In Control

Hospital Command Centers Are Changing How Providers Care for Patients and Coordinate Logistics

December 4, 2019

Partner, NBBJ

Editor’s Note: This post was originally published in Healthcare Design. It was coauthored by Teri Oelrich and Donald Bellefeuille.

Hospitals represent some of the most complex buildings on our planet, monitoring tens of millions of data points, pieces of equipment and people every day. Examining and tracking all these interconnected and critical parts in real time is a great challenge, especially when delays can be a matter of life and death. In response, many health systems, hospitals and outpatient centers are developing command centers — akin to air traffic control centers — to meet the need for monitoring, analyzing and tracking the thousands of pieces of data.

These centers — the so-called “brains” of a facility — take different forms, from a room to a series of rooms, located on- or off-campus depending on scope and space needs. They are equipped with a variety of technologies, powered by artificial intelligence and predictive analytics, to process and display a range of real-time data, from hospital bed availability and patient transfers to equipment tracking and patient monitoring. Housed within these centers is a variety of professionals, including doctors to update care protocols, nurses to monitor patient stats and vitals, technicians skilled at telemetry, and aides to monitor patients. Incorporating environmental, patient transport and material management staff can also ensure efficiencies in bed turnover, patient movement and supply delivery, helping keep costs in check by increasing overall throughput and occupancy.

This setup allows hospitals to be proactive rather than reactive by helping staff address issues as they arise. For example, staff can receive alerts when backups occur in the imaging room and patients are waiting for services, helping to quickly resolve the flow issue. Centers that monitor the physiology of patients can use the algorithms generated to spot patient changes much faster, allowing clinical staff to intervene and treat the issue sooner and avoid medical complications. Command centers can also help unite previously siloed teams, from inpatient room logistics to procedure schedulers to clinical specialists, and enhance communication among employees, enabling staff to coordinate alerts and more easily track follow-ups through a patient’s electronic medical record. Finally, these spaces can also help boost patient and family satisfaction and provide comfort to loved ones who are reassured knowing there are multiple layers of monitoring and care in place.


Design Considerations

When deciding where to locate a hospital command center, it’s important to keep in mind that these facilities don’t require expensive hospital-grade space. This can create flexibility, as both on-site and off-site locations are suitable. For a large hospital network, an off-site command center outside the urban core may help lower costs because it’s less expensive to build and can free up space for clinical care on campus. However, a smaller rural hospital may choose to keep a single-room command center on-site for integrated access and cross-utilization of staff.

Another key issue to consider is the scope and type of command center. Will it serve a single hospital or a whole system? Will the command center include one site or multiple sites with collocation and remote collaboration? Generally, a command center that monitors patient flow would be about 1,500-2,000 square feet, but the overall size depends on the amount of services a hospital plans to incorporate. For example, a command center that intends to include centralized physiological monitoring for a hospital, or for several hospitals, would need at least double or triple the space requirement noted above. Services like remote patient sitters and emergency and disaster response will also require additional square footage. In all respects, command centers should be designed to expand to accommodate future technology and added services, as well.

These variables will also impact the number of staff members who need to be accommodated in the center as well as the size and layout of workstations. For example, while a typical workstation in a medical facility is 6 feet by 8 feet (48 square feet) per person, many other details need to be considered for a command center, such as the number of monitors per station, acoustical or visual privacy, ceiling heights to accommodate large hanging computer screens, and lighting controls that ensure proper screen readability and minimize glare. This means the workstation could be smaller or larger, depending on services and equipment requirements.

Other space needs may need to be accommodated, as well. For example, command centers that incorporate telemedicine capabilities will need private rooms with monitors so the practitioner can have private conversations with patients, much like what occurs in an exam room. Having respite spaces that allow command center staff who work with frequent auditory alarms and visual alerts to get quiet off-screen time is also important to prevent fatigue and burnout. Testing different layout scenarios and building mockups of the physical space to gather feedback from a variety of key stakeholders and decision-makers can help maximize space and lead to more efficient design solutions that work for everyone.


Accounting for Costs

The main factors that drive the cost of command centers are construction fees to build the facility, the initial expense of equipment to outfit the center, and then technology upkeep. Selecting an appropriate site for a command center is critical, as the cost to build can hinge on several factors, such as off-site versus on-site locations and urban versus suburban versus rural settings. Backfilling unused, older hospital space with a command center can often be more costly than new construction in non-hospital space due to the difficulties in retrofitting modern technology into old, ill-configured space. Once all the requirements have been established, it’s vital to consider the business case for both options (backfill and new construction) to determine a cost-effective choice that fulfills not only immediate needs but the long-term evolution of the command center.

Additionally, equipment costs, as well as technology maintenance and staff training, need to be considered. Command center designs must support powerful systems that harness the algorithms, predictive analytics and artificial intelligence that can help command center staff coordinate logistics and monitor patients. Therefore, the command center will need emergency power, highly efficient Wi-Fi technology, its own data center and integration into the system’s back-up data storage.


What’s Next?

As healthcare undergoes a technological revolution, hospital command centers, still in their infancy, are paving the way for other smart innovations. For example, with assistance from a command center, what if every hospital could employ artificial intelligence-driven patient monitoring to assist caregivers to create a customized precision medicine plan that’s tailored to a specific patient, and then adjust it in real time?

Additionally, other technologies could be supported via command centers, such as transport robots that deliver automated medical supplies and patient medications throughout a hospital. Cloud-based remote monitoring could provide closer communication between hospitals and patients across the full treatment timeline — from pre-admission to treatment to recovery and long-term care.

Hospital command centers can improve patient outcomes and experiences, optimize care delivery and lower operational costs. By designing spaces that host real-time hospital data and machine learning and unite staff across hospital departments, command centers can improve the ability of staff to care for patients, predict and flag medical risks and streamline patient care.

Banner image courtesy of Tim Griffith/NBBJ.

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The Re-Socialization of Patient Care

True Patient-Centered Care Requires a Holistic Approach to Meeting a Patient’s Physical, Mental, Spiritual and Social Needs

October 28, 2019

Healthcare Partner, NBBJ

Editor’s Note: This essay was originally co-authored by Rich Dallam and Ryan Hullinger for the December 2018 issue of A+U. It is reprinted here with the permission of the publisher.

Healthcare has seen a widespread shift in focusing on the patient experience. While this encompasses many, sometimes competing, priorities, for NBBJ a major concern is the social aspect of care. Hospitals today are increasingly building single-patient rooms to reduce infection and improve the patient experience; however, true patient-centered care requires much more than maximizing comfort: it requires a holistic approach to meeting a patient’s physical, mental, spiritual and social needs.

This approach brings many different clinical specialties — physicians, nurses, mental health professionals, dieticians, physical therapists and more — together to work for the patient’s benefit. As a result, examination and patient rooms are frequently expanding in size, even as cost concerns drive healthcare providers to reduce square footage wherever possible.

To accommodate these diverse specialties without inflating space needs and construction costs, NBBJ has adopted rapid prototyping in the planning of examination and patient rooms. This process engages clinicians, patients even cleaning staff to role-play within full-scale mockups of a proposed room, and then to quickly reconfigure and iterate the layout to not only better accommodate staff workflows, but also to holistically meet patients’ needs.

In an April 2013 workshop with the Canterbury District Health Board in Christchurch, New Zealand, rapid prototyping aimed to design a multi-patient room that would improve healing by increasing socialization amongst both staff and patients, while still meeting contemporary needs for privacy and infection control. NBBJ is now using three-dimensional scanning to import physical mockups like this into digital models — a process referred to as digitally augmented rapid prototyping — which enables designers to document, analyze and make adjustments to a layout in real time and arrive at solutions faster.

Working with Native populations — particularly in Alaska and the Pacific Northwest, in addition to the Maori of New Zealand — challenges the prevailing notion that de-socialized, private patient rooms are always the best solution. In tight-knit Native communities, the social aspect of a person’s well-being is tied to their cultural identity. That’s why several integrated healthcare clinics designed by NBBJ for Alaska Natives and the Umatilla people of eastern Oregon are organized around a central gathering space, where people can connect and support each other through their healthcare journeys.

Lessons from this work with Native populations are now informing other projects, by finding new ways to incorporate patients’ families in the healing process. This has long been done, and amenities are continually improving, but new design concepts take this further by enabling the patient room to flex throughout the day to accommodate work, socializing, family meals and overnight guests — allowing daily life to continue even during an extended hospital stay.

For times when families are unable to join their loved ones in the hospital, NBBJ is now prototyping an augmented reality patient room that will enable them to be virtually present. The concept utilizes projection mapping and surround sound to create an immersive, 3D environment customized to the fixed perspective of a patient lying in bed. With this technology, the patient room can virtually disappear, replaced by a live view into the home that allows patients to remain connected to their families. This technology can also create immersive natural environments, as exposure to nature — even if only simulated — is proven to reduce stress and help people heal faster.

Like digitally augmented rapid prototyping, the augmented reality patient room utilizes the newest design tools and features. Most importantly, however, that technology is always employed in the service of increasing social connections and improving the human experience.

The potential — and challenge — of integrating new technology into the patient room suggests a new frontier for patient care: flexibility. When social demographics and technology are undergoing massive changes, too quickly for fixed infrastructure to keep up, how can we design an environment for rapid adaptation? Only when healthcare environments are flexible enough to keep pace with our evolving communities, as the ways in which people live and socialize inevitably shift, will we truly be prepared to provide the healthcare of the future.

Banner image courtesy Benjamin Benschneider/NBBJ.

All other images courtesy NBBJ.

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‘It Is Crucial That We Send the Message That Behavioral Health Patients Are Valued.’

A Conversation with Tammy Felker, Registered Nurse and Architect, NBBJ

October 11, 2019

Partner, NBBJ

Editor’s Note: The number of people reporting behavioral health issues is on the rise, a crisis often compounded by lower-than-average funding, a lack of psychiatric beds and high occupancy rates of behavioral health facilities. This week we are posting interviews with experts in behavioral health, following an NBBJ-hosted panel discussion, to learn how different parts of the country are addressing the crisis.


NBBJ: You plan spaces across specialties, but you are especially focused on behavioral health facilities. Given your expertise, how should these spaces evolve?

Tammy Felker: In the past, behavioral health spaces were designed like jails and featured prison-grade materials, such as tamper-proof lighting fixtures and plumbing. As a result, these environments feel institutional and cold.

Thankfully a shift in mindset is starting to transform the industry, creating a normalized care experience so patients feel safe, but also valued. Fixtures are becoming less institutional-like, and there’s a holistic emphasis on providing warm and therapeutic spaces.

One specific area we’re investigating is the integration of circadian lighting. Regulating sleep-wake cycles is especially important to the behavioral health population for healing, and it is ripe for further study and analysis.


What are the most impactful changes that could be made to how behavioral health spaces are designed?

The first change is to rethink spatial density. Studies show that too  many people in a small space can increase aggression. In behavioral health centers, giving enough square footage beyond the code minimum, so everyone has their own space, can make a difference in creating a normalized environment.

Another is to provide room for physical activity, from yoga to treadmills. Research demonstrates the positive benefits of exercise on anxiety and depression. Current building codes for inpatient behavioral health units don’t require exercise areas, but as a result, they are missing a great way to support the link between lifestyle choices and behavioral health.

A third element to consider is nature integration, ideally with access to the outdoors. Design that addresses our primal connection to nature can help decrease blood pressure and the use of pain meds. Even an area for horticultural therapy and opportunities to take care of plants can help.


Why should investments in treatment and design go hand-in-hand?

Our spaces and places convey meaning, and it is crucial that we send the message that behavioral health patients are valued. In fact, it may be more important to have a well-designed behavioral health facility than a typical healthcare space. That’s because behavioral health patients typically spend very little time in their bedroom and are constantly interacting with staff and other patients. Meals are usually in a group setting, and there are different therapy sessions, from art to group to individual sessions. Design needs to be supportive of this treatment model.


What makes you hopeful when it comes to addressing the behavioral health crisis?

The first is the Affordable Care Act and healthcare parity laws that require treatment of mental illnesses just like physical illnesses — and that people can get insurance that covers behavioral healthcare. Funding to train more doctors, nurses and other staff that specialize in behavioral health is another. In Washington State, Governor Jay Inslee is proposing an initiative that puts funding in place for a new 150-bed behavioral health teaching hospital in Seattle, along with community behavioral health centers across the state.


Images courtesy Sean Airhart/NBBJ.

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