Case Study: Converting Medical Surgical to Behavioral

Case Study: Converting Medical / Surgical to Behavioral A Deeper Look Designing Behavioral Health Units requires increased consideration, not only of the specific, stringent risk management standards, but also of how the design influences the people occupying the space.

There can be provisions for increased security, long-term acute care, structured activity, isolation, and group therapy while still infusing residential elements, warm colors and an overall less “institutionalized” design. Converting a med/surg unit to comply with these standards and concepts presented its own challenges.

Implementing Improvements Behavioral Health

CHALLENGE To properly care for their constituents, Mercy Health System committed to a system-wide Behavioral Health Initiative to increase inpatient beds and partial hospitalization services. The most appropriate space at their Paducah, KY facility was a shuttered med/surg unit that required a gut renovation and safety overhaul.

DESIGN OVERVIEW As part of a system-wide initiative to broaden its hospitals’ behavioral health services, Bon Secours Mercy Health implemented improvements across several System hospitals. In Paducah, Kentucky, Mercy Health Lourdes Hospital converted a med/surg unit into a dual function adult (19 beds) and geriatric (10 beds) behavioral health unit with support functions serving each population.

The Adult Unit has three beds designated for medically-frail patients, each with the appropriate level of medical gases and services on the headwall. Five flex beds use door control systems to flex to either adult or geriatric depending on facility census. The Unit’s core was completely gut renovated to open the space into a larger milieu space for activities and dining. Array created an open, accessible team workstation, which brought natural light to the core spaces.

SOLUTION

Designers planned spaces suitable for quiet activity including calming and sensory features.

A 29-bed unit, segregated to accommodate both adult and geriatric populations, provides sufficient treatment space for patients. Removing walls opened up day areas for group therapy and relaxation, as well as create a homelike, soothing environment.

activity spaces to ensure patient safety. The patient room and bathroom walls remained;

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The creative re-work of a med/surg space required optimizing sight lines to these quiet however all new fixtures, furnishings and finishes were selected to be homelike while safe for this population. An internal polycarbonate window, with integral shade device to provide comfort and security, protects the exterior glazing. Upgrades to windows and air-handling units rounded out the design effort.

A collaborative history with this client led to cost-savings measures on bulk purchases as we implemented behavioral health initiatives across the System.

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CONVERTING SPACES TEAM WORK CENTERS Med/Surg team centers and work areas are traditionally designed as a large, multi-seat workspace, sometimes glass enclosed. Amenities in the centers include computer workstations, nurse call and a pneumatic tube station, as well as copiers, printers, etc.

In the behavioral health environment, the team work center serves as the functional hub for the Unit and should be open to patients to allow visual and verbal communication. The design is such that patients cannot reach over the counter to gain access to electronics or staff. The project’s new center includes quiet treatment planning areas, a medication station, nourishment area, patient valuables storage, electronic controls for patient rooms, shut-offs for water, electric and specialized lighting controls. This station pushes out into the corridor to maximize hallway visibility in all directions.

Left: Behavioral health team workstation Above/Below: Med/surg team workstation

ELEVATOR LOBBY The med/surg elevator lobby converted into a sally port, through which is the main entry and exit for patient units, per guidelines, and waiting area for behavioral unit visitors. The sally port has control doors leading to the lobby controlled by staff. This area creates the first impression for patients and visitors.

Before: Med/Surg Elevator Lobby

After: Behavioral Health Sally Port & Waiting Area

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\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ PATIENT ROOMS The med/surg patient room has numerous features, such as a multi-

To transform the patient room into a safe and code compliant

functional patient bed with electrical components; an over-bed light;

envronment requires platform beds, a stationary desk and

a medical gas headwall with nurse call; a TV, and wall-mounted

wardrobe. The only wall-mounted devices are staff-assist stations

devices, all of which pose safety risks in a behavioral patient room.

and tamper-proof receptacles. All devices in the rooms are ligature

Components such as mechanical grilles, cubicle curtain tracks and

proof. Mechanical grilles had to be retrofitted with new registers;

sprinkler heads are not ligature proof, posing additional safety risks.

tamper-proof sprinkler heads needed to be installed; and, curtain tracks removed or recessed.

After: Behavioralcompliant ceiling

Before: Med/Surg rooms with safety risks

SOCIAL SPACES Demolishing rooms in the core of the med/ surg unit created room for open, accessible multi-use spaces. These areas allow for group and individual quiet activities, prompting the incorporation of sensory elements, such as a textured and marble wall, into the space’s

Before: Med/Surg rooms & blind corners

After: Behavioral Day Space

design. All furniture is behavioral health specific, weighted with cleanable surfaces.

Removing rooms also allowed for large milieu spaces for noisy activity and dining, bringing natural light into the core areas.

Staff can observe all spaces from a central team station, ideal for behavioral health populations. Blind corners were eliminated if possible. Where not feasible, security cameras were utilized.

After: Behavioral Milieu Space DOOR HARDWARE Due to ligature risks, behavioral health-

the openings between the hinges is a safety

safe levers were specified throughout. A

risk. All patient room doors have a top-of-

continuous hinge with a sloped top replaced

door sensor that alarms if pressure is applied

the standard butt hinges, as looping through

to the top of the door.

Top-of-door sensor sends an alarm if something is looped over.

Before: Non-ligature resistant PAGE 4 | case study: behavioral health

After: Ligature resistant

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Who We Are

Many items in the med/surg bathroom can be used for self harm.

ARRAY-ARCHITECTS.COM

Behavioral health design requires the removal of any item that the patient can loop an object, such as a bed sheet, around, including handrails, sinks, sink faucet, shower rods, paper towel dispenser and toilet.

Anti-loop grab bars replace typical med/surg grab bars. The replacement shower and faucet controls are button-operated with a water flow timer. The sink is recessed with a solid surface vanity and secure skirt panel to conceal piping.

We Are Healthcare Architects We are a team of architects and designers with unique backgrounds, but we all have one thing in common - we share a strong desire to use our expertise and knowledge to design solutions that will help people in moments that matter most.

This focus makes us leaders in our field. There’s a degree of compassion, empathy, and sensitivity that goes into every project that we touch. It’s designing a nurse station with sight lines to every patient. It’s building a Behavioral Health facility without corners, so that patients are safe. It’s translating the operational needs through the technical details to fine tune the lighting system in a neonatal unit so caregivers can match the lighting to each baby’s stage of development. It is a deeper understanding, honed through relationships spanning

Before: Injury risk due to looping

decades.

Together, we discover optimal solutions with our clients. It is our four decades of specialization that allows for effective communication, collaboration and precision in the complex, changing world of healthcare.

Array’s Knowledge Communities We believe strongly in sharing our expertise and knowledge with others. We invite you to explore each of our thought leaders and share your thoughts with the healthcare design community.

After: Loop resistant hardware

WINDOW FIXTURES The

med/surg

windows

were

operable

with

traditional

Click here to visit our Thoughts page.

insulated glass. During renovations, windows were covered with an aluminum window that includes an impact-resistant polycarbonate glazing. Behind the glazing is an operable window blind for patient privacy.

Before: Operable window and curtains = safety risk

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to view our thought leadership on behavioral health

After: Impact-resistant window with integrated blind

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Published: OCTOBER 2016

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