Trends in the Design of Cardiology Facilities, © Ian Janer and William N. Bernstein, LEED®AP, AIA

Cardiology is one of the primary focuses of almost every large healthcare facility in the country and one of the biggest specialties in the healthcare industry, so trends in cardiology facility design and operations have big impacts in the practice of medicine. Currently, hospitals around the country continue to invest in the development of their cardiology facilities for two major reasons. First of all, heart disease is the largest cause of death in the United States, and 25-30% of the deaths in the country each year can be attributed to heart disease. The other major factor is that Medicare reimbursements for the treatment of heart disease are relatively high. Compounding those two factors, healthcare facilities can make a lot of money through well-run cardiology wings.

Not all cardiology care providers are large, comprehensive hospitals, however. Many services are provided also by smaller practices and clinics, which may provide diagnostic and outpatient services. Another variation that has been growing more common in recent years is the “heart hospital,” which is a large hospital facility specializing in cardiology and cardiac surgery. Although each of these facilities has different needs and different best practices, there are a number of trends in cardiology that have implications in the design and operation of any facility. The most important trends to consider are technological advances with workflow implications, the changing standards for facility layout, the growing need for adaptability, and improvements in aesthetics. Although each of these areas serves a different purpose, a good cardiology group will take all of these developments into consideration when planning to renovate an existing space, build an addition, or construct a facility from scratch.

Technological Advances

As with any area of medicine, cardiology and design for cardiology are constantly changing as a result of new technologies. Cardiology has seen significant advances in recent decades, including improvements in scanning and interventional techniques, which have lessened the need to use the most complicated surgical procedures. However, the changes that have had the biggest influence in facility design have generally been related to workflow.

Improvements in Scanning and Interventional Cardiology: One of the central goals of any hospital is to prevent patient mortality, and this can be done by finding medical solutions that do not require complicated surgery. In the field of cardiology, improvements in cardiac catheterization procedures have decreased the need for open heart surgery. Improvements in radiological technologies, such as dual-source CT (computerized tomography), have also had an impact on cardiology. These procedures can be performed more quickly and safely now than ever before. Another advantage thanks to the increased dissemination of scanning technologies is the use of CT and MRI (magnetic resonance imaging) for screening for heart disease.

Integrated Digital Technologies: Perhaps the biggest change in medical facility operations in the last couple decades has been the adoption of the Electronic Medical Record (EMR) and other digital data storage and transportation systems.  The move to electronic data has had a large impact on the practice of cardiology. Now that doctors and nurses can access patients’ records remotely and immediately, the speed and accuracy of diagnosis and treatment have increased. By integrating digital scanning and analysis technologies, a hospital’s workflow can be improved even more. These time-saving and error-reducing techniques have had and will continue to have powerful and optimistic implications for patient care.

Consolidation of Systems: One of the biggest issues that many hospitals have had is the use of disparate technologies. Often, a single electrophysiology control room has many different monitors and computer systems, each corresponding to a different piece of equipment. With the adoption of digital data systems, these incompatibilities are difficult to overcome, so one of the goals for equipment providers is to develop consoles that combine multiple pieces of equipment into a single system with a single monitor. This reduces the clutter of procedure and control rooms, improving the efficiency and safety of procedures.

Mobile Scanning: In order to reduce the need for patient transportation, centers for cardiology now use mobile scanning devices to monitor and screen for heart problems without making the patient go to a lab. This prevents risks that may result in patient transportation. Alternatively, sometimes it is cheaper and easier to use mobile equipment. Mobile equipment is also available for off-site use, so it is possible for someone to be monitored remotely by a physician. This is most useful for the military, in prisons, or in other situations where patients may not be near a hospital but still need to be screened and treated for heart conditions. In recent years, these mobile technologies have seen improvements in both ease of use and digital connectivity.

Facility Organization

The largest design-related developments for most cardiology facilities have been changes in layout to solve problems in patient care. Although there has been a trend towards the establishment of “Heart Hospitals,” often cardiology facilities are parts of larger hospitals, which can present problems when not laid out well. For many cardiology patients, mobility is a huge concern, which many hospitals are now trying to address through centralization. There are a number of ways that facilities have used layout to save time, both for patients and staff, as well as improve patient care.

The first way that hospitals can facilitate care is through centralization: putting all the patients’ and doctors’ needs in one area. This means placing patients’ rooms, cardiac cath labs, operation rooms (ORs,) rehabilitation facilities, and doctors’ offices all near each other to minimize travel time for patients, doctors, and other staff members.

In some cases, however, it can be helpful to compartmentalize facilities to clarify their workflows. For many Heart Hospitals and other practices, separating inpatient and outpatient facilities can eliminate disruptions and cause each to run more efficiently. This is especially important now that many centers for heart care are incorporating outpatient care as a way of raising revenue and improving long-term care. Another way of compartmentalizing different workflows is to separate the patient care wing from the operations and management wing of the facility.

Some larger facilities have used sophisticated layout to better incorporate the cardiology workflow into the larger hospital system. A notable trend in hospital design has been to locate cardiac cath labs near the ORs because of their similar functions. This can allow for professionals such as anesthesiologists to move between ORs and cardiac cath labs with ease.

Layout and organizational structure can also play a role in patient comfort. Patients and families are most at ease when there is continuity of care, so setting up the hospital workflow to allow for patients to remain in the same room throughout their stay is beneficial. This may mean grouping the patients together and not compartmentalizing the rooms by function; it may also require designing each room to be adaptable. In some ways, this may be less convenient from a workflow standpoint, but sometimes workflow and patient comfort cannot be easily reconciled.

Adaptability

Renovation can be one of the most expensive and time consuming processes a hospital can go through, so adaptability of space through design can ultimately save a hospital time and money. Adaptability of rooms also makes space usage more efficient, which can increase hospital revenue.

Centers for cardiology can get better mileage out of their ORs and cath labs by designing and furnishing them to be multipurpose. If cath labs can be converted to ORs and vice versa, hospitals can meet their immediate needs and perform more procedures.

Patients’ rooms should also be adaptable. In many cases, patients have different needs before, during, and after treatment, so each room should be fitted to support whatever technologies are required. Because facilities have a limited number of beds, it is useful to be able to convert outpatient beds into intensive care beds and vice versa, depending on the demand. This is only possible if the beds are all located in the same general area, so layout can significantly help or hinder adaptability.

In most cases, the best way to guarantee that a room will be adaptable to different equipment needs is to supply the room with all the utilities and information systems possible. Because new medical equipment is developed regularly, it is best that each room be able to support future needs with the necessary infrastructure.

Aesthetics

Pleasing, uncluttered environments make a difference in hospitals, especially when it comes to cardiac care. Due to the nature of the conditions treated at cardiology facilities, reducing stress is one of the most important goals of facility design. Aesthetic improvements can play a big part in patient care and produce a better work environment for practitioners.

These improvements benefit healthcare facilities in two major ways: better patient care and higher revenue. Hospitals and practices raise revenue by motivating patients and families to choose them over other healthcare facilities, and aesthetics definitely play a part in many of these decisions.

Introducing nature into the hospital environment is one major aesthetic improvement. Using natural lighting is one way to improve hospital atmosphere, but some facilities go even farther to use nature for its soothing capacities. For instance, the Appleton Medical Center in Appleton, WI has recently incorporated a waterfall and an aviary into its new cardiology center. Not only do they seek to improve comfort and attract patients, but they expect to see a rise in staff efficiency thanks to the more comfortable work environment.

Another commonly used strategy for making a cardiology facility’s appearance serve its function is to use curves to improve the experience of the spaces. According to the Ohio State Medical Center’s website, the design of their hospital uses curves to produce an “embracing quality” in the rooms and reduce the monotony of the hallways.

The Ohio State Medical Center also uses large, open spaces and warm colors in its design to enhance the effect. Curves, natural lighting, and well-organized color schemes can make spaces look larger, which will improve the experience for both patients and staff.

Some other considerations that go a long way to making patients’ rooms more comfortable include using movable panels to conceal equipment and dividing the room into patient, family, and staff areas. Another helpful tip for new facilities is to have a designated entrance or lobby area, because this will make the facility look more professional, increase security, and ultimately put patients and families at ease.  Although these aesthetic changes will not directly affect the workflow of the facility, they can generate a lot of revenue in the long term and be valuable in patient care.

About Bernstein & Associates, Architects:

Bernstein & Associates, Architects has specialized in healthcare and lab design and construction since the firm's founding in 1990. This architecture firm is well-known for cardiology planning, cardiology design and cardiology architecture. The firm has designed multiple cardiology facilities in the past nineteen years. The firm's principal --- William N. Bernstein, LEED®AP, AIA --- is a well known cardiology architect. He has written extensively on cardiology design and construction.

For more information about healthcare and hospital design and construction, including cardiology design and construction, contact Bernstein & Associates, Architects at:

Bernstein & Associates, Architects - PLLC
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