Conquering the Complexities of Cath Lab Phasing:Communication and a willingness to take small steps help to complete complex

Retrofitting a cath lab as part of a major facility project requires multiple approaches to meet often-complex phasing issues. Cath labs must remain operational throughout any project and construction must impact the staff as little as possible. The following four steps are key to achieving success: Gather extensive data Evaluate design approaches Openly communicate with all parties throughout the design phase Phase construction to maximize the hospital’s investment while minimizing disruptions for patients, their families and staff. One Facility’s Experience The New Hanover Regional Medical Center in Wilmington (North Carolina) is in the midst of a two-phase project that will dramatically impact the hospital’s facilities and operations. Phase I has a construction budget of over $100 million and is scheduled for completion in 2008. Components include a new 26-OR surgery department with expanded preparation and recovery (76 beds), a post-anesthesia care unit (28 beds), central sterile support and a new entry. The project also involves a new women’s and children’s facility. Phase II, valued at $90 million, is scheduled to begin immediately following completion of Phase I. This phase includes renovation of the existing inpatient bed tower, emergency department expansion, new interventional suites, including cath labs, and consolidated staff support, prep/ recovery and conference areas. Also part of this phase is a completely renovated and consolidated imaging department. Future phases will include the relocation of existing intensive care unit beds into the Phase I surgery tower. This will leave space for the heart-vascular department’s preparation and recovery beds. Knowledge and Communication: Foundations for success During programming, initial knowledge-gathering and ongoing communication are two of the most important tools in complex projects’ successful phasing. While these components may be viewed as a given, too often the gathered material is not completely analyzed. Members of the programming and design team must continually discuss recommendations with appropriate hospital staff. The New Hanover project team went through an intense programming phase with hospital personnel. The team analyzed the project based on how the design will allow the hospital to offer the best patient care possible while meeting staff efficiency goals. Meetings with hospital staff involved both programmers and designers with expertise in large, complex healthcare projects. Participants discussed current and future needs, including the existing space’s limitations, based on staff preferences and hospital philosophies. The goal was to develop a cohesive solution for patient care and staff service delivery. Following these meetings, the programming and design team completed an exhaustive analysis of all the data. Presentations were then made to executive-level personnel to obtain their feedback and comments were incorporated into the initial design recommendations. This interactive back-and-forth process continued until the optimum design was achieved. Cath Lab Requirements The team determined that the new cath lab space and associated modalities required a new approach. The main goal was to consolidate services in one area rather than spreading them throughout the hospital, as is the current situation. Just meeting this goal alone will greatly improve operations. The final design addresses current and future staff needs, and also accommodates a new approach to operations within the cath labs and other interventional suites. The design will be more functional and appropriate for all users. Efficiency will increase, a more cohesive environment will be provided, circulation will improve and space will be wisely used. Small First Steps Often Make Sense The team identified a programmatic need for electrophysiology (EP) space prior to the completion of Phase I. The solution was to construct two new EP labs in the existing imaging area to meet heart-vascular demand. The labs’ construction at this point must fit within the overall plan. The team identified the labs’ ultimate location and worked the phasing and construction so that the labs will not have to be relocated during Phase II, thus meeting the current need. This approach is more cost-effective than locating and then relocating the EP labs. A Cohesive Area The new heart-vascular area will include 11 interventional suites, including cath labs, EP labs, vascular labs and special procedure/radiology labs. These will be placed so that staff can share resources between suites, maximizing efficiency. A new patient and family entry will be constructed where the current entry exists; it will include a waiting area where none currently exists. This defined entry will reduce confusion and anxiety for patients and their families, who now are forced to wait in a hallway. The entry component includes the demolition of two banks of existing elevators that serve different levels; they will be replaced with a single elevator bank that has access to all levels. The combined new elevator and entry tower will greatly improve circulation and wayfinding. The number of patient rooms will also be increased to reflect the increase in the number of interventional suites. Additionally, the patient room concept itself will change. Instead of separate holding rooms for prep and recovery, the new patient rooms will be single-point-of-care rooms. Family members can wait there while the patient is undergoing treatment, and the patient will return to the same room. This approach creates a less stressful environment for patients and their families. Each lab has its own separate and secure storage for the modality being performed in the lab. Although this requires more space than common storage that is staff-accessible from all labs, it is more staff-friendly. Inventory can be monitored closely, and supplies are located in the lab rather than outside in a storage room. Imaging will be located between heart-vascular and the surgery department when Phase II is complete. This provides the most efficient and best long-term solution for space usage and staff efficiency. Two of the 26 new operating rooms will be dedicated to heart procedures and are located closest to the heart-vascular center to minimize travel distances for patients and staff. Meeting the Goals When completed, the New Hanover project will provide facilities that meet the hospital’s current and long-term goals. Conquering the complexities of cath lab phasing will be successfully accomplished through extensive communication to find the optimum solution, resulting in an environment that is most appropriate for patients, their families and the hospital’s staff. *New Hanover Regional Medical Center in Wilmington, North Carolina. Photography provided by HDR. Mike Tangney, AIA, is a senior healthcare designer in HDR’s Dallas office, and has planned and designed healthcare facilities for more than 23 years. He may be reached at (972) 960-4106 or via e-mail at mike.tangney@hdrinc.com.

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