Design Project - The new bed tower for CRMC in Fresno

THE NEW BED TOWER FOR CRMC, FRESNO JIAZI LIANG TEXAS A&M UNIVERSITY

THANK YOU!

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hanks to my committee members, Prof George J. Mann, Prof D. Kirk Hamilton, Prof Bruce Dvorak, and the studio instructor, Prof Ray Pentecost, who has been guiding me through the whole semester.

Thanks to Mr. Phil Tobey, Mr. Vince Avallone, Ms. Heather Chung, and Mr. Arijit, from SmithgroupJJR, who offered me the project as my final study and helped with great patience.

GEORGE J. MANN COMMITTEE CHAIR

D. KIRK HAMILTON COMMITTEE MEMBER

SIGNATURE: __________________

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BRUCE DVORAK COMMITTEE MEMBER

RAY PENTECOST STUDIO PROF.

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Content 01 Project Introduction 02 Problem Seeking & Programming 03 Planning Concept 04 LDRP & C-Section Design 05 ICU Design 06 Conclusion

01

INTRODUCTION

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ommunity Regional Medical Center, as known as CRMC, in Fresno is now facing a multiyear redevelopment, which will redefine the downtown campus and the clinical services offered to many in California’s Central Region. For the next ten to fifteen years, CRMC’s focus is mainly on acute care and post-acute care services, which is also an exciting opportunity to modernize the current facilities and services.

RMC’s clinical services are comprehensive as a tertiary hospital. Along with may general medical and surgical service, CRMC is specialized in cardiovascular and cardiac services, orthopedics and rehab, neurosciences, trauma services, emergency services, burn center and bariatric surgery.

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Services Growth

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trategic growth and recruitment are underway with Neurosciences, Vascular services and Cardiac surgery projecting an increase of nearly 100% by 2030. Women’s services such as Obstetrics and High-Risk Antepartum will continue as the well-known destination for high competency care. Inpatient and outpatient pediatric services is a recent growth strategy. Key aggressive growth is projected for all pediatric services on the downtown campus.

Adult Acute Care Beds General Medical/ Surgical Beds: 578 (28% increase)

Intensive Care Beds: 151 (74% increase)

Women’s and Children’s

Post Acute Care

Pediatric Med Surg: 25 (300% increase) Pediatric ICU: 14 (40% increase) Antepartum/ Postpartum: 84 (20% increase) Neonatal ICU: 84 (no increase)

Rehab: 45 (40% increase) Behavioral Health (Inpatient): 81 (33% increase) Sub-Acute: 73 (52% increase) Skilled Nursing: 108 (86% increase)

Outpatient Services: (approximate 200-300% increase) Urgent/ Prompt Care: 5 clinical FTE Primary Care (Adult and Peds): 21.5 clinical FTE Specialty Care (Adult and Peds) 112 clinical FTE

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here are three phases of the downtown campus plan development. The first phase is the completion of a new outpatient medical office building and staff parking garage, which is underway.

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he second phase of development planned for 2025 is a new inpatient bed tower that will meet approximately half the total demand for 2030. The third major phase of the development is to build the remaining inpatient bed demand with a second bed tower by 2030.

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he third major phase of the development is to build the remaining inpatient bed demand with a second bed tower by 2030. The Central Energy Plant and parking will need to expand to meet the future need. Other areas of future development considered on campus beyond 2030 include research, academic, and student housing facilities..

CURRENT

2025

2030

GARAGE + OFFICE

NEW BED TOWER 341 DRIVES

SECOND BED TOWER 884 DRIVES TOTAL

FINAL PROJECT APPROACH THE NEW BED TOWER FOR 2025 PLANNING LDRP & C-SECTION DEPARTMENT ICU NURSING UNIT

RMC’s downtown campus is zoned as a medical campus and is bound by the railroad to the west, McKenzie to the north, and Fresno street to the east and south. The medical campus is located between highway 41 and central downtown Fresno.

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TURLOCK

MARCED

FRESNO

TULARE resno is at 36°44′52″N 119°46′21″W, which is nearly the geographical center of California and belongs to the Mediterranean climate where winters are mild and summers long and dray and rainfall is quite low. The average daily minimum temperature in December is around 42°F, while the average daily maximum temperature in July is about 98°F, and there is plenty of sunshine in the summer. As the direction of the length is north and south, the site is facing the problem of the western exposure

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BAKERSFIELD

rmc’s primary service area includes the five-county region from Merced to Tulare and expanding from Stockton to Bakersfield as their secondary service area.

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02

PROBLEM SEEKING

Site

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he site for the new bed tower is in the center area of the campus, surrounded by the existing hospital, the trauma center, and the garage. There are several facilities on the site, such as the medical plaza building, the parking structure, and women’s center.

Courtyard Ambulatory Care Center

Parking Garage

East Medical Plaza

Courtyard

Medical Plaza

SITE

CRMC Emercency Department

H Garage CRMC Hospital

UCSF

Patient Parking replaces Stuff parkFreeway CA-41

Demolition (2025-2030) Staff Parking replaces Existing Buildings

Demolition (Time Unknown)

Existing Entry

Existing Entry

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hese facilities will be demolished to make the place for the new bed tower. The east medical plaza parking garage, which is at the east side of the site, is now working as the staff parking. It will change to use for patient parking in the future for the bed tower project.

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s the serving radius will be extremely enlarged, more and more patients will come to CRMC form other places. The freeway CA41 will be the primary option for people visiting Fresno. The main entrance of the CRMC is located at the west side of campus, connecting with the Divisadero Street. The CRMC campus breaks the Divisadero Street. After the future expansion, the east side of campus, which is also the other side of the Divisadero Street, will be a primary entrance as well, guiding people who exit from the freeway CA-41

PROGRAMMING

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ccording to the stacking diagram and the programming provided by SmithGroupJJR, the new bed tower has eleven floors and one basement consisted of the tower and podium part. The tower part has seven floors including most of the inpatient nursing units, such as ICU, PICU, and acute care department. For the podium, the pediatric emergency department is located on the first floor, as well as the public lobby, the cafeteria, and the gift shop. The prep-recovery, PACU, and the blood bank are located on the second floor, which is connected with the surgery department in the existing emergency department. The third floor has the obstetric department, including the LDRP, C-Section, OB Triage, the fetal diagnostic, and the antepartum department. NICU is located on the fourth floor. The lab and pharmacy are located in the basement.

MED/SURG ICU MED/SURG PEDS MED/SURG + PICU NICU

ANTEPARTUM OB TRIAGE/FDC LDRP C-SECTION PREP-RECOVERY/PACU + BLOOD BANK CAFE+GIFT SHOP+LOBBY PEDS ED PHARMACY + LAB

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PLANNING CONCEPT Literature Review: Biophilic Design

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ature inspires our architecture-not just how it looks but how buildings and communities function-we will have made great strides as a society. Biophilic Design provides us with tremendous insight into the ‘why’ then builds us a road map for what is sure to be the next great design journey of our times.

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he book introduced the basic concepts of biophilia, its expression in the built environment, and how biophilic design connects to human biology, evolution, and development. It also shows the science and benefits of biophilic design on human health, childhood development, healthcare, and more. With exemplary of biophilic design, the book discusses how to implement biophilic design strategies to create buildings that connect people with nature and provide comfortable and productive places for people, in which they can live, work, and study.

Design Processes Further Expension for 2030

New Bed Tower for 2025

The glass altrium is curvilinear in order to emphasize the entrance and the plaza

Roof garden for inpatient department

Water feature

Gardens with flowers and bushes

The Central Plaza is as a node of the whole campus

The Facades of the new bed tower keep the same style of the existing facilities

Using the shape as the motif of the landscape while more fragile in order to provide the diversity of resting space

Master Plan

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he site, will not only mean a place where the new bed tower will be located but also involves an urban space. It will be a node where is surrounded by the campus building, as well as a place undertaking the connection between the Fresno downtown and other cities. A central plaza is designed for the site, providing a pleasant landscape and rest space, as well as good wayfinding and easy access to the hospital facilities.

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ccording to the theory of biophilic design, the central plaza is filled with natural elements, which would have positive impacts on people’s health and patient’s recovery. Several roads are connecting the facilities surrounding the plaza, which separate out several areas for landscape. Few of trees distribute in those areas imitating the scenery of Savannah but not the forest, which could still provide a useful view for wayfinding. Seating areas also spread in the plaza, enclosed by plants, which produce space for outdoor rest with privacy.

There is also water feature near the entrance of the new bed tower.

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he building itself is also designed with greenery. Landscape extends from the plaza into the interior space of the atrium. Glass mainly makes the atrium to bring sunshine inside. The waiting areas also have interior inside for each inpatient floor. There is a roof garden on the top of the podium for patients.

Vertical landscapes are also used exterior on the façade as shading features.

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DESING FOR LDRP & C-SECTION

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wo clusters organize the LDRP rooms. A nurse station is arranged in the center of the cluster, with a clean storage room in the back. Nurses could quickly go out the station from both sides into the LDRP rooms and the storage room. The benefit of using a cluster layout is that the travel load for nurses is much less than using a linear plan, such as “pod” and “round track.” Unlike other inpatient rooms, the privacy is more important than being observed for LDRP rooms so that there is no window on the door. And nurses do not have to keep their sight on the room doors.

The cluster layout also provides space for family waiting area among the LDRP rooms and the nurse station.

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he support core is opposite to the LDRP clusters, containing other clean supplement and equipment storage rooms, a medical preparation room, a nourishment room, an interdisciplinary workroom, physicians and residents workroom, a soiled room, a housekeeping room, a consult room, and two call rooms. The rooms, such as storage and medical preparation room, which are more frequently used by the staff, are arranged close to the nurse station with good accessibility. Staff who work in the interdisciplinary workroom and the physicians & residents workroom often bring their laptop and stay in a shorter time compared with nurses. Therefore, the two workrooms are designed as a hoteling space. The call rooms are shared with the C-Section department.

Area for OB/Fetal Diagnostic

Area for Antepartum

C-Section & Circulation

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he preparation/recovery rooms are designed as an open bay, and the nurse station is opposite. Therefore, the nurses could always keep an eye on the patients and react quickly to anything emergency happens. The medication preparation room is located on the back side of the nurse station to achieve easy accessibility. The anesthesia support workroom is where the anesthetist could mix the “cocktail,” which is shared by both the C-Section and the LDRP department. The C-Section department has much more demands for the anesthesia, so the workroom is arranged in the preparation/recovery area.

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here are two accesses for each C-Section surgery room. One could be entered from the “gray” corridor by the gravitas and the staffs. Another door is connected to the clean sterile core, which allows the clean supplement being transported into the surgery room.

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he “gray” corridor has two accesses for coming from or returning to the preparation/recovery area. It also has access directly from the LDRP department. Therefore, if anything emergency happens, such as difficult labor, patients could be rapidly sent to the surgery room. The “gray” corridor is also connected with the shower and locker rooms. Staffs should take a shower and get changed before entering the C-Section area. There are sinks outside the surgery room. The staff could observe the patient’s situation through the window when they are washing their hands before the surgery. After surgery, the used supplement would be transported through the “gray” corridor into the Soiled and decontamination room. The sterile core, as known as the “white” area, is used for the clean storage purpose. An elevator for the clean supplement is connected to the sterile core.

Patients Staff Clean Supplement Solied Return

8th Floor ICU

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he ICU department is located at both the 7th and 8th floor. My final project design is focused on one floor as the typical floor. There are three units on each floor and each unit has 10 single patient rooms within one isolation ICU room.

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he ICU department is located at both the 7th and 8th floor. My final project design is focused on one floor as the typical floor. There are three units on each floor and each unit has 10 single patient rooms within one isolation ICU room.

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he dimension of the ICU room is 15 feet by 19 feet, meeting the requirement to readily move equipment past the foot of the bed, which the minimum head-to-foot dimension is 15 feet. It considers the space to provide access to the patient’s head, either using a headwall or a power column, as well as the space to allow a stretcher, gurney, or equipment to pass the foot of the bed.

nlike the LDRP room, all the ICU room is designed with an outboard toilet, because the severely ill patients require close observation and monitoring from a nurse. Through the sliding glass door, the patients could easily be seen from the nurse station. lso, each two ICU rooms share with one decentralized nurse station. According to the building code, the window view to the outside is required for each ICU rooms. Therefore, the patient rooms are designed with the single loaded corridor because of the limitation of the site’s dimension. The decentralized nurse stations could solve the problem that the angle of view is not large enough from the centralized nurse station to observe the distant rooms.

SECTION 1-1

SECTION 2-2

WALL SECTION

Rendering: Altrium

Rendering: Waiting Area for Inpatient Department

Physical Model

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he project provides a chance to understand the basic theory of LDRP, C-Section, and ICU design, as well as their history and the future development trends, as well as how to use the nature to benefit people’s health.

Also, the ability has been developed to deal with the design based on the research.

F WHAT I HAVE LEARNED

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or the LDRP department, I gained a fully understanding of the process of giving birth and the relationship between antepartum, LDR, and postpartum. Also, I have learned the dimension of the LDRP unit and the hygiene, family, patient, and clinical zone. Creating a centered family model for the LDRP is the crucial factor to provide a pleasant birth-giving process.

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or the C-Section department, creating successful circulations is the primary challenge. The circulation of the patients, staff, and supplements should be fully considered and organized by the “black, gray, and white” zone. Moreover, nurse stations should be set in appropriate position as control points guiding the patients.

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or the ICU department, a high-level observation requirement mainly influenced the plan. Measures as using outboard toilet, decentralized nurse stations, and glass doors help staff be able to react quickly to the emergency situations of the patients.

REFERENCE Hamilton, D. K., & Shepley, M. M. (2010).

Design for critical care: An evidence-based approach. Routledge.

Kellert, S. R., Heerwagen, J., & Mador, M. (2011). Biophilic design: the theory, science and practice of bringing buildings to life. John Wiley & Sons.

Kobus, R. L. (2008). Building type basics for healthcare facilities (Vol. 13). John Wiley & Sons. https://www.archdaily.com/274743/aia-selectsfour-projects-for-national-healthcare-designawards https://www.fgiguidelines.org/wp-content/uploads/2015/08/2001guidelines.pdf https://www.archdaily.com/443648/new-hospital-tower-rush-university-medical-center-perkins-will https://www.archdaily.com/878986/centre-hospitalier-de-luniversite-de-montreal-cannondesign-plus-neuf-architect-e-s