commssion_hospitals_and_nhs_of_the_future

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					    New York State Department of Health

  Hospitals and Nursing Homes
          of the Future




Lisa Wickens - Deputy Director, Office of Health Systems Management
Neil Benjamin - Assistant Director, Division of Health Facility Planning
Thomas Jung - Director, Bureau of Architectural & Engineering Facility Planning
                            February 9, 2006
Factors Driving the Need for
         Change:
         Change
• Technology
• Patient Preference and Acuity
• Fiscal Pressures – Providers, Payors,
  Employers
• Reserve Capacity
• Staffing Issues – Cost, Recruitment,
  Shortages
• Difficulty Navigating the Convoluted
  System
• Competition-unregulated and regulated
  entities
      Factors Specific to
           Acute Care:

• Out Migration of Services

• Relationship with Physicians

• Availability of Capital
         Factors Specific to
          Long Term Care


• Consumer Preference for Independence,
  Least Restrictive Setting
• Integration with the Community
• Adaptability for Differing Acuity &
  Individual Needs
• Specialty Services
 Strategies for the Future

• Pay for Performance /
  Quality Improvement
• Digital Hospitals
• Centers of Excellence
• Flexibility
  – Reimbursement
  – Program
  – Construction
Green Technology
Improved / Flexible Work
Environment
Alternative Delivery
Models
Adaptable Construction
    Consumers are more
        Discerning

                       – Patient/Resident-Centered
                         Care
                       – Fast changing technology &
                         expectations
                          • accelerates obsolescence
                            of Physical Plant
St. Peter’s Hospital
                          • increases competition
    Albany, NY
                            among providers
Acute Care Hospitals




      Albany Medical Center, Albany NY
1920 Hospital Configuration



          M/S Bed Wards                      Surgical Bed Ward



                            Administration
   Lab &Support Functions        &                  Surgical Suite
                             Main Lobby




                                                  Source: Health Technology Center - HealthTech
1950 Hospital Configuration
                          TB Unit


                       Polio Unit


                     Maternity Unit


                    M/S Bed Unit(s)


      Surgical & Special Care Units   Surgery Suite


        Labs & Support Services        Emergency


          Lobby/Main      Administration &
            Entry            Records



                                              Source: Health Technology Center - HealthTech
1975 Hospital Configuration

                          M/S Bed Units



                          M/S Bed Units



                          M/S Bed Units


                      Maternity & Delivery                 Medical Office Building
Surgery
                    ICU                      CCU
 Labs, Support &
   Education       Lobby &        Administration &
                   Main Entry        Records




                                                     Source: Health Technology Center - HealthTech
     2005 Hospital Configuration



                M/S Floor             M/S Floor


            M/S Floor                 M/S Floor
                                                                             Medical Office Building

          ICU/Special Care            Surgical Suite

Admin/Records
                                                       Emergency
                                                         Room
                             Outpatient Care
 Lobby/Main Entry


                                                                   Source: Health Technology Center - HealthTech
 HOSPITALS in the FUTURE

• How many beds will we need?
  –   Population growing
  –   Outpatient modalities continue to increase
  –   Public Good Services
  –   Definition of Capacity
• Is Decentralization the future of
  technology?
  – Miniaturization of diagnostics and equipment
  – Digital Technology & Communications
• Regulatory Landscape – Physicians as
  Competitors
                 Hospital of the Future
                              Variable Acuity Patient Rooms in Vertical Modules




                                       Imaging, Diagnostic
                                               and
                                       Interventional Core


Medical Office
   Building                                                      Lobby and
                                                                                           Emergency
                                                                   Vertical                  Services
                 Lobby and Vertical
                                                                 Circulation
                     Circulation




                                                                      Source: Health Technology Center - HealthTech
Functional Evolution will impact
           design…
   Albany Medical Center, Albany NY




                                                • Emergency
                                                  Room is new
                                                  “front door”




              St. Peter’s Hospital, Albany NY
      Increased emphasis on
            flexibility…

• Universal
  Interventional
  Rooms
  – Surgery
  – Minor Procedures
  – Catheterization      GE CT Scanner


  – Minimally Invasive
                       Today’s Surgical Suite

                                                                                               Radiology & Imaging
                           Operating Rooms


                                                                             Staff

                                                Sterile Core        Support Services



                                                                                                    Endoscopy and
                                                                                                   Minor Procedures




                                                Pre-Op & Stage 2 Recovery
            Post Anesthesia                                                            Cardiac Catheterization
               Care Unit
                                                                                                Labs


Source: Health Technology Center - HealthTech
       Facilitate operational
          efficiencies…
– Combining Pre- and Post-Op…
– Combine Radiology and Surgery…
– Patient Care “pods” should be adjacent
  • Interchangeable
  • Allow “flexing” to accommodate fluctuations in
    demand
– Centralize interventional suites vs scattered
  approach
  Tomorrow’s Surgical Suite
                                        Catheterization & Vascular Intervention Module
              Staff & Support



           Image-Guided Surgical Module



                                                                         Minor Procedure Module
                    Post Anesthesia Care Unit and Recovery


Intake and Pre-Op




                                                               Source: Health Technology Center - HealthTech
        Also structural design…

• Separate “Structure” from “Utilities”
  – “…capital investment needs to be
    focused on flexibility, interoperability
    and technology as opposed to ‘bricks
    and mortar’…”
  – Source: Healthcare Reform Working Group – 11/18/04


• “Demountable” partitions?
      ….and equipment….

• Medical Equipment


• Lights and partitions
  – Hospitals want to use them…but
    perhaps not own them (Lease?)
         1920’s Hospital Ward



                 16 Bed Ward



Gang
Toilet
1950’s Hospital Rooms



4-Bedded Room       2-Bedded Room
                      160 SF (80/bed)
  320 SF (80/bed)




                                               Toilet
                                               Room




                         Source: Health Technology Center - HealthTech
         1970’s Hospital Rooms
                                  Headwall Utilities



                                              Toilet Room
Toilet Room                                   w/Shower
 w/Shower




              2-Bedded Room                            1-Bedded Room
               200 SF (100/bed)                              120 SF




                                                       Source: Health Technology Center - HealthTech
Hospital Room of the Future
                     Variable Acuity Rooms

                      Patient Toilet   Patient Toilet
                                                         Family Space
    Family Space        & Shower         & Shower




       Patient Bed                                      Patient Bed


                      Patient               Patient
                      Support               Support



                           Nurse Work Station



                                                        Source: Health Technology Center - HealthTech
             Digital Integration

• Digital Systems and
  Information
  Technology
  – Integrate across
    continuum of care
  – Clinical-Administrative-
    Financial
  – Interoperability with      Raytheon Company EPTS

    Physicians
        Anti-”silo” Technology….

• The Digital Hospital…
  – Point of Care: Lab Work &
    Vitals
• Clinical Programs and
  Functional Systems will
  likely replace Department
  Organization…..
                                  Thermo Electron Corporation

• Capital Access is Critical to   PocketChem UA



  Success
Implant Technology

• Ventricular assist
  devices for hearts
• Artificial lungs
  (short-term
  pulmonary                          Ventracor Cardiac Assist System



  support)
• Bioactive bone
  cements
                       Source: National Tissue Engineering Center
      New Hospital Models….
• Critical Access    Mobile Cardiac Catheterization




• LTACH

• Freestanding
  Emergency Rooms

• Mobile Services

                     Mobile Medical International Corporation
Reserve Capacity: Care Capability

                                                   100
                                                    90
• Planning for Care                                 80
                                                    70




                                          Demand
                                                    60
                                                    50
• Flexibility in bed                                40
  capacity.                                         30
                                                    20
                                                    10
                                                     0
                                                     Sufficient >>>>   Ultimate Standard
Source: Texas A&M University College of                         Care Capability
Architecture, Texas A&M University
System Health Science Center, Office of
Homeland Security

				
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