designing the childrens hospital of the future the new guidelines

8/10/2019 Designing the Childrens Hospital of the Future the New Guidelines

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New Childrens Facilities Regulations How WouldThey Impact Your ro!ects"#

Rick MajzunSt Louis Childrens Hospital

Judy SmithSmith Hager Bajo

Laura Poltronieri, AIAPoltronieri Tang & Associates

The International Facilities Design & Capacit Con!erence "#$"


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Learning % jecti'es

Become a(are o! !orthcoming proposed designguidelines !or childrens hospitals)e'ie( the speci!ic re*uirements applica le tochildrens hospitals

+nderstand ho( these guidelines might impact thedesign o! childrens hospital

The International Facilities Design & Capacit Con!erence "#$" "


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Agenda

,hat are the guidelines-

,hat impact (ill the ne( guidelines ha'e on ourdesigns-,hat impact (ill the ne( guidelines ha'e on %(ners

and Projects-

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Chec/list o! )esources and 0uidelines !or theDesign o! Childrens Hospitals in the +S

0uidelines !or the Design and Construction o!Health Care Facilities www$%giguidelines$org

)ecommended Standards !or 1e( orn IC+Designwww$nd$edu&' nicu des& 2ust updated 3

Pediatric Pro!essional Association 0uidelines

American Academ o! Pediatrics4e5g56 0uidelines !or Perinatal Care7

2oint Commission and D18 9 oth re!erence

F0I

The International Facilities Design & Capacit Con!erence "#$" :

Recommended Standards for New orn I!" #esi$n


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Chec/list o! )esources and 0uidelines !or theDesign o! Childrens Hospitals in the +S

%ther Pro!essional Association 0uidelinesAmerican Dieticians Association ; in!ant!eeding area design (((5eatright5orgSociet !or Critical Care


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Intent o! the 1e( Children s Hospital

0uidelines

Consolidate minimum standards !or children to onehand chapter+pdates to re!lect the distincti'eness o! childrens

hospital design

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,ho6 ,hat6 ,hen6 ,here and ,h

0uidelines committee structure

0uideline re'ie( process ; : ear c cle


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,here 0uidelines Ha'e Been Adopted

in the +S

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Starter =?ercise ,here Should ChildrensHospitals Be Designed Di!!erentl -


Je elements thatare di!!erent in

childrenshospitals

=lements

that aredi!!erent inchildrenshospitals

Patient )oomsStorage

multiple edsSa!et andSecuritSedation

Pla EActi'it Areas8olunteers and gi!t

storage=?amEtreatment

room

Famil%'ernight 1eeds

Art &Distractions

Child Li!eChild ariatric

needsFoodE1utrition

=mergenc

Seasonal SurgesBathroomsIn!ection

pre'ention

ScalePharmac

=ducationEschoolPar/ing6 drop o!!

and pic/ up


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,here Are ,e in the F0I +pdate Process-

Proposals accepted !rom pu lic6 pu lished dra!t6 andpu lic comment period egan 2une :6 "#$"Deadline !or pu lic input am CST on


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"5 $5$ Application,hat is a Childrens Hospital-

4F7acilities that pro'ide general acute pediatrichospital care and identi! and mar/et themsel'es tothe general pu lic as childrens hospitals6 pediatrichealth care centers6 or pediatric centers o!e?cellenceM

This 4does not 7 appl to independent specialthospitals (ith clinical specialiNation in areas such as

urn6 ps chiatric6 orthopedics6 reha ilitation6 orspeci!ic chronic diseasesM

The International Facilities Design & Capacit Con!erence "#$" $$


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Chapter "5 ; Speci!ic )e*uirements !orChildrens Hospitals

unless impracticalM per Section

$5$ .In%ormation contained in the ,ppendi- is ad.isory only and not +inding or en%orcea+le

$"The International Facilities Design & Capacit Con!erence "#$"


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"5 "5" Pediatric


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"5 "5"


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Pediatric Bed )oom ComparisonCurrent Code 's5 Proposed Code

The International Facilities Design & Capacit Con!erence "#$" $

Med&Sur$ Nursin$ "nit!urrent

!odePro'osed

!ode


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Pediatric Bed )oom ComparisonProposed Adult 's5 Proposed Pediatric

The International Facilities Design & Capacit Con!erence "#$" "#

Med&Sur$ Nursin$ "nitPro'osed

AdultPro'osedPediatric


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"5 "5"


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"5 "5" alliati.e Care Room

?ach childrens hospital should e.aluate the needs and re=uirements %or

palliati.e care programs and plan appropriate corresponding spaces# When childrens hospitals need this +roader spectrum o% supporti.e and

palliati.e care ser.ices* the %ollowing re=uirements should +e met(# Capacity alliati.e care room must +e a single/+ed patient room# 6i@e alliati.e care room should ha.e a minimum clear %loor area o%

1A5 6F with a minimum clear dimension o% 0A %eet# 9,ppendi-:

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"5 "5" alliati.e Care Room Family ,rea ,dditional area should +e pro.ided to accommodate

e-tended %amily and %riends# O ,t minimum* a recommended additional clear %loor area o% 25 6F per %amily

mem+er#

O ,dditional area can +e pro.ided in an ad!acent* pre%era+ly connected room#

O This area or suite can +e con%igured so that when not re=uired %or palliati.e care

%unctions* the additional space is readily a.aila+le to the general unit %orconsultation space#

?n.ironment o% Care Consideration should +e gi.en to locating palliati.e care rooms in a low/tra%%ic location#

O ro.iding a homeli8e atmosphere and %urniture arrangements#O Brienting the patient +ed toward windows with outside .iews#


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"5 "5"


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shall e immediatel accessi le to the nursing

unit4s7 ser'edM ser'e more than one nursing unit (hen it is centrall

located on the same !loor as the units ser'edM Pro'ided (ith > pri'ate area !or communication6 e5g5 cell

phones6 computers6 (ireless Internet access6 patient !amilin!ormation stationsM"5 "5"5G5" Toilet room4s7 > readil accessi le to the loungeM

> shall include space !or a uilt in diaper changing station>M

"5 "5"5G5. Consultation room 4i! re*uired the !unctionalprogram7 Pro'ided !or con!idential parentE!amil com!ort6 consultation6

and teachingM

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"5 "5. Pediatric %ncolog 1ursing +nit

"5 "5.5 5$ Patient pla area Patient pla or acti'it areas shall e pro'ided in

multi purpose or indi'idual room4s7 that are(ithin or ne?t to >M the unit

The International Facilities Design & Capacit Con!erence "#$" "


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"5 "5@ Pediatric Critical Care +nit

Applies to all t pes o! critical care units6 including PediatricCardiac Critical Care +nitPatient Care )ooms

"5 "5@5"5" Space re*uirements ; Same as adult unit6 utmust also include space !or recum ent sleep o! a parent

"5 "5@5@5$$ =*uipment and suppl storage ; Pro'isions !or!ormula and human mil/ storage"5 "5@5G5$ Famil and 'isitor lounge ; Same as adult unit6 utmust also > pro'ide seating capacit o! no !e(er than $5seats per patient edM"5 "5@5G5. ConsultationEdemonstration room ; > pro'ided(ithin or readil accessi le 4to the unit7 !or pri'atediscussionsM

The International Facilities Design & Capacit Con!erence "#$" .#


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"5 "5@ Pediatric Critical Care +nit

%ther re*uirements that are the same as !or adultcritical care units

,indo(s Patient pri'ac

Hand (ashing stations Toilet room or soiled utilit room 1urse call s stem

The International Facilities Design & Capacit Con!erence "#$" .$

$


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"5 "5$@ Bariatric Care +nit

,1$;/1$04 The need %or care o% the e-tremely o+ese patient*

including children* is growing in the 6# These patients re=uire %acilities with more space

and clearances#* as well as sta%% with greaterstrength to carry hea.ier loads#

They also ha.e a .ariety o% special health careneeds %rom climate control re=uirements to theneed %or specialty +athing %i-tures#

9,ppendi-:

The International Facilities Design & Capacit Con!erence "#$" ."

$ S i


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"5 .5$ =mergenc Ser'ices

"5" .5$5.5@ 4"7 single ed treatment rooms 4$## 1SF7 shall appl ; in lieu o! ;

"5" .5$5.5@ 4:7 pediatric treatment rooms 4$"# 1SF7

"5 .5$5@5$. Patient pla area Pro'ided in multi purpose or indi'idual room4s7 (ithin or ne?t to

areas ser'ing pediatric and adolescent inpatients

Designed to support de'elopmentall appropriate pla 6 recreation6and other !unctions such as dining and education Pro'ide access and e*uipment !or patients (ith ph sical restrictions Special design considerations

O Constructed o! sur!aces and materials that are eas to clean and dura le4nonporous and smooth7

O


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"5 5 S i l S 'i


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"5 .5. Surgical Ser'ices

"5 .5.5.5" Pre operati'e patient care area Sedation room > shall e pro'ided outside the

operating or procedure room (here sedation isre*uiredM

shall e dictated the!unctional programM


"5 5 I gi g S 'i


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"5 .5: Imaging Ser'ices


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"5 .5G )espirator Therap Ser'ices

"5 .5G5. %utpatient Testing and DemonstrationSer'ices

)espirator ser'ices 4i! o!!ered7 shall also pro'ide> rooms (here children can practice acti'ities o!

dail li'ing (ith related storage > in addition to the other 4i5e5 adult respirator

therap 7 re*uirementsM


"5 5 )enal Dial sis Ser'ice


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5 .5 )enal Dial sis Ser ice

Support Areas !or )enal Dial sis Ser'ice Facilities ,1$;/2$D$4$0E a+oratory 6pace

O


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5 0eneral Support Ser icesand Facilities

"5 5"5.5$ Special 4%n site7 Laundr Facilities Pro'ide space !or a (ashing machineEdr er and

dish(asher !or > laundering andEor (ashing plushto s and hard plastic to s respecti'el M ro.ide G washing machine dryer accessi+le to

%amilies %or the purpose o% laundering their personal

clothing when they are staying with their childrenduring e-tended hospitali@ations#9,ppendi-:

"5 5.5. 0eneral Stores

Additional storage !or donated to s6 educationalsupplies6 and recreational e*uipment %!! site location !or this storage permitted


"5 @5$ Pu lic Areas


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5 @5$ Pu lic Areas

"5 @5$5" Pu lic Toilet )ooms ; )e*uires toilet rooms(ith diaper changing !acilities throughout

,1$;/1$2$0 rop/o%% & pic8/up area at +uilding entrance ,de=uate cur+side space %or handling strollers* +a+y

carriers and toys ,dditional .ehicle =ueuing space to compensate %or

increased time necessary %or load&unload ro.ision o% sa%e @one# area %or children during

loading&unloading acti.ity duration9,ppendi-:

The International Facilities Design & Capacit Con!erence "#$" :#


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%'erall Impact o! 0uidelines


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% erall Impact o! 0uidelines


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Case Stud ; St5 Louis Children s Hospital

" # ed !ree standing childrenshospital a!!iliated (ith ,ashington+ni'ersit School o!


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Case Stud ; St5 Louis Children s Hospital

=?pansionEreorganiNation o!outpatient ser'ices6 amenitiesand support ser'ices6 including

O Additional outpatient spaceO Shell space !or operating

rooms and radiologO )eorientation o! emergenc

room ser'icesO 1e( !amil None

The International Facilities Design & Capacit Con!erence "#$" ::

0oals !or the SLCH project


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0oals !or the SLCH project

%!!er a pri'ate roome?perience


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g p

-e !hild and .amily .ocused/=?press %ur Commitment to Patient & Famil FocusedCare Through %ur Facilities

-e 0isionaryBe Leaders in Pediatric Healthcare & Consistentl)e!lect That Leadership Through %ur Buildings

-e .unctional=nsure That Form Follo(s Function Throughout AllProjects & Facilities

-e )ealthy and Safe/Pro'ide a protecti'e and com!orting en'ironment !orpatients6 !amilies6 and sta!!

-e Accounta le/Doing (hat is right !or children in a responsi le andsustaina le (a

Q R impacted ne( guidelinesThe International Facilities Design & Capacit Con!erence "#$" :@

SLCH Facilities % jecti'es


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$5


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g

FundersBoardS stemHospital leaders

Ph siciansSta!!

Pri'ate rooms are agood thing

,hen ou treat a child6ou treat a !amil ; and

!amilies need morespace

This (ill e moree?pensi'e6 ut (orth it

The International Facilities Design & Capacit Con!erence "#$" :G


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Pri1ate Rooms Are a *ood 2hin$

Pri'ate )ooms Are a Clinical and Ser'ice


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Imperati'e

2hey are safer The higher pre'alence o! respiratordisease in a childrens hospital presents a higher ris/

o! cross ; in!ection in semi pri'ate rooms

2hey eliminate co&hortin$( Toddler teenager R

lous sleep t(o unhapp !amilies R increasedreco'er times

2hey im'ro1e medical education( A lac/ o! pri'acinter!eres (ith the e!!ecti'eness and con!identialito! !amil centered rounds

The International Facilities Design & Capacit Con!erence "#$" #

Pri'ate )ooms Are %perationall


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=!!icient

$ U o! patients undergo co horting relatedtrans!ers6 (asting hundreds o! hours o! nurse time

=!!ecti'e occupanc o! #U can e reached i! roomsare $##U pri'ate 4(hich means !e(er rooms needed7

1ote running higher than #U increases ris/ o! noteing a le to recei'e outside trans!ers6 e?cess =D

oarding6 and slo(er %)Eprocedural throughput5

The International Facilities Design & Capacit Con!erence "#$" $


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3hen 4ou 2reat a !hild, 4ou 2reat a .amily 5 and .amilies Need More S'ace

Pri'ate )ooms


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Families

At a critical point6 !amilies tra'el much greaterdistances and need more space

A pediatric admission is a 'er rare occurrenceand a signi!icant !amil stressor6 not a commonlaccepted part o! aging

O : U o! /ids6 . U o! seniors A'erage parent tra'els :. miles ,elcome to our ne( home pri'ate space to

li'e6 com!ort6 entertain6 eat6 (or/6 host 'isitors6li'e6 sleep6 and store our things


Families and 8isitors 1eed Space


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%utside the )oom as ,ell

Increase s*uare !ootage in !amil and 'isitor loungeson each !loor ; e'en as (e ma/e patient rooms iggerand create a separate !amil None

The International Facilities Design & Capacit Con!erence "#$" :

Create and =?pand Support Areas !or


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Patients6 Families & 8isitors

,ill e?pand spaces li/e our si ling pla room


Create a Famil Vone ;


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All Ser'ices Co Located

Famil )esource Center

AdmittingChild Li!e0i!t Shop8olunteersChapel

Laundr%utpatient Pharmac



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2his 3ill -e More 67'ensi1e, -ut 3orth It


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Dont +nder uild ; or %'er uild


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Total recommended (med/surg) 166 170 174% of calendar days fully private 79% 87% 92%% of calendar days withsemi-privates

21% 13% 8%

Days with 1-1 patients !semi-private" 3 23 8Days with 11-2 patients !semi-private" 2 9 12

Days with 21-3 patients !semi-private" 13 1 7Days with #3 patients !semi-private" 12 7 1

%ur 0oal 1e( pri'ate medicalEsurgical eds6 at leastG#U o! admissions !ull pri'ate6 at #U occupanc



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1IC+

## D0SF as the standard (e are using Space !or the e?tensi'e medical e*uipment

needed !or criticall ill neonates Space !or edside surgeries Parent sleeping should not e inade*uate at the

most critical time in a !amil s li!e Storage space !or !amilies li'ing at the hospital

!or .# da s is 'er challenging

The International Facilities Design & Capacit Con!erence "#$" @$


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uestions ,ere Struggling ,ith4and Ho( The )elate to the 0uidelines7


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4and Ho( The )elate to the 0uidelines7

Do (e uild more Acuit adjusta le rooms-Q

Ps ch capa le rooms or a unit o! ps ch rooms-Q Shell space to accommodate !uture IT solutions-

Ho( (ill (e alance Adjacenc (ith e!!icienc 4e5g5 anesthesiolog 6 radiolog 7- %n stageEo!! stage space- Integration o! research and education space on !loorsT The need !or common space !or multi disciplinar care as

(ell as pri'ate thin/M space-Q

Q R impacted ne( guidelinesThe International Facilities Design & Capacit Con!erence "#$" @.

uestions ,ere Struggling ,ith4and Ho( The )elate to the 0uidelines7


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4and Ho( The )elate to the 0uidelines7

Ho( (ill (e utiliNe con'erted et !ormerl semi pri'ate roomsat times o! surge-Q

Ho( (ill (e le'erage design to counter in!ectious disease4e5g5 air !lo(6 materials6 sta!! practices7-

Ho( (ill (e integrate lean thin/ing into our ph sical andoperational design-

Ho( can (e e!!icientl pro'ide ade*uate recum ent sleeproom space !or ph sicians6 trainees and !amilies-Q

Q R impacted ne( guidelinesThe International Facilities Design & Capacit Con!erence "#$" @:

& A


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designing the childrens hospital of the future the new guidelines

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