By Christine Lewers
Shelly Schwedhelm can only imagine what it's like to train for a surgical career in the Hixson-Lied Center for Clinical Excellence's new operating rooms.
Surgical equipment and flat screen monitors hang from booms over operating tables. The monitors broadcast video taken from endoscopes inside bodies. They also project data and images flowing into the operating rooms from labs, radiology, and the hospital's electronic medical records system. Surgeons control the booms' positions and what information the monitors display via a touch screen panel. A 42-inch LCD flat screen monitor embedded in the operating room wall collects the images in one place where others in the room can easily see them.
GRAPHIC: Leo A. Daly
Designers met weekly with hospital staff to study the unique technology, workflow, and ergonomic issues within each department. As a result, each floor has a pulse of its own.
"You couldn't see anything when you were training," says Schwedhelm, referring to her operating room education 25 years ago. Schwedhelm was head of perioperative services and trauma during planning for the new building, which is part of The Nebraska Medical Center, the teaching hospital for the University of Nebraska Medical Center in Omaha. She's now head of emergency, trauma, and disaster preparedness.
"Now it's all right there in front of you."
The 165,000-square-foot Hixson-Lied Center opened in January 2006. The total cost of the project was $56.5 million. In addition to 20 operating rooms, the building houses the Midwest's largest emergency department, state-of-the-art radiology and interventional radiology departments, and a level III newborn intensive care unit, the highest in tertiary care.
"The entire layout of the floors was to make it No. 1 in customer service," says John Lehning, The Nebraska Medical Center's director of facilities. Top-notch patient care, he adds, boils down to how safely and efficiently hospitals operate.
But building efficiencies around the complicated equipment and tasks that go on in hospitals isn't easy, he says. Medical specialties and technologies are advancing so quickly, it's difficult to design up-to-date spaces for accommodating them.
Lehning credits the success of the Hixson-Lied building to a team seasoned in the design and construction of hospitals,making hospital staff an integral part of the design process, and incorporating early and extensive planning.
Spacious and open trauma bays help emergency department staff treat the most serious cases.
The medical center teamed with architectural firm LEO A DALY and construction company Kiewit on the project. Both have Omaha headquarters and both have been involved at various stages in the medical center's history of reorganization and renovation.
Prior to Hixson-Lied, The Nebraska Medical Center was made up of the seven-floor University Tower and the nine-floor Clarkson Tower, two buildings separated by Dewey Avenue just west of downtown. The towers operated as independent hospitals until they merged in 1997. Hixson-Lied is built on top of Dewey Avenue and connects with both towers on various floors to make one continuous hospital.
"It's designed to fit into the campus as much as it could but also to carry its own identity, which is of technologically advanced healthcare," says project designer Jeff Monzu with LEO A DALY. The building's brick and precast concrete exterior tie in with the 50- year-old Clarkson Tower. "It's clearly a modern building," he says.
But the simplicity of the outside belies the work that goes on within. The building serves as a central location for the 700-bed medical center's most clinically intensive activities.
Designers met weekly with hospital staff to study the unique technology, workflow, and ergonomic issues within each department. More than 150 hospital staffers had a hand in planning. As a result, each floor has a pulse of its own.
A hotel-like setting meets patients entering the emergency department.
The racetrack layout of the first-floor 25,400-square-foot emergency department reflects the emphasis on speed needed to treat the more than 45,000 patients who enter the department's doors each year, says Monzu. Designers put supply storage areas in the middle of the department and divided the perimeter space into smaller areas that help clinicians sort and organize patients.
Separate waiting and exam areas for fast-track patients keep less-serious cases moving quickly. The department's 17 critical-care rooms, each at 170 square feet, are large enough for people and portable equipment, such as rolling ultrasound and X-ray machines, to move around beds with ease. "We're increasing the efficiency of how they handle a patient," says Monzu. "Patient movement is minimized and high-tech equipment is easily accessible."
Trauma cases arrive through a separate entrance leading directly to a large open suite with four treatment areas. The space allows for the visual communication and speed of movement necessary for treating these patients. Rapid-image CT scanners are nearby in radiology for cases when moments matter. The new machines can capture an organ image in one second or a complete body scan in 10 seconds. A Siemens picture archive and communications system (PACS) solution processes the images digitally so they are immediately available throughout the hospital, including surgery, using a Web-based viewing application called MagicWeb.
Above the emergency department, designers planned a 57,600- square-foot surgery department around state-of-the-art technology that reflects the growing trend toward minimally invasive surgeries. Prior to Hixson-Lied, the hospital's operating rooms were equipped with KARL STORZ endoscopes. The new rooms go further by incorporating KARL STORZ OR1® technology for integrating operating room functions and systems into a touch screen panel located in the surgical field.
Monitors and surgical equipment hang from booms in operating rooms.
A huge advantage of the new setup is the ergonomics of the rooms, says Schwedhelm. In the past, nurses moved equipment on wheels around the operating room tables. OR1 gets equipment and monitors off the floor by mounting them to booms attached to the ceiling. The trick for designers was to position the equipment correctly.
Working with the vendor and design team, hospital staff set up a mock operating room in University Tower to help them get the best feeling for where the booms, control panels, and wall monitors should go. They fine-tuned everything again before the new operating rooms were fitted. "We were able to tell, ‘OK, that boom's about 6 inches off from where we'd like it to be,'" says Schwedhelm. "All of that was problem-solved before we got into the building. We had a year's worth of reality."
Designers knew early the booms would weigh from 200 to 400 pounds. Hefty steel supports as well as the cabling and conduit needed to integrate surgery with the rest of the hospital's information systems required lots of space between floors. Designers planned for 20 feet floor-to-floor from surgery to the floor above it.
Above surgery is a 30,000-square-foot, 34-bed newborn intensive care unit. Although really Hixson-Lied's third floor, in name it is the fourth floor because it is level with and connects to the fourth floor of University Tower. Alcoves around the perimeter of the department provide privacy and help control light and noise, which interfere with the development of premature babies.
The newborn intensive care unit’s play area ties in with the nature theme of the older Clarkson Tower.
To prevent structural-born vibrations from penetrating the floor, builders used lighter-than-standard gauge studs in the outside walls. Armstrong Optima ceiling tile with a Cortega back loader with minimum noise reduction coefficient of .95 and ceiling attenuation class of 37 further keeps noise from penetrating the floor. All the walls have acoustic insulation and are sealed top and bottom.
Small nurse stations just outside patient alcoves are recess lit from above to keep lighting tight. To help nurses stay alert, designers incorporated 2,000 foot-candle light showers in the two larger nurse stations and staff lounge to imitate daylight.
Mechanical and IT
Designers planned ahead to make sure the building's mechanical systems could support the specific needs of the building's people and equipment and the infrastructure was in place to support future IT needs.
"One of the challenges in the operating room was that surgeons like extremely low temperatures," says Clive Moore, senior mechanical designer with LEO A DALY. Typical temperatures required for patient care are 60 to 62 degrees. "We achieved this by having a secondary chilling coil that can further take the air temperature down."
To keep exam rooms and work spaces comfortable, the design team installed hot water reheats for each room.
Accommodating the first floor's four MRI units also required careful planning. Because of the machines' central location, 12-inch diameter pipes were needed to vent them safely. In addition, the machines require a 15- by 25-foot mechanical room for chillers that cool the magnet head.
Patient rooms in the adjacent towers look down on a rooftop garden accessible from level four of Hixson-Lied.
A penthouse floor above the newborn intensive care unit holds six Trane air-handling units: one for the emergency department, one for the newborn intensive care unit, one for interventional radiology, and two for the 20 operating rooms. The sixth is designed to handle the 10 operating rooms that will eventually expand surgery into Clarkson Tower, says Moore. All the mechanical systems are automated with an Andover direct digital control system.
The building's information structure also had to take future growth into consideration. For example, hospital staff knew they wanted to do bedside registration in the emergency department. The question was whether to incorporate cabling and a virtual LAN to support it throughout the building; the staff chose to plan for those features. In addition, gigabit capability throughout the building allows for growth, even though desktops are currently running at 100 MBps.
"I would say the key to success from an IT perspective is to be engaged very early on in the process," says Lianne Stevens, The Nebraska Medical Center's vice president of information technologyand chief information officer. "That really has to be designed in with the rest of the building."
Stevens' department worked with the University of Nebraska Medical Center's video services department to implement telemedicine and teleconferencing made possible through the KARL STORZ AIDA™ advanced imaging and data archival system, which captures, transports, and stores procedure- specific image data, patient information, and physician documentation.
It also allows for live webcasts. The hospital has done three so far, including one that demonstrated a new procedure for treating varicose veins with lasers, says Schwedhelm. "We're able to basically bring surgery to the world," Schwedhelm says.
Such up-close and immediate access to surgery has the potential to educate and inform medical students and patients wherever they are. But it's the spaces combined with the technology within Hixson-Lied that give staff the information they need, where they need it to maximize patient safety and medical effectiveness.