Case Study: Inpatient Dialysis Suite A Deeper Look An ideal inpatient dialysis unit must be right-sized, appropriately zoned and safe. We apply the tenets of patient- and family-centered care to every aspect of our bay configurations. In designing the new Unit, Array’s design team worked closely with the clinicians to provide adequate space and supply the necessary systems to achieve an ideal state to support their daily tasks and provide superior care to their patients.
Inpatient Dialysis CHALLENGE NewYork Presbyterian commissioned Array to renovate their cramped and restricted Administrative Space into an Inpatient Dialysis Suite which came with several challenges. Some highlights of these included determining how to ensure patient privacy within an open space and designing a complex headwall system within tight floorplate constraints.
PROJECT UNDERSTANDING The scope of the Inpatient Dialysis Suite includes the renovation of hospital administrative space to create an inpatient dialysis suite on the first floor of the New York Presbyterian Columbia University Medical Center’s Milstein building. This new unit accommodates eight private patient treatment bays as well as support space and cutting edge Reverse Osmosis (RO) water treatment technology. Other components include four decentralized team centers monitoring two patient treatment bays each, centralized clean and soiled utility rooms, a staff lounge, patient and staff toilet rooms, a dedicated medication dispensing room and dialysis equipment supply rooms.
SOLUTION The decision was made to create three distinct zones within the Dialysis Unit which positively impact clinical care,
On the following page, we highlight the space issues in the original layout and problems with the existing processes, which served as a valuable tool to help us understand the work processes.
nursing efficiencies, staff collaboration and patient amenities. A proprietary headwall system was also designed with three independent structural systems that are detailed within this case study.
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CURRENT STATE •
There were no nourishment stations so clinicians had to travel to the staff lounge for patient snacks during treatment.
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With no computer workstations for charting at the bedside, staff hand wrote notes prior to entering into computer system
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The utility room was located outside the Unit, adding unnecessary footsteps.
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Patient beds were too large to pass by comfortably. The space felt cramped.
LEAN ANALYSIS This project stemmed from Lean Process Analysis of the Dialysis unit within the hospital. By utilizing staff tracking, we were able
FUTURE STATE
to spaghetti diagram the space to determine efficiencies in the
In order to achieve an ideal future state, Array had to consider
program. After understanding the current state, it became clear
how the staff would utilize the space. Looking back on the
that a new space for inpatient dialysis care would be better
spaghetti diagram below, we could see a strategy for the future
positioned to respond to patient needs.
unit. The decision was made to create three distinct zones within the floor plan.
From the above diagram, it became clear that the hospital would benefit from centralizing their supplies for easy bedside access. From this, we determined two main goals: 1.
To create right-sized treatment spaces which allowed patient privacy and clinician maneuverability.
2.
To create support spaces immediately accessible by clinicians, yet separate and distinct from patient spaces.
The first zone would be the patient space (see floor plan to right). This included all treatment bays as well as the patient toilets. The second zone would be patient support spaces.
PATIENT SPACE PATIENT SUPPOT SPACE STAFF SUPPOT SPACE
These rooms would need to be quickly accessed by staff on the unit for general patient care and supplies. We then aimed to percolate these support spaces into each bay by utilizing clinician workstations which could provide all the quick-access supplies and charting requirements they had for the patient bedside as well as localized hand washing stations. The third zone was the non-patient-serving staff support spaces. These are items such as equipment maintenance, water treatment rooms and bulk storage. These spaces are not normally utilized by the staff so they could be located further away without disrupting workflow. With a new design and workflow, the time clinicians are able to spend with patients increased, improving with outcomes and patient satisfaction. By configuring rooms and supplies logically and saving footsteps, staff has less travel time per treatment and everything needed is readily available.
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THE HEADWALL To achieve the design goal of incorporating glass panels for the Inpatient Dialysis unit, there were several challenges to overcome. Patient room headwalls typically have utilities pulled from the ceiling. To achieve the correct lines of sight, a custom design solution was required - creating half height corridor walls so the glass panels could be used throughout the unit. The headwalls are structurally supporting the glass and need to be utilized in an atypical way. Ultimately the unit was designed with a proprietary wall system
In an inpatient dialysis suite, it is critical that clinicians share visual connection with their patients. Often times, for this reason, patients are serviced in open areas. By creating bays with proper sight lines and utilized varying degree of opacity with fritted glass, we were able to maintain this visual connection
that met three distinct goals: • Serviceability • Durability • Infection control
while still providing patient privacy. To bring support space closer to the bedside, decentralized team centers were incorporated
SERVICEABILITY
between every two rooms.
As a dialysis unit, this area has an especially large number of utilities in the headwall system. To serve the dialysis patients properly, each bay needs to supply a constant flow of treated RO water with no dead legs. These soft pipes need constant access for maintenance and leak protection. To provide this access, the walls were designed with heavy-duty panels which sit upon a proprietary fastener created solely for this application. These fasteners allow maintenance staff to remove each panel individually. After maintenance is complete, staff can simply align the pegs and push the panel to snap it back into place. This provides total access for the long-term function of the unit. Additionally, all through-slab penetrations were coordinated so the waterproofing system was not affected by the maintenance process. The base of the wall was designed to retain up to 80 gallons of water prior to any flooding due to water lines. DURABILITY
PLAN ORGANIZATION
Dialysis is typically a three-to-four hour procedure which means
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Larger treatment bays allowing for family area within the treatment bay.
the unit is turning over a patient bed every 30 minutes. Since
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Maximizing use of glass partitions allowing visibility for staff.
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Decentralized Nursing Stations outside of each double bay treatment zone.
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Direct departmental access for staff storage and utility rooms.
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Centralized staff area for additional
there is such high bed traffic in the space, the walls must withstand the constant abuse of patient beds against the headwall. To meet the uncommonly high abuse these walls usually take, the design utilizes three different structural systems to brace the wall. The most robust of which includes an all-weld tube steel frame the removable panels are attached to. The panels themselves are made of solid surface and fabricated with double the thickness of a standard wall application. These removable panels are also
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Who We Are
laminated to an alucobond substrate which acts as rebar for the system, keeping the rear of the panel in tension to prevent
ARRAY-ARCHITECTS.COM
cracking. If for any reason the headwall panels are cracked, Array provided a millworker firm with our computer design files so they can simply create and ship a new panel to the facility. INFECTION CONTROL
We Are Healthcare Architects
The headwall was designed to reduce the spread of infection and to also be mindful of the needs of a hospital environment. All seams within this system were created utilizing a system of shiplap joints. This allows the wall to be sealed tight without use of the less-sturdy gasketing found on conventional headwalls. The base of the wall utilizes a pre-molded flexco base, which previously had a continue seam to the floor and wall, to eliminate the spread of spills. All joints were radiused and considered for cleanability. As an added bonus, the tight system of joints created an acoustically-tight space aiding in patient privacy.
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 team center 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 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.
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