-By Jennifer Merchant, Brent Hussong, and Laura Zimmer

“Designing for Health" is a monthly, Web-exclusive series from healthcare interior design leaders at Perkins+Will that focuses on the issues, trends, challenges, and research involved in crafting today's healing environments. This month's article focuses on the challenges of renovating existing healthcare facilities.

As the aging American population grows, many medical institutions are expanding and renovating their facilities to meet this need. While new construction easily can accommodate cutting-edge technology and planning, renovation of these older, existing facilities that were once considered state-of-the-art continues to be a challenge due to existing conditions such as smaller patient rooms and infrastructure.

A campus successfully responding to these issues is Rush University Medical Center. Located in the west side of Chicago, the Campus Transformation Project is currently under construction and includes a new 15 story, 806,000-sq.-ft., state-of-the-art hospital building with an adjacent medical office building (MOB), which is the largest orthopedics building in the Midwest, a new power plant, and a parking garage. The existing Atrium Building at the center of the new campus is slated for intensive renovations immediately following completion of the new construction.

Standardization and continuity throughout the campus is a driving factor in the campus transformation project. To coordinate the dozen of cdesign professionals and contractors needed to achieve the unified campus, RUMC selected an integrated project delivery method for the key projects. Joseph DeVoss, assistant vice president, Office of Transformation at Rush, says, “We have worked with all of our outside design consultants to establish new design standards for our existing buildings that convey the same message to our patients and visitors as the design standards set in the Transformation Program's new buildings by Perkins+Will. We are being very careful not to create two tiers of environments—one old and one new."

The Atrium Building is approximately 270,000 sq. ft. and provides ambulatory, acute, and critical care services. As part of the renovation process, Rush University Medical Center requested that Perkins+Will conduct an internal, firm-wide competition to redesign a single existing patient room. Factors such as a limited construction budget and specific program requirements for upgrades to the existing layout of walls, mechanical, and plumbing fixtures provided participants with real-world challenges that resulted in concrete solutions. Strengths of the winning entry incorporate solutions that complement the new construction with creative approaches in infection control, interior finishes, daylighting, and new technology.
Infection control

Existing patient rooms in the Atrium are all single-bed rooms supporting an effective infection-control strategy and a big factor in helping to inhibit the transmission of airborne pathogens from one patient to others. Some research shows that the built environment influences the occurrence of infection and through careful consideration of environmental transmission paths including air, water, and surface in the design of the patient room, hospital acquired infections may be reduced.1 RUMC nursing staff felt that providing a conveniently located staff hand-washing sink or hand sanitizer dispenser within each patient room would reduce hospital-acquired infection among patients. In addition, the selection of finishes for horizontal and vertical surfaces that would withstand RUMC’s standard for regular cleaning and maintenance to reduce the spread of infection by contact was another key design component to be considered by RUMC’s infection control.

Interior Finishes

A consistent interior finish palette can provide a sense of unification throughout the campus. While changes to mechanical systems and architecture can be expensive during a renovation, interior finish upgrades can have a great impact on the patient and family experience at a very minimal cost. Historically, RUMC surveys have shown an increase in patient/family satisfaction when the patient units were given an interior finish face-lift.

Daylighting

Another unifying feature of the campus incorporates the use of daylight for healing and hygiene. Originating in the guiding principal of the transformation project, “Optimizing the patient and family experience,” one of the outstanding features of the winning design was the ability to draw natural light deeper into the room. The intent is to improve the patient’s psychological as well as physical well-being. According to Joseph, Anjali, Ph.D. in The Impact of Light on Outcomes in Healthcare Settings (© 2006 Center for Health Design), “Studies show that higher light levels are linked with better performance of complex visual tasks and light requirements increase with age. By controlling the body’s circadian system, light impacts outcomes in healthcare settings by reducing depression among patients, decreasing length of stay in hospitals, improving sleep and lessening agitation among dementia patients, easing pain and improving adjustments to night-shift work among staff. ”2

The design also leverages light to assist in reducing hospital-born infections. In a study that evaluated pharmacists’ prescription-dispensing accuracy, errors were significantly reduced when illumination levels were increased from 45 to 150 footcandles. 3 For the same reason, it is anticipated that the clearstory window providing natural light into the patient toilet/shower will improve departmental hygiene through improving visibility for cleaning staff

New Technology

Like the new patient tower, it is important that the existing Atrium patient rooms reflect and accommodate the new technologies expected by today’s well-informed healthcare consumers. The existing Atrium single-bed room headwalls have three duplex electrical outlets and a single voice outlet but no data outlet, which was the standard when constructed some 20 years ago. With today’s ever-changing medical technology and the increasing number of bed-side procedures using mobile diagnostic and treatment equipment, there is a tremendous need for increased numbers of electrical and data outlets within each patient room, especially at the headwall. Mobile medical equipment, including portable bedside diagnostic devices, electronic charting devices, physiological monitors, flat-screen televisions, patient gaming devices, and cell phone charging all will be accommodated with an increased number of electrical outlets and voice/data outlets at the existing Atrium patient rooms.

In addition to the winning competition entry, all 21 submissions helped to create a richer database of design solutions for the renovation project moving forward. Valerie Larkin, program manager from Power Jacobs Joint Venture of RUMC Transformation Program, says, “The design competition for the renovation of the patient room allowed Perkins+Will to tap into the creativity of its young designers nationwide to bring a better, more cost-effective result for the client.” The client and all the design professionals involved in the Campus Transformation Program have worked together to create a unified, harmonious campus that will aid in the number one guiding principle at Rush: “Optimize patient and family experience.”

1. Joseph, Anjali, Ph.D., Less Infectious by Design © November 2006 Center for Health Design.
2. Joseph, Anjali, Ph.D., The Impact of Light on Outcomes in Healthcare Settings © 2006 Center for Health Design.
3. Buchanan TL, Barker KN, Gibson JT, et al. Illumination and errors in Dispensing. American Journal of Hospital Pharmacy. ©1991: vol. 48: pages 2137-42.

Past installments of "Designing for Health" include (click on title to access the full article):
• Leading by Design – A Place to Flourish
• Expanding the Definition of Sustainability to Include Chemical Awareness
• 10 Strategies to Move Your Client Toward Sustainability
• The Age Factor--Energizing the Healthcare Workplace
• Medical Teaming Centers
• Integrating Security in Hospital Emergency Departments
• We Eat What We Build
• Evidence-Based Healthcare Design Forum