designated as a Level I Trauma center. •
Parkland is a regional designated Burn Center accredited through the American •
Burn Association and serve both pediatric and adult patient populations.
Over the last 6 months PHHS has received Stroke Program accreditation by the •
Joint Commission.
The Parkland’s ED currently serves as a major hub and treatment center for •
routine acute care for the indigent and Medicaid population in Dallas County.
Command Central Bio-Tel for both EMS-ground and air transport is located •
within the ED suite.
The Emergency Department at Parkland Hospital is crucial to both the emergent •
care of patients and as a point of access/entry to the hospital.
Currently 80% of all PHHS admissions come through the Emergency •
Department.
According to Price Waterhouse Cooper research and data, 60% of the patients •
who come to the ED are repeat patients.2
Approximately 10 - 11% of the emergency room visits result in admissions.• 3
The psych emergency room and the ICC are adjacent spaces and provide •
specialized care to specifi c patient populations.
1 Source: Kaufman Hall 2006 data (9months annualized), Price Waterhouse Coopers
(PWC) Volume Capacity, Projections. Master Facility Plan, June 2007.
2 Source: Kaufman Hall 2006 data (9months annualized), Price Waterhouse Coopers
(PWC) Volume Capacity, Projections. Master Facility Plan, June 2007.
3 Source: Kaufman Hall 2006 data (9months annualized), Price Waterhouse Coopers
(PWC) Volume Capacity, Projections. Master Facility Plan, June 2007.
Functional Narrative - Emergency
Sec3:81
Background / Current State:
While the Emergency Department works aggressively to manage patient fl ow, sources of ineffi ciency include a poorly •
functioning front end: triage and registration and ineffi cient means to manage the large volume of patients who require urgent
care.
The ED waiting space is out of the line of site of the ED. This creates a situation where it is possible to be in the back of the ED •
and have no idea how many patients are waiting.
The current space confi guration of the ED which separates patients into medical and surgical tracks in different geographic •
spaces leads to ineffi ciencies in staffi ng, management oversight, supplies, and transportation of patients.
Patients who require chronic dialysis and non-emergent orthopedic referrals from outside EDs, are two specifi c large volume •
populations who need to be effi ciently managed and processed.
The current average wait time in the ED is about 10 hours.•
The current confi guration of the decontamination support is not optimal. The current fl ow of patients, staff, and vehicles •
during a time of decontamination is chaotic as a direct result of the current space, equipment location, driveway, etc.
confi guration.
Although adjacent the Psych ED and the ICC have no direct connections to the Main ED. When emergencies occur in theses •
spaces or a patient needs a service offered only in the Main ED delays result.
Vertical and horizontal pathways to the OR, cath lab, and GI suite are not effi cient.•
Vertical and horizontal access to the heliport are not effi cient.•
PLANNING CONSIDERATIONS:
Model of Care:
Incremental growth has been projected for the Emergency Department• 1, however PHHS new strategic endeavors: CT surgical
program, Stroke Program Certifi cation and plans to become part of NCI Cancer Center may bring an increased volume to the
ED that was not considered at the time of Price Waterhouse Cooper’s assessment.
Parkland Hospital will continue to be a Level One Trauma Center•
Parkland Hospital will continue to be a Burn Center treating children and adults.•
PHHS will treat a growing number of patients who require emergent neurosurgical intervention as a result of their Stroke •
Program Certifi cation.
The cardiology and CT surgical volumes may continue to grow as a result of reestablishing a CT surgical program at PHHS •
and the newly accredited interventional cardiology fellowship program. In addition the number of patients seeking routine or
urgent care through the emergency department may continue and as PWC projected continue to grow.
The ED leadership is currently reconfi guring and their operating model of care delivery. Lean operations will be implemented •
in the future space.
The following assumptions: Guiding Principles were used when developing the ED program.•
- Patients with acuity Levels 1-3 will be treated / evaluated in the ED
- There will be an Urgent Care / Fast track in the future ED
- There will be no clinical observation unit managed by the ED
- Care will be delivered by teams and space will be designed in complementary modules to support this operating model.
- Quick Triage will take between 5-8 minutes.
- Goal - Door to MD time in the future will be 24 minutes. This time was based on like benchmark hospitals ie. Detroit
Receiving Hospital.
- Goal - Patients who are being admitted will have a bed within 6 hours, patients who are discharged home will be
discharged within 4 hours.
1 Source: Kaufman Hall 2006 data (9months annualized), Price Waterhouse Coopers(PWC) Volume Capacity, Projections. Master Facility Plan,
June 2007.
Functional Narrative - Emergency
Sec3:82
- Goal - Patients who are treated in the urgent care / fast track will be discharged home within 4 hours.
- PHHS will develop a primary care strategy to treat patients who currently misuse the ED in the community.
- ICC and Psych ED will be located adjacent to the main ED with off stage connectivity so if emergencies arise and a
patient needs to be transferred or responded to in any area there is close proximity.
- Registration will occur in a decentralized way at the patient bedside.
Disaster Preparedness: Parkland hospital is a designated disaster site. Staff has requested that this space be designed to •
function like an “Emergency One” model. PHHS staff has also requested that the space reference and support the
operations similar to Magen David Adom Hospital in Israel . These requests and details should be further discussed during
the next phase of this project.
Space Program:
Ambulance:• The future ED space should be designed to with separate ambulance and walk in entrances. The ambulance
access should be large enough to accommodate the ambulance volume as well as the transport of inmates and psych
patients who are escorted to the ED.
Heliport: • Effi cient access to the heliport is imperative. Heliport access to the ICU and OR should be part of the future
design.
Security spaces: • All patients, visitors entering the ED will go through metal detectors.
-Security / Control Station: This space is programmed to be 100NSF.
-Police workroom: This space is programmed at 252 NSF and will accommodate 4 computer workstations.
-Gun Lock-Up Room: This should be a secure space with internal secure gun lockers.
Waiting space: • To accommodate 200 people is planned.
Front End: • In the future it is assumed that patients will come to the ED and sign in. Within a brief period of time they will be
called to a quick triage point, where an experienced professional (physician - nonresident, midlevel provider or experienced
nurse) will triage patient based on chief complaint, basic demographics, vital signs, quick assessment. Patients will be given
an acuity score and sent to the most appropriate treatment space. Registration will be decentralized and occur at the
bedside.
Centralized command space• is planned and should be equipped with an electronic tracking board to assist with
management and coordination of patient fl ow.
Functional Narrative - Emergency
Sec3:83
Admissions / Bed Flow:• Currently there is considerable backup of patients waiting for beds. This is part of a larger problem
resulting from a multitude of issues related to discharge, room turn-over time, etc. A clinical decision / observation unit and
a discharge lounge are planned for the new hospital. Both of these spaces should help to create effi ciencies with bed
management and patient fl ow. Implementation of these measures should decrease / resolve the delays currently
experienced by patients admitted through the ED.
Disaster Preparedness:• Parkland hospital is a designated disaster responder. Decontamination space has been
programmed. Staff have requested that this space be designed to function like an “Emergency One” model. This program
and detailed operations should be discussed further during the design phase of the planning.
Treatment Spaces:•
- There will be 112 treatment spaces confi gured into self-contained modules of 14 rooms. All treatment spaces will be
universal and equipped to manage critical care patients. Decentralized / bedside computers for orders and charting
are requested.
- Six (6) Resuscitation Rooms are planned. These spaces should be adjacent to the CT scanners. These rooms should
be equipped with general imaging equipment that can fl ex between the rooms via a ceiling track. These spaces
require close proximity to the ambulance entry and immediate proximity to elevators providing transportation of
patients to the OR’s, ICU’s, Cath. or GI suites. A horizontal adjacency to radiology (IR, MRI, etc.) is planned.
- Specialized spaces: Ophthalmology, Dental, Orthopedics-which includes imaging capabilities and casting space.
Imaging: 2 general radiology modalities to support main ED in addition to modalities in resus space. 2 CT - to be •
located in close proximity to resus rooms.
Clinical Support:•
- Stat lab to support the ED is planned.
-Satellite pharmacy to support the ED is planned.
Provider Workroom: • 8 of these spaces are planned- one per module. They should be equipped with PAC viewing, computer
workstations.
Resident and Fellow • (offi ce) LRC’s are planned in close proximity to the ED.
Command Central / Bio-Tel• : to support ground and air patient transports. EMS support space should be located in close
proximity to this space.
Functional Narrative - Emergency
Sec3:84
Service 2017 Visits
Less 30% of Level 4-
7 to Urgent Care
Less AdmissionHold/CDU
Average key room Minutes/
Visit
Total Key Room
Minutes
Key room Visits
Available / Room
Key Rooms Required at
85% Capacity
Key Rooms Required at
75% Capacity
2012 Assumed Key
Rooms
Visits / Key Room
Current Key
Rooms
Difference:Assumed vs.
Current Rooms
Psychiatric ER
Total 11,920
Daytime Volume Beds at 85% Beds at 85%
50% of Visits 5,960 60010 Hr ALOS
3,575,972 352,000 12.0 13.5 12 497
Overnight Volume
50$ of Visits 5,960 84010 Hr ALOS
Plus 4 hr Post
Sedation Observation
5,006,361 352,000 16.7 19.0 16 372
TOTAL BEDS 11,920 28 426 7 21
Psychiatric ER Volumes/Utilization – Detailed Information
Source: Kaufman Hall 2006 data (9months annualized), Price Waterhouse Coopers(PWC) Volume Capacity, Projections. Master Facility Plan, June 2007.
Service 2017 Visits
Less 30% of Level 4-
7 to Urgent Care
Less AdmissionHold/CDU
Average key room Minutes/
Visit
Total Key Room
Minutes
Key room Visits
Available / Room
Key Rooms Required at
85% Capacity
Key Rooms Required at
75% Capacity
2012 Assumed Key
Rooms
Visits / Key Room
Current Key
Rooms
Difference:Assumed vs.
Current Rooms
Urgent Care Centers
Visits 18,334 180 3,330,175 525,600 9.0 10.5 10 1,833
Urgent Care Centers Volumes/Utilization – Detailed Information
Utilization / Hours of Operation:
24 hours a day- 7 days a week •
- Most admissions occur between 3pm -11pm
- Most discharges occur between 12pm-4pm
Jail Health:
There will be treatment spaces within the Inmate Treatment Center where inmates requiring urgent type care can be •
managed.
Those inmates requiring emergent care (Levels 1-3) will be managed with in the main ED space.•
Psych ED:
The Psych ED will be adjacent to the main ED. Psych patients requiring general emergency room services can be easily •
accommodated within the Psych or main ED space. There will be a convenient fl ow between the two spaces.
The Psych ED will be located on the outer parameter of the ED to provide easy access for patients who are escorted by •
police. The sallyport adjacent to the inmate unit should support this space. Patients should go through main ED security.
ORGANIZATIONAL AND KEY ADJACENCIES:
The ED requires an immediate vertical adjacency with the OR suite to accommodate trauma patients. It is envisioned that a •
off stage bank of elevators will connect the ED/trauma bay with the OR.
There will be a vertical adjacency with the interventional space (cardiac cath and the GI Suite) to accommodate those patients •
requiring emergent endoscopic or catheterization intervention.
Radiology will be adjacent to the emergency department. It is imperative that the ED physicians, trauma surgeons, etc. have •
easy access to the radiologists. Radiology reading space has been programmed in the new space
Adjacency Diagram
Functional Narrative - Emergency
ED
ICC
Imaging
Clinical Lab
ORInmate Treatment
Center
Psych ED
IP Units
Interven-tional Unit
Sec3:85
Sec3:86
THIS FUNCTIONAL NARRATIVE IS ASSOCIATED WITH THESE SPACE PROGRAMS:
Psych ED•
PLANNING WAS INFORMED BY THE FOLLOWING:
Proven Evidence Based Design•
Identifi ed Best Practices•
Completed Staff Questioners•
User Group Discussions•
PWC- PHHS Strategic Planning Document •
SCOPE OF SERVICES AND OPERATING PARAMETERS:
The Psych ED provides 24/7 emergency services to adolescents over the age of •
13 and adults with psychiatric disorders.
Background / Current State
Patients arrive in department through either the “Back Door” (involuntary, with •
police) or via Triage (voluntary) from the main ER.
Back Door patients are registered and briefl y interview by a 4 person team to •
determine level of dangerousness.
Dangerous patients are medicated and placed in a secured seclusion room. •
All other patients are processed in, including vital signs and lab draw. •
Voluntary patients are fi rst interviewed by a nurse, then processed in by a tech •
and placed in the day room.
Dwell time lasts 10-12 hours. •
During this time the patient is interviewed by a provider, social worker, and drug •
& alcohol counselor.
After the evaluation is complete, the patient is either transferred to the inpatient •
unit or another hospital or referred to outpatient treatment.
Patients transferring to another hospital leave via the Back Door; patients going •
to inpatient unit or being discharged back to the community leave via the Front
Door.
Functional Narrative -Psych ED
PLANNING CONSIDERATIONS:
Model of Care:
The Psych ED should be designed to provide maximum visibility for staff while at the same time there should be a feeling of •
privacy for patients.
The Psych ED would like to be able to provide a higher level of medical care in the new space: blood draw, simple procedures •
ie. stitches.
Space Program:
Waiting Spaces: • The Psych ED will have its own waiting space.
Treatment rooms: • There will be 18 treatment spaces confi gured into 10 exam rooms, 4 airborne isolation rooms and 4
seclusion rooms.
- These spaces should support capabilities to perform simple procedures, ie. sutures, etc.
Seclusion Room: • Private spaces where patients can be by themselves. Theses spaces should have remote video monitoring
for patient safety.
Provider workroom:• (2) 224 NSF workrooms are planned.
Staff support space;• lounges, lockers, etc. will be shared with main ED
Functional Narrative - Psych ED
Sec3:87
ORGANIZATIONAL AND KEY ADJACENCIES:
The Psych ED will be adjacent to the main ED. Psych patients requiring general emergency room services can be easily •
accommodated within the Psych or main ED space. There will be a convenient fl ow between the two spaces.
The Psych ED will be located on the outer parameter of the ED to provide easy access for patients who are escorted by police. •
Adjacency Diagram
Functional Narrative - Psych ED
Sec3:88
Lab Central
Imaging
Psych IP
Main ED Psych ED
THIS FUNCTIONAL NARRATIVE IS ASSOCIATED WITH THESE SPACE PROGRAMS:
Main Surgery (23 OR’s + 1 MRI)•
PLANNING WAS INFORMED BY THE FOLLOWING:
Proven Evidence Based Design•
Identifi ed Best Practices•
Completed Staff Questioners•
User Group Discussions•
PWC- PHHS Strategic Planning Document •
SCOPE OF SERVICES AND OPERATING PARAMETERS
PHHS only has a small fraction of the general and surgical subspecialty market •
in its’ primary service area- Dallas County. (2006-9 months annualized)
CT-5.1%, Urology- •
18%,Truama-22%,•
General Surgery-11%, •
Plastic-21%, •
Orthopedics-11%, •
Burns-82%. •
These numbers refl ect about 1/3 of the indigent population. •
Presently OR’s are dedicated to specialty areas:
General Surgery- 2 OR’s, •
Transplant- 1 OR, •
Plastic Surgery- 1 OR, •
Orthopedics- 3 OR’s, •
Urology-1 OR, •
Dental- 1 OR, •
GYN- 1 OR, •
Neurosurgery – 1 OR, •
ENT- 1 OR, •
Ophthalmology-2 OR’s, •
Vascular Surgery- 1 OR, •
Cystoscopy- 1 OR, •
Burn- 1 OR. •
Functional Narrative - Surgical Services
Sec3:89
Background / Current State:
Currently the surgical services at PHHS are performed in 18 operating rooms. •
Frequently elective or non-emergent cases are bumped because of trauma cases. •
In addition the current model of scheduling leads to ineffi ciencies and requires extensive work on the part of the OR director •
to maximize OR utilization.
The OR manager backfi lls cases daily-moment by moment to compensate for changes in the OR schedule and canceled •
cases in order to maximize OR time.
A strategic plan to secure future market and surgical growth is needed. •
Currently CT surgery only manages emergencies for patients who cannot be accommodated quickly enough at Zales or St. •
Pauls. Because of delays in much needed CT surgical procedures for the patients PHHS treats; there is a strategic initiative
to bring CT surgery to Parkland. A full CT service line is planned for the future.
The plans for PHHS to be a part of an NCI Designated Cancer Center in collaboration with UTSW, and recent Stroke Program •
certifi cation, and an expanded burn market should help increase surgical volumes as well as support the recruitment of
attending MD’s and trainee programs.
Parkland’s mission to serve the vulnerable- indigent populations in Dallas County has lead to a model of few privately •
insured patients. PHHS is embracing a strategic mission to increase payer mix.
Parkland continues to be committed to fellow, resident and medical student education and training. PHHS has the following •
accredited fellowships:
- Emergency Medicine,
- General Surgery-inc. Trauma, Urology, CT Surgery and Plastic Surgery.
As is the case with many institutions PHHS also anticipates a future shortage of anesthesiologists. •
PLANNING CONSIDERATIONS:
Model of Care:
It is anticipated that PHHS will continue to realize growth in its surgical populations. •
There continues to be capacity at the Ambulatory Surgical Center, surgical volumes which are appropriate for the •
Ambulatory Surgical Center will continue to be routed to the Ambulatory Surgical Center.
Surgery services will include 6 distinct areas: Pre-operative services, Operating Rooms, Post-operative Services, Staff •
Support, General Support and Central Sterile Services.
The operating rooms are programmed to be confi gured around 2 cores. A case cart system will be implemented. Central •
Sterile will have direct vertical adjacency with the sterile core of surgery (1 clean and 1 soiled). There will be dedicated full
size elevators for easy and effi cient transport of equipment and supplies including case carts between the two locations.
Planning also includes dedicated elevators for the Trauma area in the Emergency Department and the operating rooms for •
the fast and safe transport of trauma patients. An elevator with direct access to the surgical ICU’s is also planned.
An interventional platform for invasive cardiac and GI procedures is planned. This suite will have a vertical adjacency to the •
operating rooms. This will provide economies with anesthesia.
Twenty-three (23) OR’s are planned.•
Four (4) OR’s will be dedicated to GYN services. •
All OR’s will be collocated on one fl oor. •
Labor and delivery will be located on the same fl oor as the OR’s. •
C-sections and elective obstetrical surgery will be performed on the labor fl oor, adjacent to the main OR’s. •
PACU/ recovery space and ECU will be contiguous for maximal fl exibility and anesthesia coverage. •
Functional Narrative - Surgical Services
Sec3:90
Simulation Modeling:
Simulation modeling was performed and identifi ed that a total of 18 general OR’s was the sweet spot in terms of effi ciency •
(this excludes GYN volume).
Cases per OR were in the 850-900 range when simulated. •
At the far end of the spectrum simulation modeling demonstrated, that with effi cient smoothing of the schedule, PHHS has •
capacity for 1,042 cases per room with 86% utilization through 15 OR’s and 60% utilization through the 3 remaining trauma
OR’s.
Through discussion with OR and hospital leadership it was felt that a throughput of 1,000 cases per OR was unrealistic. •
Based on that determination, the decision to build 23 OR’s was made. •
Throughput time for academic medical centers ranges from a low of 600 (ineffi cient) to a high of 1,200 (extremely effi cient). •
It is anticipated that the average case time will continue to be 3.2 hours which is within the benchmark for teaching •
hospitals, (2.5-3.5 hours).
OR turn time is expected to be 20 minutes. Refer to simulation modeling in the appendix of this report. •
Space Program:
Public Spaces: • A 2,240 NSF space is planned to accommodate centralized surgical registration and waiting.
Operating Rooms:• 23 OR’s are planned. Two sizes of operating rooms have been programmed.
- Four (4) large operating rooms have been programmed at 720 NSF. These OR’s are sized to manage large orthopedic
cases, CT surgical cases with bypass, endovascular cases requiring imaging, and future use of robotics.
-Nineteen (19) smaller OR’s are planned at 680 NSF and will accommodate general surgical and other surgical
subspecialty cases. These smaller OR’s are sized to accommodate laparoscopic procedures.
OR’s are planned to be grouped into groups of 4 around 2 sterile cores.•
-Each OR will be equipped with several computers allowing for staff documentation and order entry.
-Imaging viewing stations will be accessible in each OR.
MRI:• An MRI suite fl anked by 2 of the large OR to be used for neurosurgical cases is planned. The MRI room should be
designed in such a way that it can be used for non-OR MRI cases when it is not in use for Neurosurgery cases.
Pre-op preparation area.• 24 single spaces are planned. The Pre-op area will utilize single patient spaces of adequate
size to accommodate a family member / support person. Anesthesia may utilize this space to insert invasive lines and
provide time consuming preparation activities rather than tie up an operating rooms.
Post-operative spaces:• 36 single spaces are planned to adequately support the operating rooms and are in compliance
with the Texas Administrative Code. Careful analysis has been given to these ratios based on an understanding of the
various types of procedures and expected room turnover rates as demonstrated in simulation modeling.
The • Post-operative areas will include PACU for stage I and stage II recovery. These spaces will be single patient spaces
with either 3 solid walls or 3 solid walls and a glass footwall. These spaces should be designed to provide optimal visibility
and patient safety while accommodating patient privacy.
Frozen section/Gross dissection:• will be located within the OR suite.
Functional Narrative - Surgical Services
Sec3:91
Blood bank• will be located on the second fl oor of the hospital and have a vertical adjacency to the operating rooms. Other
laboratory needs and testing will be accommodated via pneumatic tubes.
A • satellite pharmacy will service the OR’s; specifi cally anesthesia needs. Medication dispensing machines will be located
in each OR.
The • Sterile Core will be supported by Central Sterile Services that will be vertically adjacent to the operating rooms with
full size elevators (1 clean and 1 soiled).
A three tiered system will be utilized for supply management. •
The case cart system will be managed by Central Sterile Services and provide necessary sterile instruments and supplies •
for each case. 2880 sf are planned for general storage and case cart holding.
Additional equipment storage in supply areas and in the OR’s to supplement as needed.•
Functional Narrative - Surgical Services
Sec3:92
18 Pre-Op Holding Rooms
(Includes 4 Isolation Rooms)Need to adjust in inc burn and GYN
30 PACU(includes 8 Isolation Cubicles)
Need to adjust in inc burn and GYN
OR
OR
MRI
OR
OR
OR
Sterile Core
Blood Bank(W/I Surgery)
FrozenSection
AnesthesiaWorkroom
Surgery Patient
Check-In
Surgical Waiting
Surgery Public Zone
ConsultRooms
(Qty 2)
Pre-Surgical Testing
(30% day of surgery)
Operating Zone (assumes 18 + 1 burn and 4 GYN=23 OR’s)
Teaching/ Resident
TelMedRoom
ConferenceArea
SimulationLab
Education Zone
Staff Office Area
PhysicianWorkroom
CallRooms
Staff Lounge
Staff Lockers
Staff Support Zone
Morgue
Endo / GI / BroncDepartment
EmergencyDepartment
CentralSterile
SatellitePharmacy
(Located in ED, supports LDR and OR)
AnatomicalPathology
Surgical Connections
Surgery Services
Backstage connection for large specimens
Doesn’t require family to go to Morgue, while providing a backstage connection to the Morgue for body transport
Which education spaces will move across street needs to be determined with UTSW.
Positioning of GYN OR’s – requires additional input.
Needs further VP level discussion.
Backstage Transportation
Flash Sterilizing
OP & Same Day Entry
Pump Room
Control Room
Equipment Logistics
Not sure of location
Utilization / Hours of Operation:
The operating rooms in the inpatient hospital are open 24 hours a day 7 days a week.•
PHHS staffs 18 rooms Monday through Friday – 7 AM until 3 PM, 10 rooms from 3 PM -5 PM. Room utilization continues to •
decrease into the evening hours.
Functional Narrative - Surgical Services
Sec3:93
KeyRoom 2006 2012 2017 KHC Request
Hospital Operating Room 18 20 22 23 OR
Prep / Hold Beds 6 10 11 14
PACU Beds 26 40 44 30 Main OR
Phase II / DSU Beds 39 30 33
ASC Operating Rooms * 0 6 6
Prep / Recovery Beds * 0 18 18
TOTAL OPERATING ROOMS 18 26 28 23
TOTAL PREP / RECOVERY BEDS 71 98 106 30
Existing Phase includes 2 East06/11 Includes 2 Procedure Rooms, 8 Prep / Recovery beds used for Endoscopy
Surgical Services Key Rooms
Source: Kaufman Hall 2006 data (9months annualized), Price Waterhouse Coopers(PWC) Volume Capacity, Projections. Master Facility Plan, June 2007.
KeyRoom 2006 2012 2017 KHC Request
Hospital
Inpatient 2,181 2,801 2,926
Emergent 4,946 5,694 5,948
Same Day Admission 2,543 2,995 2,990
DSU (Outpatient) less ASC 5,393 3,615 6,546
ASC
Outpatient (Excluding Endoscopy) 6,000 6,000
TOTAL CASES 15,063 21,104 24,209
TOTAL ORs 18 26 28 23
CASES / ROOM / YEAR 837 812 872
Hospital Key Rooms
Source: Kaufman Hall 2006 data (9months annualized), Price Waterhouse Coopers(PWC) Volume Capacity, Projections. Master Facility Plan, June 2007.
Functional Narrative - Surgical Services
ORGANIZATIONAL AND KEY ADJACENCIES:
Surgical services should be easily accessible to the ED and ICUs to accommodate trauma and seriously ill patients, by a •
designated elevator.
Direct vertical adjacency to the Burn Unit is requested.•
Services such as Interventional radiology, imaging, blood bank and frozen section are accessed frequently and often under •
emergent circumstances, thus need to be in close proximity to the OR’s. Blood bank and frozen section spaces are
programmed within the OR suite.
The OR’s serve a large number of Day Surgery patients- thus easy way-fi nding from the front door is imperative.•
Waiting space for families / support person should be easily assessable to the ORs.•
Easy access to the cafeteria for staff on breaks – not consuming too much time should also be considered.•
Adjacency Diagram
PACU
Frozen Section
ICU
OR
ED
Sterile Processing
Front Door
Blood Bank
Day Surgery
IR
Sec3:94
THIS FUNCTIONAL NARRATIVE IS ASSOCIATED WITH THESE SPACE PROGRAMS:
Cardiac and Endo Procedures•
Cardiac and Endo Procedures -Admin•
PLANNING WAS INFORMED BY THE FOLLOWING:
Proven Evidence Based Design•
Identifi ed Best Practices•
Completed Staff Questioners•
User Group Discussions•
PWC-PHHS Strategic Planning Document •
SCOPE OF SERVICES AND OPERATING PARAMETERS:
Invasive procedures include: cardiac catheterization, electrophysiology, •
including pacer and wire implants and cardioversions.
Non-invasive procedures include: EKG, Echocardiology, TEE. Invasive •
procedures include: Catheterization, Angioplasty, Pacer, ICD, Lead,
Electrophysiology and Ablations. Nuclear cardiology studies: Perfusion Scan,
MUGA Scan will be performed in nuclear medicine.
Background / Current-State
Invasive and non-invasive procedures currently have two different registration •
processes. Current registration is ineffi cient and results in 50% of patients
being no shows. Because of the high no show rate patients are scheduled at
150% capacity to compensate for the high no show rate and subsequent number
of procedures that area canceled.
Currently the cardiac services at PHHS are fragmented geographically. This •
geography impedes staff fl exibility and effi ciency.
There is inadequate procedure space, recovery space and teaching space. The •
restrictions caused by space cause procedural delays and bottlenecks.
Educating residents and fellows is diffi cult because of the fragmentation and the •
lack of dedicated conference room space.
Functional Narrative - Cardiac Unit: Invasive and Non-Invasive
Cardiology
Sec3:95
PLANNING CONSIDERATIONS:
Model of Care:
In the future invasive cardiology and non-invasive inpatient cardiology will be co-located. •
The volume of non-invasive cardiac procedures has grown to the point that the cardiologists believe there is adequate •
volume to justify staffi ng two non-invasive cardiac services.
The future model will include 2 non-invasive cardiology services (1 inpatient based in the main hospital, 1 outpatient based in •
the clinic building).
It is imperative for accreditation reasons that the programs be one program in two locations. All staff (MD, tech and •
managers) will work between the 2 locations. Having two services will ensure that there is always a physician available in
the outpatient department. This will meet the cardiac rehab requirements of having a physician available in the building at
all times when patients are being treated.
All invasive procedures and inpatient procedures, with the exception of EKG, will be performed in the interventional platform. •
In the future all EKG’s will be performed bedside. •
All ICU ECHO’s will be performed at the bedside. Patients on the acute care units who require ECHO studies will come to the •
Cardiology suite in the interventional platform for studies.
Technology will allow ECHOs to be read in either the inpatient or the outpatient reading room. •
It is assumed that all services will operate 250 scheduled days a year, 10 hours a day, in addition to 24/7 availability for •
emergent procedures.
Invasive cardiology space and interventional radiology space is planned to be fl exible to accommodate volume shifts.•
This program also assumes that nuclear cardiology studies will continue to be the studies of choice. According to Cardiology •
faculty PHHS will not be moving to more advanced MRI/CT technology.
Recovery space will be shared with the interventional platform. This offers effi ciencies and economies, afforded by sharing •
staff, space and equipment.
PWC-PHHS board approved program recommended 2 cardiac cath rooms and 1 EP room. According to PHHS cardiologists •
a newly established invasive cardiac fellowship program and the new CT surgical program will increase volumes to justify 2
cath labs and 2 EP labs.
Two Cardiac Cath rooms and 2 EP rooms are planned. One EP room could be shelled until volumes increase. The •
cardiologists and VP believe that invasive cardiology volumes will increase with the development of invasive cardiology
fellowship program (new) and the development of a new CT surgical program.
Functional Narrative - Cardiac Unit: Invasive and Non-Invasive Cardiology
Sec3:96
Functional Narrative - Cardiac Unit Invasive and Non-Invasive Cardiology
Future Model of Care: Invasive Cardiology
Procedure Room
Recovery
IP Unit
Front office contacts patient, verifies
insurance. If a patient has no insurance and
the test is not emergent, the patient is referred to financial
counseling for funding. If the test is emergent, the test will
be scheduled. The patient will meet with financial counseling
post-procedure.
Referral placed
Entry Point
ED
Referral Origin:
IP Units
OP Cardio Clinics
Outside Hospital (Zales)
End Point
Morgue
Jail
Home
Pre-Procedure Day of Procedure
Pre-Procedure Evaluation
Consent obtained
Monday Before Procedure
Registration
Shared registration with Interventional
Suite
Sign in to procedure area
Pre Procedure Room
• Check out desk where follow up appointment can be scheduled will be located in the recovery space.
• Patients who do not have a support person present to take them home will be discharged to a supervised discharge lounge, where they can wait for their support person to arrive.
Sec3:97
Functional Narrative - Cardiac Unit Invasive and Non-Invasive Cardiology
Future Model of Care: Non-Invasive Cardiology
Sec3:98
Entry Point
ED
Referral Origin:
Units
OP Clinics
Outside Hospital (Zales)
End PointPre-Procedure Day of Procedure
Patient scheduled for procedure, given
pre-procedure instructions.
Insurance verified.
If test not emergent and patient does not
have insurance, patient receives
financial counseling.
Referral placed
Patient arrives
and registers.
Patient checks in at Cardiac
Desk
Recovery
IP Unit
Morgue
Jail
Home
Most procedures done in the ED
Prep areapatient change clothes, IV, etc.
ECHO
EKG(Bedside
for IP)
• HolterMonitor
• Stress Test
IV Room MUGA Scan
Hot room / Bathroom for patient Hot Room
TEE
Space Program:
Registration and Waiting• : Registration will be co-located with adjacent services- promotes effi cient use of staff and space
- Separate waiting spaces for inpatient and outpatient
- Most inpatients will go directly to pre-procedure area or procedure room
Pre-procedure area •
- Space will be single occupancy for privacy. There will be locked space for patient belongings
- Non-invasive procedures: patient goes directly to procedure room
- Space single occupancy for privacy. Locked space for patient belongings will be programmed
- Patient bathrooms will be programmed into this space
Diagnostic:•
- Stress Testing 2 rooms
- Echo 2 rooms will be programmed in the future (one to accommodate TEE)
- Reading rooms large enough to accommodate several readers, fellows, residents and students (6-8)
Cardiac Cath EP Labs: •
- Cardiac cath. lab and EP lab will be adjacent to each other
- 2 cardiac cath labs will be programmed
- 1-2 EP lab will be programmed
Control Rooms:•
- Spaced large enough to accommodate 6-8 people at a time for
- Layout confi guration will determine if there is one or multiple control rooms
- On any given day 3-4 fellows, + medical students and residents may be present for procedures
- Control room with large monitors is an optimal location for real-time teaching to take place
Recovery: •
- 6 recovery spaces will be programmed. These spaces will be private rooms, and equipped with telemetry monitoring
and gases.
- Patients who require prolonged recovery will continue to go to the telemetry unit.
Staff Work Space:•
- Charting stations with in the procedure rooms
- Centralized reading, control, conference space for collaborative teaming able to accommodate 20 people at a time
- Adequate waiting and registration space will improve process and make more effi cient
- Larger control rooms, reading rooms, conference room/ staff work space will improve teaching and patient outcomes
and make the process more effi cient
- Combining recovery with central or combined interventional recovery area will allow staff to be focused on other
procedures, increase room turn over time.
Utilization / Hours of Operation:
It is assumed that all services will operate 250 scheduled days a year, 10 hours a day, in addition to 24/7 availability for emergent
procedures.
Functional Narrative - Cardiac Unit Invasive and Non-Invasive Cardiology
Sec3:99
ORGANIZATIONAL AND KEY ADJACENCIES:
Adjacency Diagram
FUTURE FLEXIBILITY:
Flexibility: co-location of cardiac services with easy access to telemetry and CCU will improve effi ciency in fl ow and patient •
safety. Will allow staff to fl ex for coverage.
Sicker patients / patients requiring admission could go directly to CCU and bypass recovery / PACU•
One EP lab could be shelled and built out as patient volumes increase. •
Functional Narrative - Cardiac Unit Invasive and Non-Invasive Cardiology
Non-invasive
Cardiology
OP Cardiology
OR
ED
Cardiac Rehab
Cardiac Cath
IP Units
Nuclear Medicine
Interventional Platform
Sec3:100
THIS FUNCTIONAL NARRATIVE IS ASSOCIATED WITH THESE SPACE PROGRAMS:
Cardiac and Endo Procedures •
Cardiac and Endo Admin•
PLANNING WAS INFORMED BY THE FOLLOWING:
Proven Evidence Based Design•
Identifi ed Best Practices•
Completed Staff Questioners•
User Group Discussions•
PWC- PHHS Strategic Planning Document •
SCOPE OF SERVICES AND OPERATIONAL PLANNING:
The following procedures are performed in the GI Lab:
Endoscopies•
Colonoscopies•
ERCP•
Liver Biopsy•
Bronchoscopies•
Paracentesis•
The majority of the procedures that are performed are interventional and not •
screening procedures. The majority of the screening procedures are performed
at the Ambulatory Surgical Center.
The current GI lab is plagued by space constraints which promote ineffi ciencies. •
There is not adequate waiting space for patients so they end up waiting in the
hall, which is not private and violates HIPAA.
Ninety-fi ve percent of bronchoscopy procedures are performed at the bedside •
on inpatients.
Background / Current State:
Only 3 of the 6 GI labs can accommodate general anesthesia, which 30% of all •
patients require.
The smaller 3 rooms also are too small to accommodate ERCP procedures. •
Only 1 room has fl uoroscopy. This room is dedicated to bronchoscopy, but •
serves as an overfl ow room for GI procedures, specifi cally those that require
fl uoroscopy.
There are 22 GI fellows and 22 attending faculty who perform procedures. •
- Currently there are 4 GI fellows - being staffed by on attending MD doing
procedures at one time. The current space layout and confi guration
makes this staffi ng ratio diffi cult.
There are inadequate bathrooms for patients who have undergone bowel preps. •
Functional Narrative - GI Lab including Bronchoscopy
Sec3:101
PLANNING CONSIDERATIONS:
Model of Care:
It is assumed that there will continue to be 35 GI faculty, of which 22 will continue to perform procedures in the GI suite. •
It is also assumed that PHHS GI will continue to fi ll their 22 fellowship slots. •
It is believed that the new colon cancer screening program will increase the volume of referrals to the GI suite. Thus, 8 •
procedure rooms were programmed instead of the 6 recommended by PWC
Liver biopsy and paracentesis have prolonged recovery times. They will be accommodated in the recovery space.•
Currently patients recover in the GI lab recovery space and are managed by the GI unit staff. This model of care results in •
staff being pulled to the recovery space, which takes them away from the procedure rooms. Even though the unit operates
for 10 hours a day, this includes recovery time. In the future these patients will recover in a dedicated recovery space by
dedicated staff, thus resulting in staff being able to be dedicated to procedures 10 hours a day- which will increase
procedural capacity.
Space Program:
Eight (8) GI procedure rooms at 480 NSF are planned. These rooms are large enough to accommodate GI fellow, attending, •
nursing staff, equipment, anesthesia and fl uoroscopy. Bronchoscopy procedures can be accommodated in any of the GI
rooms.
Entry:• Registration will be shared with interventional platform. There will be a back stage entry and separate waiting space
for inpatients.
Pre-procedure area:• Private spaces with bathrooms are planned and will accommodate patients who have had bowel preps.
Functional Narrative - GI Lab including Bronchoscopy
Waiting space for Family.
Hours of operation: M-F 7am-5pm, M&F full day schedule, T&Th ½ day schedule
Test scheduled
Patients referred by GI, ED, Floor, JailAll are urgent
diagnostic tests no screening procedures
performed here.All referrals come to
Parkland and are triaged by RN. If
patient has any risk factors procedure
performed at Parkland if screening and no
risk factors scheduled in ASC.
ASC = 20k screening/ yr
Patient brought to
suite emergently
Patient checks in Procedure room:
• Sedated• Intubated• Procedure
performed• Extubated
Recovery room
Morgue
ICU
Patient D/C home
In patient unit
Jail
Patient sees financial counselor if necessary
Patient waits in the waiting room
Patient goes to pre-procedure room. Changes clothes, gets IV, consent
obtained.
Patient walks to the procedure room.
Patient taken emergently to procedure room
Sec3:102
Procedure rooms:• 5 general GI rooms are planned as well as 3 larger rooms to accommodate procedures requiring
fl uoroscopy.
Anesthesia workroom:• Anesthesia plays an important role in the care of patients during many of the GI procedures.
Anesthesia will have workroom space programmed into the interventional unit.
Recovery: • Recovery space will be shared with interventional platform. It is imperative that there will be adequate
bathrooms. Patients who do not have a support person present to accompany them home will be discharged to a supervised
discharge lounge until a support person is available to take the patient home. Follow-up appointments if necessary can be
made at the discharge check out.
Staff work space: • There will be decentralized work space for staff throughout the suite. Computer access to EMR and Pacs
will be available in each procedure room and physician/staff work rooms.
Provider workroom:• 1 physician work rooms / conference rooms with video telemedicine capabilities to watch procedures
from this remote location are planned. These spaces will provide space for GI teaching and patient management
conferences. Fellow and MD offi ce space is also planned.
Scope Cleaning: • One centralized cleaning room is planned. A 320 SF gross cleaning / decontamination room is planned. A
320 SF cleaning room is programmed. The cleaning area shall allow the fl ow of instruments from the contaminated area to
the clean assembly area and then storage. A 360 SF storage area is planned. This area will contain cabinets for scope
storage and accommodate a rotational pattern for scope use.
Utilization / Hours of Operation:
Assumes 250 scheduled days a year. Operates 10 hours a day.•
Assumes on call availability for emergencies 24 hours a day- 7 days a week.•
Functional Narrative - GI Lab including Bronchoscopy
Department Hours of Operation % Procedures at peak day shift
GuidelinesHours of Operation
Administration 8 7.5 – 8
Endoscopy 8-10 plus call 90% 7.5 – 8
GI Laboratory 8-10 plus call 85% 7.5 – 8
Other 8-10 plus call 90% 7.5 – 8
X – Open 250 days / year Available for emergencies
Utilization / Hours of Operation
Source: Kaufman Hall 2006 data (9months annualized), Price Waterhouse Coopers(PWC) Volume Capacity, Projections. Master Facility Plan, June 2007.
Sec3:103
ORGANIZATIONAL AND KEY ADJACENCIES:
The GI / Bronchoscopy unit should have the following vertical adjacencies: OR, ED, ICU (specifi cally MICU), acute care units •
and the front door.
Anesthesia will have work space within the GI / Bronchoscopy Suite.•
Adjacency Diagram
Functional Narrative - GI Lab including Bronchoscopy
Sec3:104
Modality 2006 (Existing) 2012 2017 KHC Request
GI Lab & Bronchoscopy
Total Procedures, including Pulm.Bronch 7,637 9,130 10,170
Total Procedure Rooms 5 6 6 6 (3 with Flouro)
Less: Rooms in the ASC 0 -3 -3
Net Hospital Procedure Rooms 5 3 3
Hospital Prep / Recovery Beds 17 8 8
Total Procedures / Room / Year 1,473 1,522 1,695
Notes:Procedures include Colonoscopy, Flex. Sig., ERCP, Bronchoscopies, EGD, Endoscopic Ultrasound, and PEG only.Hospital Prep / Recovery beds assumes 2.5 per room.KHC per Texas Adm. Code � 1.5 Recovery per room
Pulmonary
Total Spirometry Procedures 5,037 5,579 4,740 Outpatient
Total Spirometry Rooms 1 1 2 Clinic Building
Volume Summary
GI (IP + OP) 6,095 8,114 8,109
Pulmonary Bronch (IP + OP) 5,427 6,348 6,966
Bronchoscopy (IP + OP) not including bedside 303 541 656
Room Requirements
Source: Kaufman Hall 2006 data (9months annualized), Price Waterhouse Coopers(PWC) Volume Capacity, Projections. Master Facility Plan, June 2007.
Anesthesia
ICU
OR
ED
Acute Care Units
GI Lab
Front Door
THIS FUNCTIONAL NARRATIVE IS ASSOCIATED WITH THESE SPACE PROGRAMS:
Imaging / Radiology•
PLANNING WAS INFORMED BY THE FOLLOWING:
Proven Evidence Based Design•
Identifi ed Best Practices•
Completed Staff Questioners•
User Group Discussions•
PWC- PHHS Strategic Planning Document •
SCOPE OF SERVICES AND OPERATING PARAMETERS:
The Department of Radiology currently provides diagnostic x-ray, CT, MRI, •
nuclear medicine, interventional imaging, ultrasound services to inpatients and
outpatients. Currently there are 2 CT- scanners in the emergency department.
Services such as general imaging and ultrasound are provided at the bedside for •
patients deemed too ill to travel to the department.
In 2006 (9 months annualized- there were 327,134 studies performed. •
Current hours of operation by modality:
General imaging- 24/7•
CT- 24/7 •
Ultrasound 24/7•
MRI 24/7•
Interventional Radiology: M-F 6:30 AM - 5:00 PM and 24/7 on call•
Nuclear Medicine: M-F 7:30 AM - 5:00 PM and 24/7 on call•
Breast Imaging: M-F 7:30 AM - 5:00 AM•
Nursing staff is available in the department M-F 6:30 AM - 11:00 PM•
PLANNING CONSIDERATIONS:
Model of Care:
It is projected that in 2017 the imaging department will perform 453,121 studies •
on inpatients and outpatients. These future inpatient and outpatient volume
projections were analyzed by PWC.1
The number of modalities to accommodate the volume and future capacity were •
projected. The current program was informed by the PWC document and
discussion with senior leadership and the Chair of Radiology. 2
1 Source: Kaufman Hall 2006 data (9months annualized), Price Waterhouse
Coopers(PWC) Volume Capacity, Projections. Master Facility Plan, June 2007.
2 Source: Kaufman Hall 2006 data (9months annualized), Price Waterhouse
Coopers(PWC) Volume Capacity, Projections. Master Facility Plan, June 2007.
Functional Narrative - Imaging
Sec3:105
In the future all imaging services will be performed in the main hospital building. •
The imaging center will need to be designed to accommodate both inpatients and outpatients.•
Mammography will be programmed in the outpatient building as it services only outpatients. •
Interventional radiology will be part of the imaging department not the interventional unit. Four (4) rooms are programmed. •
Recovery space is planned within the imaging department and will accommodate any imaging patient who required sedation
for an imaging procedure. Ten recovery spaces are programmed.
The current department is already digital allowing physicians to view studies remotely from any number of Pacs reading •
stations throughout the department and hospital.
In the future dictated reports will be integrated into the electronic medical record. •
Functional Narrative - Imaging
Type Number of Machines
Diagnostic / R&F 7 general / 3 fluoroscopy
CT 6 (does not include ED)
PET/CT 1
MRI 6 (does not include NICU or OR)
Nuclear Medicine 7 (includes Nuclear Cardiology)
Ultrasound 10
Imaging Equipment List
Sec3:106
Space Program
Central Registration and waiting• : Registration will be centralized for the department in the future program. Eight (8)
registration booths are planned. This number was based on 95,803 patient visits annually, an average registration time of 15
minutes and a 12 hour operating day.
Each modality is programmed with support spaces specifi c for that modality. •
Gowned waiting:• One centralized gowned waiting space for male and one for female is envisioned.
Nuclear Medicine• : Space for 7 dual scanners, a hot lab and provider workroom with 4 PACS viewing stations are planned.
General Radiology and Fluoro:• Seven (7) general imaging and (3) fl uoro rooms are planned with reading spaces, (25) general
imaging reading spaces and (3) fl uoro are planned.
CT:• Six (6) 400NSF CT rooms with adjacent 140NSF control rooms are planned in the imaging department. An additional (3)
CT scanners are programmed to be within the ED space. The modalities in the two spaces should be in close proximity of
each other to allow staffi ng fl exibility and patient overfl ow.
MRI:• Six (6) rooms at 660NSF are planned. In addition (1) MRI will be located in the OR and (1) in the NNICU. The MRI space
has designated control rooms and reading rooms within this space.
Ultrasound:• Ten (10) ultrasound rooms at 172NSF each with adjacent reading space are planned. Rooms are sized to
accommodate two stretchers.
Reading Rooms: • Each modality has a designated number of reading rooms.
Anesthesia workroom• : Designated space to accommodate anesthesia MD who are covering cases requiring anesthesia or
sedation in the imaging suite is planned.
Administrative program: 10,587 DGSF is planned to accommodate MD offi ces, conference space, resident and fellow space •
and department administrative space.
Functional Narrative - Imaging
Sec3:107
Utilization / Hours of Operation:
It is anticipated that the hours of operation will continue to be the same. The current hours of operation by modality are:
General imaging- 24/7•
CT- 24/7 •
Ultrasound 24/7•
MRI 24/7•
Interventional Radiology: M-F 6:30 AM - 5:00 PM and 24/7 on call•
Nuclear Medicine: M-F 7:30 AM - 5:00 PM and 24/7 on call•
Breast Imaging: M-F 7:30 AM - 5:00 AM•
Nursing staff is available in the department M-F 6:30 AM -11:00 PM•
Staffi ng:
The existing staffi ng plans are adequate for present volumes. The additional services that are proposed (PET- CT, additional
MRI, pediatric services) will require an operational plan for staffi ng.
ORGANIZATIONAL AND KEY ADJACENCIES:
The Department of Radiology currently supports imaging modalities in remote areas (ED, patient care units, OR) so vertical •
and horizontal adjacencies with effi cient access would be optimal.
Adjacencies to the patient care units for effi cient transport for patients who require testing on modalities that are not •
portable - MRI, CT.
Acutely ill patients may be present for imaging modality that is not portable, contrast reactions occur, sedation incidents •
are just examples of the emergencies that can occur in Radiology requiring Rapid Response or Code Team, thus easy
access from ED, ICU, OR are important.
Access to laboratory central receiving via p-tube or by person is important for the transport of specimens that are acquired •
during imaging procedure.
Adjacency and easy access to the outpatient building is essential as the majority of the non-general imaging studies are •
outpatient studies.
Adjacency Diagram
Functional Narrative - Imaging
IP Units
Inmate Treatment
CenterPathology
Clinical Lab
Imaging
OR
ED
Sec3:108
THIS FUNCTIONAL NARRATIVE IS ASSOCIATED WITH THESE SPACE PROGRAMS:
Clinical Pathology•
Anatomic Pathology•
Morgue•
Blood Bank•
PLANNING WAS INFORMED BY THE FOLLOWING:
Proven Evidence Based Design•
Identifi ed Best Practices•
Completed Staff Questioners•
User Group Discussions•
PWC- PHHS Strategic Planning Document •
Lean Laboratory Models•
SCOPE OF SERVICES AND OPERATING PARAMETERS:
Clinical lab is responsible for specimen pick-up, receiving, and processing; Lab •
draws occur on the individual fl oors and units such as the ED and specimens are
then delivered via pneumatic tube or courier, with courier pick-ups scheduled at
two times per hour.
Anatomical pathology is concerned with the diagnosis of disease based on the •
gross, microscopic and molecular examination of organs, tissues and whole
bodies.
The Blood Bank: Is responsible for ABO typing and antibody screens, for blood •
and tissue typing. This lab is also responsible for ordering, obtaining and
dispensing blood products.
The primary functional laboratory areas include:
Clinical Pathology •
- Pathology Call Center: Sample receiving and phone question are fi elded.
- Phlebotomy Offi ce: Coordinated phlebotomy services.
- Specimen Processing Core Lab- includes send out.
- Core Laboratory: Chemistry / Toxicology, Hematology, Blood gas / Routine
coag, Urinalysis, Microbiology, Virology, Bone Marrow Special coag,
Referral Lab, Flow Cytometry, Immunology
Anatomic Pathology•
- Cytology Processing Lab
- Histology Lab- provides accessioning and grossing of surgical specimens,
tissue processing, production of slides and blocks in preparation for
reading
- The histology space includes a gross room, specimen storage, frozen
storage, saw room, and biocabinet for storage.
- Surgical Pathology-frozen section (See OR program)
- Molecular Pathology
- Morgue
Functional Narrative - Clinical Pathology/Anatomic Pathology/
Blood Bank/Morgue
Sec3:109
The primary functional laboratory areas cont:
Blood Bank: Is responsible for ABO typing and antibody screens, for blood and tissue typing. This lab is also responsible for •
ordering, obtaining and dispensing blood products.
Transcription•
Resident / Fellow teaching•
Background / Current-State:
The Clinical Laboratory is currently located on the ground fl oor of the main hospital. •
Lab Central is located in close proximity to the Emergency Department. •
There are two smaller labs, storage space and offi ce space outside the main lab. •
There is additional refrigeration / freezer/ and small equipment storage in the PSA area close to the dock. •
Clinical lab is responsible for specimen pick-up, receiving and processing. •
Currently the department of Anatomical Pathology is located in several different geographical locations: Histology and •
faculty offi ces are located in Building 2EE, Gross Room and faculty offi ces in Building 2E and the Morgue located on the
ground fl oor of building D.
Pathology administration is the front door for the department and the hub of activity however pathology administration and •
support services are widely dispersed throughout the department (mainly on the ground fl oor).
There is no family space for body viewing.•
Pneumatic tube system is ineffi cient.•
PLANNING CONSIDERATIONS:
Model of Care:
The future lab will support both inpatients and outpatients. •
Receiving should be easily accessible for couriers who deliver specimens. •
Pneumatic tubes should be networked through the new hospital and clinic building to provide easy delivery of specimens that •
can travel to the lab via a tube.
The core lab space should be designed to be Lean and support the specimen processing work fl ow from receiving, specimen •
preparation, specimen review and reporting and transcription.
-This will optimize operational effi ciencies.
The space should be open to incorporate a high level of fl exibility allowing for adaptation of equipment and processes as •
science and procedures change in the future.
- Movable furniture and open cabinets is preferable.
The lab currently has several biohazard hoods, high volume biohazardous waste disposable capacity, cylinder gas storage •
space, fl ammable liquid storage, room fume ventilation, slide block storage (secured room), reverse osmosis water system
all of which are programmed in the new space.
Equipment and reagents are temperature sensitive, thus adequate cooling and heating are required. •
The space must also meet security needs per Homeland Security regulations. •
Functional Narrative - Clinical Pathology/Anatomic Pathology/Blood Bank/Morgue
Sec3:110
The future Anatomical Pathology will continue to have 50 residents / fellows in their training program. •
-PHHS is the primary site for resident training.
-Because of the nature of the work that pathologists perform it is necessary to provide offi ce space- with microscopes
to accommodate all residents.
-Offi ce space is distributed throughout the department.
-The Morgue is a highly secured area.
-Two dissection rooms are planned in the morgue, one with negative pressure ventilation.
-The current cooler holds 8 bodies which is suffi cient. Shelving should be provided to accommodate infant bodies.
There is a secure viewing room for families programmed in the new facility. The morgue requires easy access to a
loading dock, where funeral homes may pick up bodies. A viewing room for next of kin is planned in the new space.
In the future electronic order entry and reporting will replace manual systems. The lab currently uses Cerner Millenium for •
its electronic reporting, in the future this system will be integrated with EPIC. It is envisioned that in the next 5 years all
dictations will utilize voice recognition technology.
Currently administrative staff employed by UTSW, who support AP faculty, have their offi ce space within AP department. •
This administrative space is planned in the new facility.
Functional Narrative - Clinical Pathology/Anatomic Pathology/Blood Bank/Morgue
Sec3:111
Staff Support Space
Staff Lockers Staff Lounge
Education
Conf / Classroom
Wet Conf. Room
Scope Room
Pathology Administration
PathologistOffices
Team Work Area
Central Office Area
Workroom
Transcription
Mgmt Offices
File Storage
Lab Support
Glassware Washing
Walk-in Refrigerator
General Storage
Water System Closet
Flammable Storage
Clean Laboratory
Coats
Soiled Holding
EVS ClosetCardboard Breakdown & Recycling
Lab IS Server Closet
Courier Support
Clinical Pathology
SupplyPick-Up
Walk-up Windows &Staging Counter
Work stations
IP Phlebotomy Home base
“office”Work Counter Space (10
to 15 people)Orders Assigned
Employees Dispatched5 to 8am – 20
Phlebotomists / Trays
Processing Area for Core Lab
Bone MarrowSpecial Coag
Microbiology LabBacteriology
VirologyTuberculosis
MycologyParisitology
Infectious DiseaseMolecular (STD)
Pathology Services Center
(Call Center)(Stand alone with close
proximity to sample receiving. Needs P-Tube.
Can be shared, high acoustical privacy needed.)
Data link only
*Blood Bank, locate on Surgical Unit.
Core LabModular analytic system
“Spinning down”Cerner Thin Client
MicrobiologySample Receiving(Hand delivered & P-Tube)
Referral Lab
Flow Cytometry
Immunology Lab
Laboratory Support(See next page)
P-Tube
Microbiology Lab(Secured Area within Main Clinical Lab)
Blood Bank
Lab Information System (LIS)
Sample ReceivingReception
Staging(Bins, etc.)Storage
P-Tube
Offices & Work-
stations
DarkRoom
Scope Teaching
Room
Provider Workroom
Micro-bioEngineering
WasteDisposal
Functional Narrative - Clinical Pathology/Anatomic Pathology/Blood Bank/Morgue
Sec3:112
Space Program:
Clinical Pathology
Sample Receiving and Supply Pick Up: • 1,130 NSF are planned for reception, receiving and staging of newly received
specimens.
Pathology Call Center:• 812 NSF, which included 8 call center workstations are planned for this space.
IP Phlebotomy Offi ce: • Coordination of phlebotomy services will be performed out of this space.
Specimen Processing for Core Lab: • 890 NSF are planned for this space. Specimens which need to be sent out to other
laboratories will be prepped, processed and packaged in this space.
Core Laboratory:• 15,638 NSF are planned to accommodate the core clinical laboratory services which include: Chemistry
toxicology and special testing, hematology, blood gas and routine coag. and urinalysis.
-This space should be designed to follow Lean processes. The space should be open and fl exible to accommodate
future process and technology changes.
Microbiology:• 5,816 NSF are planned to accommodate microbiology and virology. This space includes a 520NSF dedicated
negative pressure space to accommodate AFB processing. Teaching support space also provided.
Referral Lab: • a 306 NSF processing and receiving space has been programmed.
Flow Cytometry: • 648 NSF is planned, this space will accommodate 2 BD Facscalibur with SPA and resident and pathologist
space.
Immunology Lab:• 760 NSF is planned. This space is envisioned to be open fl exible benches where immunology testing will
occur.
Laboratory Support: • 760 NSF is planned to support glass washing, storage and water closet.
Anatomical Pathology:
Cytology Processing Lab: • Cytology is a biohazard laboratory. This space should be designed to be Lean and contain fl exible
open counter spaces. 990 NSF are programmed to support cytology functions. 1,416 NSF are programmed for cytology
administration. This space should be adjacent to the cytology lab.
Anatomic Pathology: • 2,596 NSF are planned. This space includes: accessioning space, grossing stations, saw lab, frozen
section, reading station, photograph station and storage.
Histology Lab: • 3,298 NSF have been programmed to accommodate histology processes.
Surgical Pathology and Cytology Transcription: This space includes 4 workstations for transcription.•
Faculty / Resident Offi ces: 1500 NSF has been programmed to accommodate 10 faculty in private offi ces, 8 resident work •
stations and administrative support staff.
Staff Support: 2,270 NSF have been programmed to support blood bank and anatomical pathology staff. This space includes •
a 400 NSF pathologist work room which contains a multi-head microscope (min. 25 heads) and a projection system. A 600
NSF conference room, staff break room locker space.
Blood Bank
4,541 NSF are planned for the bloodbank. •
This space includes: administrative offi ces, secure space for blood irradiation, specimen receiving, workstations for product •
testing, receiving, storage and walk-up counter and workstations for dispensing blood products.
There is 450 NSF dedicated to tissue management.•
Functional Narrative - Clinical Pathology/Anatomic Pathology/Blood Bank/Morgue
Sec3:113
Morgue:
Public Space: 244 NSF is dedicated to waiting and family body viewing.•
Autopsy Area: includes 480 NSF refrigerated space; for 16 adult bodies.•
Staff support area: this space includes a small class room, 1 private offi ce, staff lockers and breakroom. •
Utilization / Hours of Operation:
Anatomical pathology M-F 6:30am-5:00pm and 24/7 on call•
Clinical Pathology 24/7•
Blood Bank 24/7 •
Staffi ng:
Staffi ng: * Pathology Administration will be in the Administration Building•
ORGANIZATIONAL AND KEY ADJACENCIES:
Clinical and Anatomical Pathology have requested that they be located next to each other to maximize fl exibility and work •
fl ow.
Internally, the Inpatient Core Laboratory has the following critical adjacency and proximity requirements:•
-Specimen Receiving / Send-outs and Blood Bank both require a close proximity or adjacency to a primary service /
support corridor to accommodate in-house and contract courier services access for delivery and pick-up.
-Specimen Receiving also requires a secondary adjacencies to Microbiology and Anatomic Pathology, unless there is
pneumatic tube service between them for specimen delivery.
-Specimen Processing area requires an immediate adjacency to both Specimen Receiving and an automated, 24 Hr.
Work Cell area (comprised of the major, high-throughput, multi-test Chemistry, Hematology, Coagulation and
Urinalysis instruments). Similarly, a secondary adjacency is required to a manual, 24 Hr. Work Cell area (comprised of
the non-automated, non-high-throughput Chemistry, Hematology, Coagulation, and Blood Gas instrumentation). An
additional tertiary adjacency is required to the Special Chemistry, Toxicology, Special Hematology, Flow Cytometry and
Immunology instrumentation.
-Blood Bank requires an immediate adjacency to the manual, 24 Hr. Work Cell’s Hematology instrumentation, due to the
sharing of some specimens. Blood bank and AP are programmed to share support space.
-Microbiology’s Virology, Molecular Microbiology and TB/Mycology/Parasitology laboratories do not need an immediate
or secondary adjacency to any other laboratory section, but should be immediately adjacent to the specimen receiving
and media preparation areas.
-Anatomic Pathology requires an immediate adjacency to the Molecular Pathology lab. It also requires a secondary
adjacency to Specimen Receiving area.
-Laboratory Support, Laboratory Administration, Staff Support and Education components require secondary and, or
tertiary adjacencies to all of the major technical areas of the laboratory.
The main laboratory should be easily accessible to Radiology and the OR’s. Frequently pathologists are requested to •
participate in diagnostic procedures in these departments.
There will be dedicated space in the operating room suite for frozen section/surgical grossing lab, in order to accommodate •
real time rapid microscopic diagnosis.
**The blood bank should be located between the OR and the ED with vertical adjacencies to both departments. This location/ •
adjacencies has changed since the program was signed off. Currently Blood bank is programmed in the OR and shares
support space with AP.
The morgue should be located in the hospital lower level and have access to a dock for funeral homes to pick up bodies.•
Functional Narrative - Clinical Pathology/Anatomic Pathology/Blood Bank/Morgue
Sec3:114
FUTURE FLEXIBILITY:
The future space should be designed to be fl exible and adaptable. •
Science and technology will continue to advance and it is imperative that the lab be able to grow and adapt in relation to the •
changing fi eld of science.
As clinical programs at PHHS change a future expanded scope of laboratory procedures may be required. Genetics is a good •
example. Real time integration- genomics based translational science anatomical pathology may have an expanded role in
the clinical care of patients.
Functional Narrative - Clinical Pathology/Anatomic Pathology/Blood Bank/Morgue
Sec3:115
THIS FUNCTIONAL NARRATIVE IS ASSOCIATED WITH THESE SPACE PROGRAMS:
Pharmacy•
OR Pharmacy Satellite•
ED Pharmacy Satellite•
ICU Pharmacy Satellite•
PLANNING WAS INFORMED BY THE FOLLOWING:
Proven Evidence Based Design•
Identifi ed Best Practices: Lean approach, Robotics, Nurse server model of •
medication administration,
Completed Staff Questioners•
User Group Discussions•
PWC- PHHS Strategic Planning Document •
SCOPE OF SERVICES AND OPERATING PARAMETERS:
The Pharmacy provides the following services: ordering, procuring, preparing •
and dispensing of all medications for inpatient, outpatient (not public) and staff,
including all IV solutions and compounding of P&T approved medications.
Pharmacy services are currently located throughout the hospital and clinic •
building.
The pharmacy currently operates the following services: Pharmacy •
Administration, Central Pharmacy, Satellite Pharmacies, Drug information,
Investigational Drug Services, Sterile Products, ChempaK room and a Bulk
Stores area.
The department also manages the stocking of all Pyxis machines, this includes •
repackage bulk medications into unit dose.
Parkland’s pharmacy has a FDA license which classifi es it as a medical •
repackaging facility within the Prescription Center Pharmacy.
The pharmacy currently supplies outpatient medication to UTSW CV, heart and •
liver transplant patient.
The pharmacy also supports drug information, an investigational drug service •
and the mixing of all chemotherapy agents.
Background/Current State:
Pharmacy services are currently located throughout the hospital and clinic •
building.
Pharmacy Administration, Central Pharmacy, Drug information, Investigational •
Drug Services, Sterile Products, ChempaK room and Bulk Stores area are all
located in the basement of PHHS. Also in the basement are the Associate
Director and Coordinator offi ces, classroom and conference room.
Functional Narrative - Pharmacy
Sec3:116
Other pharmacy service locations are: Emergency Department satellite, Outpatient Clinic Pharmacy, Oncology and SICU •
satellite pharmacies, NNICU satellite pharmacy, L and D satellite pharmacy, OR satellite pharmacy, Med Specialty clinic
satellite pharmacy, Internal Med clinic satellite pharmacy, Transplant satellite pharmacy and the Medicine satellite
pharmacy, located throughout the hospital and clinic building. There is an HIV satellite pharmacy in Amelia Court and the
Prescription Center at 4911 Harry Hines.
Other pharmacy service locations are: Emergency Department satellite, Outpatient Clinic Pharmacy, Oncology and SICU •
satellite pharmacies, NNICU satellite pharmacy, L and D satellite pharmacy, OR satellite pharmacy, Med Specialty clinic
satellite pharmacy, Internal Med clinic satellite pharmacy, Transplant satellite pharmacy and the Medicine satellite
pharmacy, located throughout the hospital and clinic building. There is an HIV satellite pharmacy in Amelia Court and the
Prescription Center at 4911 Harry Hines.
The department has a contractual relationship with UTSW to provide discharge medications for cardiovascular patients, and •
heart and liver transplant patients.
The pharmacy manages all pyxis med stations.•
The pharmacy prepares all IV mixtures.•
The pharmacy prepares and dispenses all inpatient medications as unit dose.•
Robotics are currently used in the following locations:•
- A Talyst packer and Euclid tabletop packager are currently used; there is a horizontal carousel in the basement BSA
area.
- The IV room has a Baxa TPN compounder.
- A robot has been approved for inpatient drug distribution for FY 09.
The pharmacy also provides training to pharmacy students, technician students/interns and pharmacy residents.•
The current order entry and reconciliation system is totally manual.•
There is currently no dedicated IT system to over see PAR levels. A report is run 3 times a day to determine PAR levels. •
- Morris &Dickson is the wholesaler, but PHHS manages all inventory, receiving and procurement.
The department is 797 compliant.•
The pharmacy needs to follow class A, C and D pharmacy regulations.•
- PHHS has a FDA licensed medical repackaging facility within their Prescription Center Pharmacy which packages
medications for out Class D pharmacy locations.
PLANNING CONSIDERATIONS:
Future Process Model:
The pharmacy will continue to operate as a Central Pharmacy, Outpatient Pharmacy (clinic building). The inpatient satellites •
will be consolidated to include only the NNICU satellite pharmacy (see NNICU program), ED satellite pharmacy, ICU satellite
pharmacy, OR satellite pharmacy, and Oncology satellite pharmacy (clinic building) in the new hospital.
The Oncology satellite pharmacy will be responsible for making all the chemotherapy for both the inpatient and outpatient •
areas. Because the Oncology satellite pharmacy is only open Monday – Friday during the day a backup chemo hood is
programmed in the Main pharmacy.
In the future all medication orders will be automated via the EPIC system. •
A robot has been approved in the FY 09 budget, for inpatient drug distribution.•
In the new hospital inpatient medication administration will be accomplished by use of a nurse server. •
Functional Narrative - Pharmacy
Sec3:117
Functional Narrative - Pharmacy
Bar code medication administration is becoming the future standard of care for safe medication administration. The •
Institute for Safe Medication Practices has petitioned the FDA to require bar coding on all medications. The bar coded
information would include NDC number, lot number and the expiration date.1 Further evaluation regarding medication
packing and bar code medication administration is needed.
The future design should separate the medical repacking facility within the Prescription Center Pharmacy, which currently •
repackages medications for all Class D pharmacy locations. In the future this space should be and independent but adjacent
space to aid in regulatory compliance.
The pharmacy must be 979 compliant.•
Future Process Model
1 Docket No. 02N-0204. Michael R. Cohen, RPh, MS, ScD at the Food and Drug Administration’s July 26, 2002, public meeting on bar code
labeling for drug products.
Sec3:118
The future inpatient pharmacy will occupy a space of 24,604 NSF.•
Product receiving:• a dedicated dock and breakdown area is planned
Storage and staging:• a 2,748 NSF space is programmed to be dedicated to storage and staging. Disaster drug / cache are
programmed into separate secure spaces.
Compounding and Packaging:• 3,448 NSF are planned and will include a narcotics vault, compounding area, staging space
which accommodates robots, hand pick areas for manual order fi lling.
Specialty cart/tray staging:• This function will be centralized in the future.
IV Preparation: • 979 compliant hoods, chemo mixing station, IV conveyor system. Future considerations would be for more
packing equipment to support bar code med administration and IV robotics.
Central Pharmacy: This space should be designed as a mini retail station and include drug storage, preparation •
workstations and a walk-up window.
Medical Assess: Open workstations are planned for data entry and inventory techs.•
Ordering and Procurement: Shared offi ces for 2 buyers and workstations for procurement and inventory specialist are •
planned.
Information Systems: In the future the pharmacy would like to explore the ability of EPIC interfacing with pyxis. An automated •
program for inventory and ordering management will be explored in the future.
Regulatory: Compliance with 979 and FDA regulations for Class A, C and D must be followed.•
Satellite Pharmacies: OR, ED, ICU satellite pharmacies are planned. Each pharmacy is programmed to be 896 NSF and •
include spaces for ordering processing and pick-up, storage and staging, compounding and packing and specialty care/tray
staging.
Functional Narrative - Pharmacy
Sec3:119
Future Process Model
Functional Narrative - Pharmacy
Position or Title Inpatient Ambulatory PharmacyAdmin.
Pharmacy Systems
Procure-ment
Inventory Control
JailHealth
Repack Benefits
Director 1
Assoc. Director 1 2 3 1
Coordinator 4 9 2 1
Clinical Specialist 5 9 1
Staff Pharmacist 70 69 5 4 1 6
Pharmacy Tech 85 54 4 3 5
Mess Aide 2
Billing Manager 1
Sr. Med Access Spec. 1
Med Access Spec 15
Data Entry Operator 1
Inventory Tech 1
Business Analyst 1
Administrative Assistant 3
Perf. Imp Specialist 1
Clin.Drug Usage Analyst 1
Med Safety Officer 1
PGY1 5
PGY2 1
Inventory Coordinator 1
Procurement Assistant 5
Buyer 1
Sec3:120
Hours of Operation
Main Pharmacy: 24 hours a day – 7 days a week•
Inpatient Satellite Pharmacies: 24 hours a day – 7 days a week •
Pharmacy administration: 8:00am-5:00pm Monday - Friday •
ORGANIZATIONAL AND KEY ADJACENCIES:
The pharmacy will be responsible for stocking pyxis machines and nurse servers on the patient care units.•
- Clinical pharmacists will continue to be an integrated part of the patient care team. With the implementation of EMR
the pharmacist will be able to have a more involved role in the clinical / pharmacologic management of patients.
The pharmacy has a MRD related support role in collaboration with respiratory therapy, imaging and care management.•
Pneumatic tubes will provide additional connectivity with patient care areas. •
Adjacency Diagram
Care Mgt.Patient Care Units
Radiology
Respiratory Therapists
Central Pharmacy
IT –Telecom -
DPS
Functional Narrative - Pharmacy
Sec3:121
FUTURE FLEXIBILITY:
Opportunities for improved operational effi ciency and lean approach with regard to work fl ow, automation and patient safety •
should be explored.
Designing for the highest possible level of standardization and exploring open layout and modularity to ensure future •
adaptability as equipment and processes change should be considered.
THIS FUNCTIONAL NARRATIVE IS ASSOCIATED WITH THESE SPACE PROGRAMS:
Respiratory Care•
- This functional narrative addresses only the inpatient program and
functions.
PLANNING WAS INFORMED BY THE FOLLOWING:
Proven Evidence Based Design•
Identifi ed Best Practices•
Completed Staff Questioners•
User Group Discussions•
PWC- PHHS Strategic Planning Document •
SCOPE OF SERVICES AND OPERATING PARAMETERS:
Respiratory care services are provided in both the inpatient and outpatient •
settings.
Respiratory care provides services to patients throughout the hospital. •
It is assumed in the future that RT will be dedicated to fl oors or units and thus •
have dedicated workspace within the fl oor core or unit.
Respiratory care provides a variety of services including: airway clearance •
maneuvers, such as chest physiotherapy, nebulizer and meter dose inhaler
treatments.
They manage all invasive and noninvasive ventilation throughout the hospital.•
PLANNING CONSIDERATIONS:
The inpatient Respiratory Care program is 3,472 NSF and includes:•
-1,224 NSF dedicated to equipment
-1,880 NSF dedicated to administrative space, including dedicated teaching
space to accommodate respiratory therapy students.
-368 NSF dedicated to staff support
The following spaces are dedicated to respiratory care and are not included in •
the respiratory care program. They are included in the patient are programs
listed below.
-In addition to bottled gas storage, 144 NSF is programmed in each unit
fl oor core (10) as dedicated respiratory work space.
-400 NSF is programmed in the NNICU as dedicated respiratory work
space.
-100 NSF is programmed in the inmate treatment unit as dedicated
respiratory work space.
-100 NSF is programmed in the ED as dedicated respiratory work space.
Functional Narrative - Respiratory Care
Sec3:122
Functional Narrative - Pharmacy
Sec3:123
ORGANIZATIONAL AND KEY ADJACENCIES:
The main respiratory care department needs adjacency to biomedical engineering.•
Discussion re. placing this department or the storage / repair function of this department with Central Logistics.•
The administrative space could be collocated with PFT and the non-invasive home ventilatory program managed by RT. •
Theses functions will be in the clinic building.
FUTURE FLEXIBILITY:
The placement of the storage / repair function of this department with Central Logistics offers future fl exibility.•
The placement of administrative space collocated with PFT and the non-invasive home ventilatory program managed by RT •
offers future fl exibility and adds cohesiveness to the department.
THIS FUNCTIONAL NARRATIVE IS ASSOCIATED WITH THESE SPACE PROGRAMS:
Main Lobby•
Women’s Lobby•
PLANNING WAS INFORMED BY THE FOLLOWING:
Proven evidence-based design.•
Identifi ed best practices. •
Completed staff questionnaires.•
PHHS input.•
SCOPE OF SERVICES AND OPERATING PARAMETERS:
Current lobby serves as the main entrance to the hospital and is open 24 hours a •
day.
Main lobby houses reception, information and waiting services. •
Women’s lobby and reception desk exists, but is not staffed nor located so that it •
is well utilized for this purpose.
PLANNING CONSIDERATIONS:
Lobbies will be points of orientation for the hospital and will address security •
and waiting functions.
Lobbies will provide opportunities for positive fi rst impressions for all who enter •
and should be clearly visible with easy access upon arrival to the hospital
campus.
Each lobby in the new facility is programmed to be approximately 4,441 DGSF. •
Space includes a large information desk, which should be centrally located and •
is sized at 160 NSF to accommodate 2-4 staff workstations.
Open hotel type seating at approximately 600 NSF is planned to accommodate •
waiting.
Child friendly seating that is easily cleanable.•
Public male and female restrooms with diaper changing areas•
Access to the main set of public elevators with clear line of sight from the entry •
or reception area for optimal way fi nding.
Wheelchair, including bariatric wheelchairs will be stored in close proximity to •
the entrance.
Minimize cross traffi c and congestion with either of the lobbies and the •
emergency department entry or the loading docks.
Security at each entrance to the fl oors will be provided, although security •
offi ces/headquarters are located in another building.
Functional Narrative - Main Hospital and Women’s Services
Lobbies
Sec3:124
ORGANIZATIONAL AND KEY ADJACENCIES:
One central entrance is planned for all services except woman’s services. •
Separate entrance is planned for woman’s services and should tie to the bank of elevators that travel to the women’s and •
infant patients fl oors.
Women’s lobby must be adjacent to a drop off with short-term or valet parking for the arrival of women in active labor. •
Central and secure entrances will be open 24 hours a day. •
Space should be designed as the greeting space. •
Visitors and patients should have a convenient path from the gift shop and chapel to the Main Lobby.•
Clear orientation and wayfi nding should be provided to the lobbies for arrival and departure from parking structures, DART •
and other transportation areas.
FUTURE FLEXIBILITY
Lobbies were programmed with options in mind about their proximity and location, which will be developed further during •
the design phase. Discussions included locating them at opposite ends of the main fl oor, on two different levels due to grade
differences, and as two separate lobbies along a shared drive using an “airport” arrival design model among other ideas.
Functional Narrative - Main Hospital and Women’s Services Lobbies
Sec3:125
THIS FUNCTIONAL NARRATIVE IS ASSOCIATED WITH THESE SPACE PROGRAMS:
Patient Navigator / Discharge Lounge•
PLANNING WAS INFORMED BY THE FOLLOWING:
Proven Evidence Based Design•
Identifi ed Best Practices•
Completed Staff Questioners•
User Group Discussions•
PWC- PHHS Strategic Planning Document •
SCOPE OF SERVICES AND OPERATING PARAMETERS:
The need for a solution to the discharge process of inpatients has been •
identifi ed. Many times patients are medically cleared for discharge, but there is
a lingering social problem: placement, fi nancial / funding for prescriptions,
access to transportation.
PHHS is creating a new service: a Discharge Lounge.•
This service will provide a place for patients to wait while they are waiting for a •
ride home or accessing the pharmacy for prescriptions, supplies, or meeting
with fi nancial counselors, case managers or social workers to arrange follow-up
care.
A professional level staff member will be present to facilitate follow-up •
appointments and care arrangements.
The success of this service will be assessed by the availability of inpatient beds.•
PLANNING CONSIDERATIONS:
1,747 NSF are planned to accommodate the Discharge Lounge.•
This space will accommodate seated / wheelchair including bariatric, waiting •
space for 24 patients.
Four workstations and (2) private offi ces are planned to accommodate patient •
related appointment, fi nancial needs, etc.
Staff support space is also planned for this space.•
Functional Narrative - Patient Navigator / Discharge Lounge
Sec3:126
ORGANIZATIONAL AND KEY ADJACENCIES:
The discharge lounge should provide easy access to the eligibility center and pharmacy.
FUTURE FLEXIBILITY:
The addition of the discharge lounge service should provide increased and bed fl exibility.
Functional Narrative - Patient Navigator / Discharge Lounge
OR / Recovery
Interventional Unit
Pharmacy Discharge Lounge
Patient Care Units
Sec3:127
THIS FUNCTIONAL NARRATIVE IS ASSOCIATED WITH THESE SPACE PROGRAMS:
Patient Relations•
Interpreters•
PLANNING WAS INFORMED BY THE FOLLOWING:
Proven Evidence Based Design•
Identifi ed Best Practices•
Completed Staff Questioners•
User Group Discussions•
PWC- PHHS Strategic Planning Document •
SCOPE OF SERVICES AND OPERATING PARAMETERS:
The Patient Relations Department functions as an advocate for patients and •
serves to ensure that patients and their families have a good experience at
Parkland Hospital and Health System. Patients and families access these
services by telephone, email, written correspondence or by walking into the
department.
- Patient satisfaction is of paramount importance as it ensures that patients
are satisfi ed and will most likely return to Parkland Hospital when they
require additional medical services.
The interpreter service provides interpreter and translation services for non-•
English speaking patients and families. Currently there are 34 Language
Assistants who work directly with patients and families. The Language
Assistants work throughout the inpatient and outpatient areas. Back-up
services are provided through a telephone language line.
The current space is not adequate to support both Patient Relations and •
Interpreter Services.
The Patient Relations Department is planned to be located within the hospital, •
although there has been discussion about moving the space to the clinic
building, if easy access to the hospital can be maintained.
PLANNING CONSIDERATIONS:
The Patient Relations Department and the Interpreter Services can be co- •
located but each service needs individual space to support departmental and
staff functional and operational needs.
Approximately 1,384 NSF is planned for the Patient Relations Department. This •
space includes reception and waiting space for patients and offi ce space for
staff.
The Interpreter space is 1,032 NSF and includes touchdown space for Language •
Assistants and private offi ces for patient advocates. Additional space is provided
on the patient care units in the form of hoteling space which is shared among
those staff who are mobile.
Functional Narrative - Patient Relations and Interpreters
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ORGANIZATIONAL AND KEY ADJACENCIES:
These departments support the entire institution and can do so from any location. •
The Patient Relations Department needs to be located in a place that is easily accessible to patients and families. •
The Language Assistants need to be able to easily access all inpatient and outpatient care spaces where there services are •
currently used.
Functional Narrative - Patient Relations and Interpreters
Sec3:129
Functional Narrative - Gift Shop
SCOPE OF SERVICES AND OPERATING PARAMETERS:
The Gift Shop at Parkland Hospital has been serving patients and visitors since •
1941.
The Gift Shop is currently located in the lobby on the fi rst fl oor of the hospital •
and is open Monday thru Friday 9:30 AM to 5:30 PM and from 10:00 AM until 4:45
PM on Saturday and Sunday.
The Gift Shop, staffed by approximately 6 FTE’s, sells toiletries, food items, gift •
and novelty items and realizes approximately $200,000 in annual sales.
PLANNING CONSIDERATIONS:
A new Gift Shop was programmed for the hospital and is approximately 2,340 DGSF.
Requests were made that the program include:
A dedicated rear entry for deliveries if possible•
Space for fl oral and beverage coolers•
Helium storage•
Retail shelf space•
ORGANIZATIONAL AND KEY ADJACENCIES:
The Gift Shop should be located in a high traffi c area.
Sec3:130
THIS FUNCTIONAL NARRATIVE IS ASSOCIATED WITH THESE SPACE PROGRAMS:
Cafeteria / Dietary Services / Formula Room•
PLANNING WAS INFORMED BY THE FOLLOWING:
Proven Evidence Based Design•
Identifi ed Best Practices•
Completed Staff Questioners•
User Group Discussions•
PWC- PHHS Strategic Planning Document •
SCOPE OF SERVICES AND OPERATING PARAMETERS:
This program is sized to support for a 988 bed hospital and the adjacent clinic •
building.
This program does not include clinical dietician work space, this space has been •
included in the teaming space on the inpatient care units.
The formula room is included in the NICU.•
The cafeteria will provide food for purchase for family and visitors during regular •
hours of operation.
A room service / made to order model was presented to PHHS dietary staff and •
leadership. The decision to continue with a pre-selected menu was made.
PLANNING CONSIDERATIONS:
The formula room will be located with in the NNICU.•
26,827 NSF are planned to accommodate a dining room, servery area, loading •
and receiving, refrigerated and frozen storage, bulk production area, patient
meal staging, ware washing and administrative support space (clinical dietician
home base).
The programmed space affords maximum fl exibility so that a food services •
consultant during the architecture phase will have needed SF.
ORGANIZATIONAL AND KEY ADJACENCIES:
The cafeteria should be located in a highly visible space. •
The cafeteria should be easily accessed and off a main corridor. •
The cafeteria / food service requires access to an outside dock.•
FUTURE FLEXIBILITY:
The programmed space affords maximum fl exibility so that a food services •
consultant during the architecture phase will have needed SF.
Functional Narrative - Cafeteria
* It is assumed that a Dietary Consultant will be involved
with the architecture and design of this space.
Sec3:131
THIS FUNCTIONAL NARRATIVE IS ASSOCIATED WITH THESE SPACE PROGRAMS:
ADT & Patient Flow•
PLANNING WAS INFORMED BY THE FOLLOWING:PLANNING WAS INFORMED BY THE FOLLOWING:
Proven Evidence Based Design•
Identifi ed Best Practices•
Completed Staff Questionnaires•
Price Waterhouse Cooper- PHHS Strategic Planning Document •
User Group Discussions•
SCOPE OF SERVICES AND OPERATING PARAMETERS:
The Admission, Discharge and Transfer Department (ADT) operates 24 hours a •
day 7 days a week and is responsible for bed management, which includes the
coordination of all admissions, including those referred from other hospitals and
EMS, internal patient transfers and discharges.
ADT is reliant on technology for every aspect of their work. All departmental •
applications are computer based. TeleTracking ® is the software package that
Parkland Hospital currently uses and plans to use in the future for managing
ADT patient fl ow and maximizing bed capacity.
Currently the hospital has multiple operational and space related issues that •
lead to ineffi ciencies with regard to patient fl ow throughout the institution. Often
patients wait in the ED for hours before a bed is available. Patients who have
been discharged currently wait in their rooms for family members for
transportation. These practices create delays in the room availability. While
these operational and space constraints are not the direct responsibility of ADT,
they impede ADT’s ability to effi ciently move patients throughout the institution.
Background/Current State
The ADT staff is satisfi ed with their current space and have asked that the •
program for the new hospital refl ect their current practices and space
confi guration. Space should be planned as a bullpen arrangement of
workstations that are in close proximity to each other for ease of
communications.
The work space also requires a view of the bed board. The transfer coordinator •
work space should be located in close proximity to the bullpen, but provide
acoustical privacy to support phone work. “Off-stage” work areas have been
planned for the patient fl ow coordinators and the admitting nurse to allow for
confi dential patient conversations
Functional Narrative - ADT
Sec3:132
ADT offi ce at PHHS - this space works well.
PLANNING CONSIDERATIONS:
The Joint Commission of Hospital Organization’s, revised standard, LD 3.15 addresses patient fl ow throughout the hospital •
and became effective January 1, 2008. The standard charges hospital leadership with “developing and implementing plans
to identify and mitigate impediments to effi cient patient fl ow throughout the hospital.” 1 This standard requires hospitals to
have policies and processes to address patient fl ow and safety throughout the organization. In addition to operational
changes many institutions have developed discharge lounges and clinical decision units to facilitate more effi cient patient
fl ow.
Automated patient tracking systems, like the one that Parkland is currently using have proven effective in improving the •
movement of patients throughout the institution. A total electronic environment including EMR and order entry is planned
and will enhance this process.
Hours of Operation:
24 hours a day – 7 days a week •
- safety and security of staff during the “off-hours” must be taken into consideration.
The future Parkland hospital includes a discharge lounge and a clinical decision unit, both of which should enhance bed •
availability. The implementation of a total electronic environment in conjunction with the TeleTracking ® system will make
the current ADT process most effi cient in the future.
1 The Joint Commission’s patient fl ow leadership standard, LD.3.15
Functional Narrative - ADT
Sec3:133
Future Process Model
ORGANIZATIONAL AND KEY ADJACENCIES:
The patient fl ow coordinators spend considerable time as they work to coordinate of the admission and discharge process:
on the patient care units,
in the ED
A convenient location within the hospital that allows for easy access to the patient care areas is essential.
The ADT Department should have a close adjacency to the discharge lounge, which will allow effi cient follow-up with patients
who may have lingering discharge needs.
Adjacency Diagram
FUTURE FLEXIBILITY:
The future vision of an electronic environment will greatly enhance the role of the ADT coordinators in addition to allowing them
to do their work remotely or centrally throughout the institution.
DischargeLounge
ADT Office24/7
Patients waiting for bed. Do
they share the Discharge
Lounge? What about Immun. Compromised
patients?
Same Day Admit Patient
IP BedAvailable
Bed Available
Bed Not Available
Patient Flow Coordinators
(3 staff)4a to 10p
Visit IP Units multiple times daily
Hotline Nurse(M-F Peak)
ADT Staff“Phone” Work
AreaCall Center
Lounge & Restroom
ADT Call Center and Patient Flow Coordinators need to be co-located. Patient Flow Coordinators must be located in the Main Hospital for patient access. ADT Office needs to be located ‘backstage’ within the main hospital.
Can be same space acceptable, acoustical separation needed
Conference for 7 people
Management Offices (See Survey)
* How does this relate to ED patients waiting for beds?
Functional Narrative - ADT
Clinical Decision
Unit
IP Units
ED
PACU
D/C Lounge ADT
Sec3:134
THIS FUNCTIONAL NARRATIVE IS ASSOCIATED WITH THESE SPACE PROGRAMS:
Medical Records•
PLANNING WAS INFORMED BY THE FOLLOWING:
Proven Evidence Based Design•
Identifi ed Best Practices•
Completed Staff Questioners•
User Group Discussions•
PWC- PHHS Strategic Planning Document •
SCOPE OF SERVICES AND OPERATING PARAMETERS:
The medical records offi ce provides birth certifi cate information for patients •
born at PHHS and release of information for the receipt of medical records.
PLANNING CONSIDERATIONS:
1,404 NSF is planned for this space, which includes waiting space, work stations •
and offi ce support equipment space.
ORGANIZATIONAL AND KEY ADJACENCIES:
This space services in and outpatients and should be easily accessed from both •
the in and outpatient areas..
Functional Narrative - Medical Records
Sec3:135
THIS FUNCTIONAL NARRATIVE IS ASSOCIATED WITH THESE SPACE PROGRAMS:
Eligibility Center•
PLANNING WAS INFORMED BY THE FOLLOWING:
Proven Evidence Based Design•
Identifi ed Best Practices•
Completed Staff Questioners•
User Group Discussions•
PWC- PHHS Strategic Planning Document •
SCOPE OF SERVICES AND OPERATING PARAMETERS:
The eligibility center helps patients navigate and apply for programs such as •
medical assistance.
PLANNING CONSIDERATIONS:
1,824 NSF are planned for this space, which includes waiting space, eligibility •
work stations and offi ce support equipment space.
ORGANIZATIONAL AND KEY ADJACENCIES:
This space services in and outpatients and should be easily accessed from both •
the in and outpatient areas.
This space should be in close proximity to the discharge lounge.•
FUTURE FLEXIBILITY:
The services provided by the eligibility center are critical to the funding and •
ability of many of PHHS cliental to receive medical services.
Functional Narrative - Eligibility Center
Sec3:136
THIS FUNCTIONAL NARRATIVE IS ASSOCIATED WITH THESE SPACE PROGRAMS:
Chaplaincy•
- The chapel will be programmed at approximately 1,124 NSF and includes
space for seating 60 people. A meditation room adjacent to the chapel is
also planned.
PLANNING WAS INFORMED BY THE FOLLOWING:
Proven Evidence Based Design•
Identifi ed Best Practices•
Completed Staff Questioners•
User Group Discussions•
PWC- PHHS Strategic Planning Document •
SCOPE OF SERVICES AND OPERATING PARAMETERS:
Background / Current State:
The Pastoral Care Department at Parkland Hospital and Health System is a •
multi-denominational ecumenical ministry. In addition to being supported by the
hospital it is supported by multiple community churches and agencies.
The chaplain is part of the healthcare team and plays an important role in •
guiding the patient with regard to ethical, religious and spiritual issues.
A chaplain is available in the hospital 8:3 AM until 5:00 PM, Monday thru Friday •
and is on call 24 hours a day.
The hospital’s chapel is open 24 hours a day for purposes of prayer and •
meditation.
PLANNING CONSIDERATIONS:
Model of Care:
The Pastoral Care Department requested co-location of three elements of their •
work: the chapel, pastoral care administration and the clinical pastoral
education program.
The chapel and the pastoral care administration will be located within the new •
hospital space.
The education program will be located in the new administrative offi ce building. •
This space includes 2 private offi ces, 12 work stations for clinical pastoral
education students, a small private conference room with seating for 8 and a
large conference room programmed to seat 20 individuals.
Functional Narrative - Chaplaincy
Sec3:137
Space Program
Administrative offi ce• space for the Pastoral Care Department will be located adjacent to the new chapel and is programmed
at approximately 1,292 NSF.
This space should be accessible to families and be designed to offer privacy to families who seek services in times of grief. •
Nine private offi ces• for priests and pastoral workers are planned. These spaces can be use to meet with families.
A • small nourishment room with seating for 12 is also planned.
A • bereavement room is planned within the emergency department space.
Private consult rooms• are planned on the patient care fl oors and can accommodate private space to meet with families.
There will also be hoteling space on each care unit that pastoral counseling staff may use.
ORGANIZATIONAL AND KEY ADJACENCIES:
The chapel should be conveniently located with easy access to the patient care areas.
Adjacency Diagram
FUTURE FLEXIBILITY:
The Pastoral Care Department currently provides a large array of supportive and educational services to patients, families and
the community. Providing space for these services in the administrative building will allow the programs the spaces for
expansion.
Functional Narrative - Chaplaincy
Volunteer ServicesIP Units
Social Work
Body Viewing
Pastoral Care
ED
Sec3:138
THIS FUNCTIONAL NARRATIVE IS ASSOCIATED WITH THIS SPACE PROGRAM:
Employee Lactation Rooms•
PLANNING WAS INFORMED BY THE FOLLOWING:
Proven evidence-based design.•
Identifi ed best practices.•
Completed staff questionnaires.•
Series of PHHS user group discussions resulting in recommendations and •
general consensus.
SCOPE OF SERVICES AND OPERATING PARAMETERS:
Provide appropriate facilities for breast pumping women who are part the PHHS •
workforce, including employees, residents, faculty, volunteers and others.
Background / Current State:
PHHS supports breastfeeding patients; teaches classes to expectant mothers •
and is a recipient of grants to support community-wide efforts to increase
breastfeeding rates.
PHHS provides pumps and limited space for staff to breast pump on-site and •
indicated in user group meetings that there is a strong desire to improve this
situation.
PHHS was not listed as one of the hospitals on the Texas Department of State •
Health Services (DSHS) with “Mother-Friendly “designation. Presbyterian,
Children’s and Methodist are designated Dallas area hospitals, according to a
recent view of this list that DSHS is required to provide to the public. (www.dshs.
state.tx.us/wichd/lactate/mother-worksites.shtm website was checked 3-18-
2009).
DSHS administers the Mother-Friendly Worksite Program created in 1995. •
PHHS would need to provide work schedule fl exibility to allow time for pumping
breast milk or nursing infants, offer a private space for women returning to work
or new hires to either pump or nurse, and ensure easy access to clean running
water and refrigeration. An application with the policy must be submitted to
DSHS.
PLANNING CONSIDERATIONS:
Spaces and equipment for breast pumping should be dispersed throughout the •
hospital and clinics.
Research supports both the health benefi ts and business benefi ts. •
Breastfeeding mothers are 50% as likely to miss a day of work for a sick child
compared to mothers of formula feeding infants. (Cohen, Mrtek & Mrtek, 1995)
Texas Instruments, Cigna and many other companies have reported benefi ts that •
are posted on the DSHS website:
“We believe this program offers a win-win situation. Breastfeeding results in •
healthier babies, which leads to less absenteeism for parents and reduced
medical costs and more productive employees.” ~ Betty K. Purkey, Texas
Instruments
Functional Narrative - Employee Lactation Rooms
Sec3:139
Best practices at Cigna attributed annual savings to their lactation program in the amounts of $240,000 in health care •
expenses, 62% fewer prescriptions, $60,0000 saved in reduced absenteeism rates (Dickson, Hawkes, Slusser, Lange, Cohen
& Slusser, 2000).
Space Program:
Ten employee lactation rooms with sinks to be dispersed throughout the hospital. •
Additional rooms for clinic and offi ce buildings are excluded from this program.•
Utilization / Hours of Operation:
Availability 24 hours a day - 7 days a week.•
Anecdotal information was provided in the absence of data regarding need.•
Staffi ng:
Cleaning, organization and management of the rooms will be required, but the space does not need to be staffed. •
Information on the responsibilities for tasks associated with these rooms was not defi ned during programming.
ORGANIZATIONAL AND KEY ADJACENCIES:
PHHS indicated preference for dispersion throughout facilities for staff convenience and productivity, rather than •
centralization of these rooms.
Facility layout will help identify appropriate locations during the design phase.•
Functional Narrative - Employee Lactation Rooms
Sec3:140
THIS FUNCTIONAL NARRATIVE IS ASSOCIATED WITH THESE SPACE PROGRAMS:
Central Sterile Processing•
-14,430 DGSF are programmed for the Central Sterile Department in the
new hospital.
PLANNING WAS INFORMED BY THE FOLLOWING:
Proven Evidence Based Design•
Identifi ed Best Practices•
Completed Staff Questioners•
User Group Discussions•
PWC- PHHS Strategic Planning Document •
SCOPE OF SERVICES AND OPERATING PARAMETERS:
Sterile processing is responsible for the cleaning, decontamination, sterilization •
and inspection of all surgical instruments, devices and implants for the inpatient
and outpatient areas at Parkland Hospital.
This department is also responsible for controlling and monitoring medical •
devices.
SPD plays a critical role in maintaining patient safety and infection control •
practices.
Background / Current-State:
Currently there are multiple decentralized sites at Parkland where sterile •
processing takes place.
The current process is manual, ineffi cient and results in delays. •
There is no instrument tracking system which results in the loss of expensive •
equipment.
PLANNING CONSIDERATIONS:
Model of Care:
Sterile processing will be consolidated into one centralized department. •
With the exception of endoscopes and fl exible bronchoscopes, which will be •
cleaned in the GI suite, all instruments requiring cleaning, decontamination and
sterilization will take place in one centralized location.
This space should be designed to accommodate Lean-thinking and should •
support a 3-zone linear fl ow design concept- soiled to clean to sterile, and
feature pass-thru sterilizers.
A case cart system will be implemented. This system will be supported and •
driven by the surgery and procedural area information systems. The future
requisition process will be automated, streamlined and timely.
The case carts will be assembled by Sterile Processing and delivered to the •
sterile surgery core area.
Adequate space is planned in the operating room suite to accommodate two •
case carts per OR.
Functional Narrative - Central Sterile Processing
Sec3:141
A rotation system will be employed as cases are completed in surgery. •
Clean carts will be transported via a clean elevator and used carts with soiled instruments and trays will be returned via a •
soiled elevator.
There will be a designated and labeled location for all supply, equipment, and instrument containers; the case cart fl ow •
process will inform the internal locations for these functions.
Bar coding will be used for identifi cation and tracking. •
A wireless system will be used for case carts; this is expected to reduce demand redundancies, and a tracking system will •
inform accurate demand forecasting
General instrument trays will be standardized, assembled in containers, and processed in a sterile processing area, adjacent •
to the case carts. These provide at least 90% of necessary instruments.
General Instrument trays will be handled in a manner equivalent to the Sterile Processing model.•
Additional instruments, such as clinical specialty or surgeon specifi c items, will remain in the department, in a centralized •
location.
A bar coding system will also be utilized for instrument tracking and location.•
The supply process primarily relies upon a case cart system. However, some supplies will be stored in the surgical suite, •
with easy access for surgeons/staff during surgery. Case carts will be used for the delivery of necessary supplies.
The carts will be stocked with general instrument trays, ordered in advance of the procedure. •
More specifi c carts will be stored in a central location.•
Space Program:
The Sterile Processing department will be located on the ground fl oor of the new hospital and will require a vertical •
adjacency to the operating room, c-section and imaging spaces.
Dedicated clean and soiled full size elevators for delivery and pick of case carts and supplies is planned. •
The department should be easily accessible to vendors from the outside. •
Assembly will occur at a central counter, with 3 - 4 workstations, each equipped with a lighted magnifi er, compressed air, and •
video monitors attached to the surgery information system.
Pathways to ensure mission critical instruments are functional and not damaged will be in place, and a bar coding system •
will be utilized for instrument verifi cation and location.
The equipment list includes 2 Large Steam sterilizers, 2 Sterad Sterilizers, 4 Ozone Sterilizers, and space for 120 carts is •
planned.
Stations with medical air, light source, video monitor, lighted magnifi er, demagnetizer, and other bio med devices should be •
located in the surgical suite with ready access for technical support staff.
Functional Narrative - Central Sterile Processing
Sec3:142
ORGANIZATIONAL AND KEY ADJACENCIES:
A vertical adjacency to the operating rooms is essential, clean and soiled elevators are planned. •
Easy access to all patient care units, the Emergency Department, cardiac catheterization and the clinic building will be •
important for the transport of equipment.
Adjacency Diagram
Functional Narrative - Central Sterile Processing
L&D
ClinicsIP Units
Vendors
Central Sterile
Processing
Cath Lab
ED
ASC?Central
Equipment Garage?
Sec3:143
Key Room Diagrams and Room Data Sheets
Karlsberger Healthcare Consulting
Planning | Strategy | Operations | Programming
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