"Designing for Health" is a monthly, web-exclusive series from the healthcare interior design leaders at Perkins+Will that focuses on the issues, trends, challenges, and research involved in crafting today's healing environments.
For most cancer patients, the chemotherapy suite is where a majority of their treatment time is spent. Treatment can take up to nine hours with most patients returning weekly for several months at a time.
Having recently designed several cancer centers with significant chemotherapy suites, we wanted to understand how they are functioning for patients and what improvements might be made in future projects. With the help of two healthcare professionals who work in these suites, a better understanding of design for improved patient experience was garnered.
Dr. Lucille Robillard is a systemic oncologist at the General Campus of The Ottawa Hospital Cancer Centre, Ottawa, Canada. The chemotherapy suite where she works was expanded in 2010 and has 45 patient treatment bays and three segregation rooms, and treats approximately 100 patients per day. Cindy McLennan is a clinical manager of systemic therapy and radiation therapy nursing at both the General Campus and the Queensway Carleton Site. The chemotherapy suite at the Queensway Carleton Site has 31 patient treatment bays and two segregation rooms. The suite is only partially operational at this time and treats approximately 25 patients per day. The suite is located in the Irving Greenberg Family Cancer Centre, a new facility completed in 2011.
During the development of Generic Output Specifications for Healthcare Design, the Province of Ontario’s Ministry of Health and Long-term Care determined that the standard chemotherapy bay size should increase. The two centres referenced in this article comply with this new standard. The larger bay size of seven feet wide by 10 feet long provides flexibility to accommodate either a recliner or stretcher, to allow for emergency response without displacement of patients in adjacent bays, and to provide space for a visitor.
The treatment bays are grouped in ‘pods’ of five to six bays and a nursing station to create communities of patients. Design features include floor to ceiling fritted glazing, radiant ceiling panel heating, custom wood headwalls, wood ceilings in feature areas, and direct and indirect lighting.
The following questions were posed to Robillard and McLennan:
What is the range of treatment time for patients?
Treatment time ranges from 15 minutes to nine hours, with two-and-a-half hours being the most common duration. The treatment cycle has a large range, but for most patients treatments are weekly for two to four months.
Do patients choose to have treatment in a recliner or stretcher?
Initially the determination of recliner or stretcher is made by the clinical team and depends on the patient’s regiment. If this is not a factor, the patient is then able to choose. McLennan notes that the use of stretchers has increased as regiments changed to slower delivery of medication and longer stays: Her estimate was a 50/50 split. Robillard notes that "well" patients and those with particular disease sites prefer recliners. In her estimate, more stretchers were used than recliners.
Do patients prefer to have privacy during treatment or converse with other patients?
This varies, however, Robillard notes that the large treatment bay size provides enough personal space for patients "to choose whether to interact with their neighbour or not." McLennan notes studies have shown that grouping patients of the same cohort together encourages "cross-pollination" or interaction, but they have so far not been able to provide this option due to scheduling demands.
Do patients generally have visitors stay with them during treatment?
Most patients have visitors, but only one is permitted. The larger bay allows adequate room for the visitor and the healthcare team to care for the patient. McLennan notes that accommodating visitors is “highly valued” by patients.
Are reading lights, outlets for personal electronic devices used by patients when in treatment?
Patients often bring their own electronic devices. Wireless Internet access is provided. Reading lights are well used by patients.
Is the natural light and view to the outside generally something enjoyed by the patients?
Patients enjoy the natural light and view. Robillard comments that one of her more optimistic patients said the light “makes her feel joyful.” McLennan remarks that the east-facing glazing presents glare problems early in the morning. Robillard notes that chemotherapy suites are often located deep within a floor plate. Having access to windows and borrowed lighting made the space seem “less hectic” and “peaceful.”
How do you find the noise level in the chemotherapy suite?
Both McLennan and Robillard have had no issues with the noise level. Robillard comments that the low noise level creates "less staff fatigue."
Is there adequate storage in the suite for patient belongings, staff supplies?
The patient cubbies within the treatment bays are rarely used. Often patients leave their coats on the visitor chair or in the coat closet in the waiting room.
Do you have any other comments on the design of the chemotherapy suite?
Significant issues with the volume and cold temperature of supply air provided by the linear diffusers above each treatment bay were very uncomfortable for patients. The temperature has since been rectified but the ‘draft’ of air remains an issue with patients.
An illuminated indicator system is being added to the pharmacy preparation area to signal when drugs are ready for each treatment pod. McLennan notes that telephones are not permitted in the chemotherapy preparation area where drugs are being mixed, and the only way for nurses to determine if the drugs were ready was to walk over to the pharmacy counter.
The increased size of the treatment bay has increased safety during an emergency situation, as adjacent patients do not need to be moved out of the area.
The "pod" layout is also more comfortable for nursing staff. They can concentrate on the patients in their pod and not feel responsible for all patients in the unit.
Design highlights generated from McLennan and Robillard’s input include:
- Chemotherapy suites benefit from subdivision into smaller treatment areas as they improve visibility and concentrate staff responsibility.
- Treatment bay sizes of seven feet by 10 feet appear to be optimal.
- Natural light in chemotherapy suites is strongly desired.
- Low draft air delivery, such as laminar flow diffusers, should be provided for patient comfort.
It is a very satisfying process to review the completed design with end
users. They are extremely willing to share their experiences and
appreciate that designers are interested in learning how to improve the
Mary Jo Hind is a principal in Perkins+Will Ontario. She has practiced architecture for 23 years and has been involved in the architectural and interior design of several cancer centres in Ontario, Canada. Her project experience includes the Windsor Regional Cancer Centre, the London Regional Cancer Centre, the Juravinski Cancer Centre, The Ottawa Hospital Regional Cancer Centre, and the Simcoe Muskoka Regional Cancer Centre. She can be reached at MaryJo.Hind@perkinswill.com.
Province of Ontario Ministry of Health and Long-Term Care Generic Output Specifications 2008 Draft Release
Past installment of "Designing for Health" include (click on the title to access the full article):
Exploring Collaboration in the Consolidated Interventional Platform
The Differences between U.S. and U.K. Clinical Planning Models
Widening a Circle of Natural Inclusion
Mentoring the Next Generation of Healthcare Design Professionals
When the Professional Becomes the Patient--An Insider's Perspective