That was the opportunity presented to the cath lab team at The University of Kansas Hospital in October of 2001 when work began in earnest to design our new Center for Advanced Heart Care. The facility was conceived as part of the vision of the Mid-America Cardiology and MidAmerica Thoracic and Cardiovascular Surgeons, two groups of physicians who came to The University of Kansas Hospital in 2000 after leaving a successful heart program at another hospital.

Challenges in Planning and Construction Decisions

In October 2001, the hospital hired a prominent health planner, Frank Zilm of Frank Zilm and Associates, to assist in determining the appropriate size for a new heart facility and create an initial space plan. Subsequently, an RFP was issued to architectural firms following a national search for teams that specialized in heart centers. After a review of the RFP responses, site visits and interviews, the firm RTKL of Dallas, Texas, was selected to design the facility.

The other members of the team included one of the leading health care construction firms in the country, Kansas City-based J.E. Dunn & Associates, and a project management company from Denver, called Owners Representative Services. This team worked closely with our cath lab nurses and technologists, with the goal of creating a schematic plan for how the cath lab and its support elements would function in relation to each other and to the Center for Advanced Heart Care as a whole. The University of Kansas Hospital was also fortunate to have a very talented business and strategic development department that helped determine the right size for the facility based on the number of procedures that could be performed in the cath lab in a given period of time, plus factoring in estimated growth of the facility over the next few years.

Perhaps the most difficult planning element was accounting for the changing scope of practice within cardiac cath labs. It was felt that procedures were getting longer and becoming more acute. Therefore, traditional notions about how many cases could be done in a lab during a normal work day were challenged. As a result, space was allocated for future labs and 15,647 square feet is contained within the footprint of seven cardiac laboratories.

Another significant challenge was trying to understand what would happen to lab procedures in the period of time from the development of the design to the opening of the facility and beyond. Among the elements considered were the new pieces of equipment that would be added to the cath lab and how much space they would require. Equipment choices would also have to support the continuing endovascular trend. In the electrophysiology area, it was felt that there would probably be some other forms of navigational assistance equipment added to the lab to support the increase in ablation procedures, particularly for atrial fibrillation. In both the cath and electrophysiology (EP) areas, a great deal of time was spent exploring advanced concepts for integrating all equipment, as well as how data displays would be arranged in the laboratories. All of the ideas represented some significant challenges to conventional thinking.

Considerable time was spent in looking at how work was done in the cath lab. The director was adamant that the traditional control room concept did not work because the rooms were simply too accessible and needless traffic often distracted the physicians and staff during critical parts of procedures. Additionally, the labs were increasingly operational 24/7 and dealing with acute cases during off hours. The director felt it didnt make sense to isolate a technical staff member in an outside control room away from the procedure. To resolve these issues, an outer corridor was created away from the cath lab. A control room was created inside the lab so the technical staff member could very easily move from monitoring and recording to assisting with procedures. The role of the nursing staff was also carefully examined. It was decided that nurses needed a designated work area for charting and other tasks associated with the procedure, so a desk was added to the room. Each cardiac cath lab is 775 square feet.

In addition to making the cath lab large enough to accommodate unidentified future equipment, one of the other most significant construction decisions was ensuring that all of its systems conformed to operating room standards. This created an environment that could accommodate combined surgical/interventional procedures in the future or allow a scheduled interventional endovascular procedure to become an open surgical case without moving the patient. Within the cath lab, all air handling is similar to that found in operating rooms, with the required number of changes and filters in place. In addition, no sinks or drains are located in the cath lab.

Since the rooms were already large, it seemed perfectly feasible that if the right equipment was installed, the rooms could be used for a variety of procedures by different groups of specialists. Within the cath and EP labs, there is a central core (similar to an operating room central core) that serves all rooms. Patients are transported into the rooms using an outside corridor surrounding all of the laboratories. If cardiac labs were ever converted to surgery rooms or combined facilities became routine, it would be easy to connect all perimeter areas to sterile corridors. To further support this potential, an extensive card access system is used in this area and throughout the facility to regulate traffic.

Space planning called for modest office space for the clinical and technical director of the labs, as well as for the coordinators of the cath and EP labs. Space also was created for scheduling patients, two on-call rooms, a lounge/kitchen and a multipurpose classroom that can be divided into two smaller classrooms. Lots of supply areas were added. In addition, both lab areas have physician review and dictation space, including PAC stations for both radiology and cath images.

Prior to occupying its new heart facility, The University of Kansas had two cath labs, with a four-bed holding area right outside of the cath lab and a six-bed cardiac treatment and recovery space on another floor. When the new lab space was designed, cardiac treatment and recovery (CTR) was expanded to include 22 private rooms immediately adjacent to the cath lab. These are used for shorter stays and as an overflow for the chest pain area. CTR has its own central nursing station and 11 direct observation nursing stations immediately outside of each CTR room. Like other areas of the facility, these nursing stations are designed so CTR nurses are just steps away from anything they need to take care of patients. The eleven separate nursing/charting areas ensure that nurses are available for direct patient observation. Each private treatment and holding room is 171 square feet. The entire CTR area is sized at 7,606 square feet. Patients who require longer stays are transferred to one of the progress care units located in the Center for Advanced Heart Care. These rooms are all private, larger than the CTR rooms and measure 306 square feet. They feature a zone for the patient, the family and the caregiver, as well as a bathroom with a walk-in shower and folding shower bench. Hand-washing sinks are located just inside the door. The rooms also have individual thermostats that can be controlled by the patient or a family member. The observation/charting area is located between two patient rooms and has space for medications, supplies and patient records.

A large lobby consisting of 5,566 square feet is immediately outside of the CTR area and is shared with the adjacent Coronary Care Unit. A patient learning and resource center located on this same level supports all of the cardiovascular activities within the Center for Advanced Heart Care. Typically, staff from the CTR area brings patients from the facility’s admitting area up to the waiting areas. The family is usually asked to wait in the lobby area until the patient is in one of the individual CTR rooms and prepped. At that point, the patient’s family is free to come into the room and remain there until the patient returns from the procedure and is ultimately discharged. The CTR area has storage, and clean and dirty utility rooms similar to those on each end of the cardiac laboratories. Access into the CTR area is card-controlled, as are most areas within the Center for Advanced Heart Care. The cardiac labs, CTR area and coronary care are right above the emergency department and connected by large service elevators. This close proximity has contributed to a significant decrease in door-to-balloon time.

Surgical suites and a cardiovascular surgical intensive care unit are located on the floor directly above the cardiac labs. These operating rooms were designed using virtual reality techniques because of the large number of booms and surgical lights. The rooms feature flat-panel display technology in a fully integrated system with high-definition video systems.

A Place for the Heart, Built from the Heart (The Devil is in the Details)

The cardiac labs are a part of the Center for Advanced Heart Care at The University of Kansas Hospital. One of the ads for the new facility says it all when it notes, The Heart Center features capture and reflect a collective vision. The ad goes on to say that evidence-based design was used to create a healing environment. Taking the lead from the architects, many design features were incorporated that have been shown in literature and in practice to:

Produce better patient outcomes;

Prevent infections;

Create a safer environment for patients;

Reduce staff stress and ultimately, staff turnover.

Overall, the design focuses on creating an experience of total care for patients and their families. The healing environment concept suggests that a facilitys design has therapeutic effects on patients. Perhaps the earliest description of this concept can be found in passages of Florence Nightingales Notes on Nursing, What It Is and What It Is Not. Written and published in 1859, she says, I have seen in fevers (and felt, when I was a fever patient myself) the most acute suffering produced from the patient not being able to see out of the window and the knots in the wood being the only view… Little as we know about the way in which we are affected by form, by color and light, we do know this, they have an actual physical effect. Variety of form and brilliance of color in the objects presented to patients are actual means of recovery.

The physical environment does indeed play a role in patient outcomes and staff productivity, says Donald R. DeBord Jr., AIA, vice president of RTKL, the architecture firm that designed the Center for Advanced Heart Care. Current research continues to validate that private rooms, quiet environments, positive distractions, and natural light all aid healing. Furthermore, well-designed floor layouts increase staff efficiency and satisfaction. The Center for Advanced Heart Care is an exceptional example of how the many characteristics of healing environments can be incorporated into hospital design.

Evidence-based healing environment is apparent throughout the Center for Advanced Heart Care, from the front door and the public spaces to the back corridors and behind-the-scenes systems. Lobbies and waiting areas feature large, open spaces with a great deal of natural light. Careful attention was paid to colors, which include purples, greens, blues and teals, suggesting comfort, balance and tranquility. The building itself is very high-tech, with high-performance systems throughout. There are lots of quiet zones, and visitors often comment that there is almost no noise.

Great attention was paid to patient privacy. There are separate elevators for patients and staff movement and for the public. Seating in public spaces takes the family into account, by grouping chairs for family members to gather and relax. There is enough space between groupings to give a feeling of privacy. The seating takes advantage of natural lighting whenever possible and is supplemented by lots of indirect lighting at night. The lobby areas resemble the public spaces in an upscale hotel, once again offering a calming effect on guests. Safety for guests and staff is another important consideration of design. The facility has many card access control zones to include elevators, security checkpoints and an extensive video surveillance system with automated features.

Detailed employee input helped define the overall project, which sought to bring caregivers closer to patients. Decentralized nursing stations and nursing stations within specialized procedure areas facilitate treatment and minimize staff movement. Hotel-style amenities abound in the building and include valet parking, room service food and a concierge service. Elizabeth Clark, Director of Clinical Services for the Center for Advanced Heart Care, summarized everyone’s feelings when she said, Its thrilling to see how many features of the Center for Advanced Heart Care reflect our vision.

The Finishing Touches

The new Center for Advanced Heart Care promotes an atmosphere of comfort and convenience, as well as an inspiring environment for healing. Art showcased throughout the facility contributes to the healing atmosphere and the overall well-being of patients and their families. Thirty-one original paintings by a prominent Kansas City artist are displayed in the public atriums on the first three levels and a remarkable glass installation, called Pulse Flow, hangs in the foyer. The long, curving line of the sculpture is meant to suggest a cardiogram. A glass chandelier made of the same glass elements hangs near the grand staircase. This represents the heart. Close to 1000 other framed pieces of art are hanging in corridors and guest rooms throughout The Center for Advanced Heart Care, including close to fifty in the cardiovascular treatment and recovery area.

From curbside to bedside, for staff, physicians, patients and families, the Center for Advanced Heart Care is an inspiring environment for healing. It is a place where patients and their loved ones come for the regions most compassionate, high-quality care.

John Florio can be contacted at: jflorio@kumc.edu