Creating Flexible Space Out of Existing Space

Bakersfield Heart HospitalCreating Flexible Space Out of Existing Space

September 21, 20111:30pm to 3:00pm

Presenters• Michael Bell, MBA Vice President, Operations

Bakersfield Heart Hospital• Phillip Bahr, AIA Associate Principal

Cannon Design• Joseph Livengood, MD, FACS Acute Care Surgeon

Medical Center of the Rockies

Flexible Care Design

Change Makers

Learning Objectives

• Identify patient entry point and flow characteristics unique to the Cardiac Hospital.

• Evaluate the use of a Flexible Care Unit to serve multiple patient care areas.

• Identify metrics for critical review when building a Flexible Care Unit.

• Explore an advanced concept for Flexible Care Design inspired by the Bakersfield project.

Bakersfield Heart Hospital


• Throughput Symptoms• 110% at capacity during peak hours• LWBS rate increasing• Transfer requests turned away due to “No

Beds”• ER patient satisfaction complaints

increase• Related to privacy and comfort• Inpatient holds hours increasing

Bakersfield Heart HospitalPrior to 1st design

Owner’s Perspective

Michael Bell, MBA VP, Operations


• Vision of a team of physician and staff specialists “dedicated to fighting one disease – heart disease.”

• Physician Led - empowered physician leadership with significant decision making roles for technology .

• Patient Focused - reduce number of caregivers interacting with patients.

Effective: Clinically proven care provided at the right time and

way for the patient’s needs.

Efficient: Services provided are appropriate to the needs of

the patient while managing resource utilization.

Safe: Care provided that minimizes risk of harm to the

patient and staff

Patient Centered: Keeping the emotional, spiritual and physical well-being of the patient in the center of our care results

in a positive patient experience.

Hospital Origination and Vision

Facility Overview

• 47 private inpatient beds (including 10 critical care beds)• 3 operating rooms with complete facilities for heart and vascular surgery • 4 cardiac catheterization labs with 1 lab equipped for electrophysiology • 20 outpatient and recovery rooms• 8 bed emergency department • Technologically advanced cath labs• Over 228 employees in addition to the medical staff • Highly trained, caring clinical staff • Over 20 of the leading cardiologists and cardiothoracic and vascular surgeons

in Bakersfield

Floor Plans

DepartmentsSquareFootage

ClinicalOperating RoomCardiologyAdministrative & GeneralOperationsEmergencyRadiologyDietaryHousekeepingLaboratoryMedical RecordsRespiratory TherapyPharmacy

28,68512,19210,444

9,8069,6934,9714,6623,5781,5671,1721,1281,0711,031

Service OfferingsBakersfield Heart Hospital (BHH) is a 47-bed acute-care hospital providing care in:

• General Medicine• General Surgery• Hematology• Nephrology• Neurology• Medical Oncology• Pulmonary• Rheumatology• Thoracic Surgery• Vascular Surgery• Cardiology• Cardiovascular Surgery• Emergency Medicine• Interventional Radiology

Procedures Supporting Services InpatientOut

PatientCardiology

Diagnostic Angiogram X XAngioplasty X XDrug Eluting Stent X XIntravascular Ultrasound X XElectrophysiology Studies X XPace Maker Implantation X XAICD Implantation X XEcho Cardiography X XStress EKG X XUltra Sound X X

Cardiac SurgeryCABG on and off pump XValve Repair X

VascularPeripheral Vascular Angiography X XPeripheral Vascular Intervention X X

General Surgery X XMedical Procedures

Bronchoscopy X XEndoscopy X XAcute Dialysis X

Payor Mix Trend

Payor Mix (based on Admits, budget based on Net Rev) FY2009 FY2010

FY11 June YTD

Medicare 53.00% 59.4% 59.4%Medicaid 4.60% 4.4% 5.8%HMO 7.50% 2.4% 2.3%Commercial (Other, PPO, Blue Cross) 10.40% 13.5% 12.8%Self Pay 2.80% 3.2% 3.9%Medicare HMO 21.80% 13.6% 10.4%Medicaid HMO 1.40% 1.9% 2.1%Medicaid Pending 0.70% 0.7% 1.9%Medicaid Outsourced 0.00% 0.0% 0.0%Indian Health 0.00% 0.0% 0.0%Worker's Comp 0.50% 0.5% 0.6%Champus 0.20% 0.0% 0.7%

Architect’s Perspective

Phillip Bahr, AIA Associate Principal

Cannon Design

CAMPUS SITE PLAN

Campus Site Plan

First Floor Plan

Second Floor Plan

Schematic Detailed Plan

Change Makers

YouTube Construction Video

Hotel Stacking Diagram

Hospital Level Diagram

UNDER 23 HOUR

OVER 24 HOUR

Clinician’s Perspective

Joseph Livengood, MD, FACS Acute Care Surgeon

Medical Center of the Rockies

Bakersfield Heart HospitalPost- Design

Patient Care Areas

• ED• OB/Gyn• Pre-op• PACU• SICU• CICU• NICU• TICU

• Step-Down• Telemetry• Surgical• Post-Trauma• Med/Surg• Women’s Care• Oncology• Orthopedics• Neurology• Rehab

Acuity-Adaptable DesignA patient space that accommodates the care of patients along a continuum of needs.

Universal Room DesignBuild a space that can accommodate all patients from ICU to Floor

Flexible Room DesignBuild a basic room and bring care to the patient.

Patient Care Areas

•ED•OB/Gyn•Pre-op•PACU•SICU•CICU•NICU•TICU

•Step-Down•Telemetry•Surgical•Post-Trauma•Med/Surg•Women’s Care•Oncology•Orthopedics•Neurology•Rehab

•ED•OB/Gyn•Pre-op•PACU•SICU•CICU•NICU•TICU

•Step-Down•Telemetry•Surgical•Post-Trauma•Med/Surg•Women’s Care•Oncology•Orthopedics•Neurology•Rehab

Staff Qualification

• ICU-Level ED Preop PACU ICU

• OR Spine Cardiac General Trauma ENT GYN Robotic EyeFloat Pool ??

• Floor Medical Cardiology Surgical TraumaWomen’s

Care

Slide Title

Pre-opPACU

Endoscopy

CathLab

EROBS

Thursday, 8pm

1 Call RN

1 Call RN

1 Call RN

1 Call RN

Foreign Body

AcuteCholecystitis

LAD

IntoxicatedConcussion

ManagerStaffCall SchedulePolicies




Peri-Operative Area

Pre-opPACU

Endoscopy

CathLab

EROBS

Peri-Operative Area

Foreign Body

AcuteCholecystitis

LAD

Intoxicated Concussion





2 Call RN

Procedural CallStaff- GO HOME

2 Call RN

1 Manager1 Staff Pool1 Call Schedule1 Policy Set

Thursday, 8pm

Pre-opPACU

Endoscopy

CathLab

EROBS

Peri-Operative Area1 Manager1 Staff Pool1 Call Schedule1 Policy Set

Procedural Call Staff- GO HOME

2 Call RN

• ER OBS Unit now staffed 24 hours• Off-Loads In-Patient Units• Minimizes Reimbursement Confusion

Universal Room Design

• Benefits• Simplified flow

• Detriments• Patient satisfaction• Difficult to staff• Expensive

Flexible Room Design

Traditional room design confines a patient to bed predisposing topreventable complications.

The Platform opens up the room to the patient, empowering mobility and improving outcomes.

Barriers to Flexible Design

• Operational Silos• ED• Peri-op• OR• ICU• Step-Down• Med/Surgery

• Staff Training• Flexible • Float Pool• Open Unit• Overflow

Cardiac• ED• Cath Lab• CCU• Telemetry• Rehab

• ED• CT• OR/PACU• ICU• Step-Down• Post Trauma• Rehab

• 60 minutes• 30 minutes• 3 hours• 3 days• 2 days• 4 days• 3 weeks

TimeTrauma

Slide Title?

Discontinguous Care Units

SICU NEURO

Flexible Care Unit

Flexible Design Areas

• ED• Peri-Op• ICU - Intermediate - Med/Surgery• Med/Surgery

Emergency Preparedness

• Design and planning should incorporatedisaster planning

Expanded Float Pool

• Organize by skill sets more so thandepartments

Leadership Behind the Change

• Strong, committed management team

• Lean Process (along the entire serviceline)

Summary

Closing Slide Text?

Contact Information

• Michael Bell, [email protected]

• Phil Bahr, [email protected]

• Joseph Livengood, MD, [email protected]

mailto:[email protected]�



Thank You

Creating Flexible Space Out of Existing Space

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