Minimize the Stress, Maximize the Comfort

Individuals requiring the services provided in a cath lab are often under stress. Their medical condition also creates stress for their families and often for those providing treatment. Two overriding considerations guide cath lab design staff efficiency, and patient and family comfort. These considerations impact the way service is delivered, including locations and adjacencies, which impact patient transport and aesthetics. Keeping these two missions at the forefront during planning and design results in facilities that successfully fulfill their mission. Locations and Adjacencies In an ideal world a new cath lab facility all services are in one location. Everything can be placed as desired to create the optimum environment and adjacency. However, new Greenfield facilities are not always possible. The challenge, then, is to expand or renovate an existing facility to provide the required cath lab and support environment. Unfortunately, this may mean that the optimum location or adjacency cannot be provided. The goals for all projects are the same: Minimize transport of the patient which benefits both the patient and staff; Put all services/products as close to users as possible; Maximize communication among cath lab staff; Create a calming environment for patients and their families to reduce/minimize stress, which includes keeping them as close to each other as possible. Inpatient and outpatient services merit different design considerations. Again, new facilities have an edge because they are developed from a clean slate. The $29 million Wisconsin Heart Hospital, in Wauwatosa, Wisconsin, provides a good example. Officials elected to situate outpatients on the first floor of the new 127,000-square-foot, 61-bed facility (40 beds for inpatients, 21 beds for outpatients) based on its projection of 85 percent of its service caseload being outpatients and 15 percent inpatients. Day patient/outpatients are immediately across the hall from the cath labs to allow for the immediate provision of treatment services. The first floor also includes an emergency chest pain entry, which also offers quick access to one of the facility’s six cath labs three general labs, one electrophysiology (EP) lab, one vascular and one special procedures lab. Inpatients are situated on the second floor near the hospital’s three open-heart operating suites. Patients who require services but who may not be in immediate danger are adjacent to the services they will need for scheduled procedures. Transport distances are minimized and routes do not compete with emergency situations, resulting in a more efficient movement for staff and patients. Close is best is a good maxim to keep in mind, and that obviously includes the situation of services and products for the staff. One key issue, which can be overlooked, is to provide adequate storage in the cath labs themselves. In fact, having more storage is better than less. This allows cath labs to stock for any eventuality in order to maximize time when it may be of the essence. There is no need to bring something in from another room. Maximizing communication among staff is also critical. And there are differences in communication arrangements, in this case, cath labs and control rooms, between large and medium, or small facilities. Two examples illustrate this point. The cath lab ratio at the Wisconsin Heart Hospital is 1:1 one cath lab to one control room. Control rooms are adjacent to each cath lab with no barrier between the two rooms. Administrators and physicians determined that this was the optimum arrangement to allow for maximum speaking interaction between the physician and the control technologist. The control tech hears everything in the lab without having to resort to a microphone and speaker. At Saint Mary’s/Mayo Clinic in Rochester, Minnesota, administrators and physicians employed a different design configuration that is more appropriate for their much larger facility, which is licensed for 1,200 beds. The hospital has a 2:1 ratio, or two cath labs per one control room, and a shared computer room. The hospital has 12 cath labs in one location/one floor, and it was determined that this arrangement would allow radiology personnel to participate in the provision of services in two cath labs if required. Personnel at individual facilities must determine up front whether the 1:1 or 2:1 ratio is best for them, depending upon individual practice needs. Finally, waiting areas for families must be close to the cath labs, which is especially true for outpatients. This may not be possible in renovated or expanded facilities, but it should be optimized as much as possible. Keeping families as close to the patient as possible during treatment can reduce their stress and anxiety. Aesthetics A residential design feel is very appropriate for cath lab facilities. This helps to reduce stress, and creates a comfortable environment for patients and their families. Cath labs have a high degree of technology, which can create a feeling of confidence for patients and their families since they know sophisticated services are available. However, technology also can be intimidating. The goal is to soften technology’s impact and the individual’s situation through a facility’s aesthetics. Patient transportation again comes into play. Hospitals should consider the experiences a patient encounters when being transported, in addition to the distances they cover. What will the patient see, and what will they pass? Make it as soothing as possible through the sensitive use of materials, design details, colors and lighting. Earth tones are soothing and calming. Bright colors, while an excellent choice for a pediatric unit, may not be suitable for a cath lab facility. The inpatient/outpatient arrangement at the Wisconsin Heart Hospital allows for a window in every patient room, including 23-hour stay rooms. Being able to look outside provides an alternative to watching television, conversing with family and friends, or counting patterns in the wallpaper, and also reduces stress. This is an important design provision, since a patient may have to wait a long period of time before treatment. Having a connection with the outside world helps patients feel more secure and in control. Some hospitals have separate areas for cath lab patients to recover following procedures since they are awake (as compared to surgical patients who may awaken over time). This ideally requires slightly more square footage per patient so that they do not feel boxed in the room. Cath lab patients must remain prone for a time following a procedure, and they should not have to stare at the walls. At Saint Mary’s, televisions with individual remote controls are included in each recovery area. Patients have something to occupy them, if desired, until they can be moved or discharged. Cath lab design greatly impacts the experience for staff, patients and their families. Administrators and facility personnel who keep the two main goals in mind staff efficiency and patient and family comfort will successfully provide facilities that minimize the stress while maximizing the comfort. Bernie Gehrki, AIA, senior vice president, HDR, is a nationally recognized leader in the planning and design of cath labs and other healthcare facilities. He has more than 20 years of experience in both new and renovation projects, and has worked with clients throughout the country. Gehrki may be reached at (402) 399-1000 or via email at Bernie.gehrki@ hdrinc.com. Mike Tangney, AIA, is a senior healthcare designer in HDR's Dallas office, and has planned and designed healthcare facilities for more than 20 years. He can be reached at (972) 960-4000 or via email at mike.tangney@hdrinc.com.

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