Patient-Focused Interiors:

Patient-Focused Interiors:
Color, Comfort Dictate Facility Design

By Kelli M. Donley

When a patient thinks of the average doctor’s office, images of pastel wallpaper, framed Thomas Kincaid prints and modular furniture come to mind. However, outpatient centers are no regular doctor’s offices; they are the home of the latest surgical technologies and their dècor is just as innovative.

Alan Wilson, vice president at the architectural firm RTLK Associates, says minimally invasive surgical advancements have created new challenges in the design of outpatient centers.

“We are designing around changes in the surgical process,” he says. “That starts with how much of the paperwork and the admitting process has already gone on before a patient shows up at an outpatient center. Typically, patients have met with a surgeon who has decided a surgical intervention is required. When the patient gets to an outpatient surgical center, most of the paperwork process has been done at the physician’s office.

The state of the art is headed toward a center where a surgeon will have all of the paperwork done in his or her office and then transferred electronically to the surgery center where the patient will be operated on.”

E-mail, the Internet and other telecommunication advancements have changed the importance of reception areas at outpatient centers. Wilson says the wait time is brief and the focus of design has been shifted to protecting patient privacy and keeping waiting family members comfortable.

“When someone is waking up from anesthesia, you could probably have them at a bus stop or a train station because they don’t know what is going on,” Wilson says. “Post-surgically, the outpatient center is designed around the needs of the nurse who is taking care of the patient and the waiting family members. They could have floodlights on, music blaring and the patient typically won’t know what is going on, but the family and medical staff do. In private rooms, you have the possibility of having a private television that is on an articulating arm for family members and dimmable lights if the patient is going to be there a little longer and needs to sleep.

Wilson says the private rooms his firm typically designs also include supply cabinets for healthcare workers use and a sink, because “ It stimulates handwashing among staff, and allows family members to get someone a drink.”

Wilson says the anesthesia leaves most patients unaware of their surroundings for most of their time in the outpatient center.

“The private room is designed for two perspectives: One, when the patient is fully awake going into surgery, and two, when they are under sedation coming out, because even when they are going through stages two and three of recovery, they still are not going to remember a lot of what is going on.”

Wilson says advancements in anesthesia and medical practice have changed the design of the typical outpatient operating room as well.

“The advances in anesthesia have a lot to do with speeding up surgical cases, the recovery time,” he says. “Patients want to get in and out as soon as they can. Everything is headed toward outpatient. If you take a procedure that is currently being done in an inpatient operating room today, someone in this country is working on how to do it on an outpatient basis and minimally invasive basis. Surgical technique is being aided by new kinds of instrumentation, imaging capability and robotics. There are surgeons, although it is not widely accepted yet, who are starting to do total joint replacement using minimally invasive surgical technique. Any procedure they can do non-invasively speeds up the recovery process so much. That is the future of surgery in this country.”

This future must adapt to meet the needs of the instruments required for such complicated surgeries.

“I have an axiom that the smaller the room, the bigger the operating room because they are typically using more robotics and scopes where the surgeon is guided by what they can see with scopes and watching what they are doing on television monitors,” he says. “It takes more equipment to do minimally invasive technique.”

This equipment, according to Wilson, includes voice-activated lighting.

“Depending on where surgeons are looking in the body with a scope, they may want to the lights up or down, depending on what they want to do during a particular time and case,” he describes. “If money was no object, you would design these operating rooms for the maximum degree of flexibility — for plug and play. You’d plug in new technology that is coming, but isn’t here yet. We pay a lot of attention to the infrastructure, to the systems that support the equipment in the operating rooms for digital images for voice transmission, close circuit television and for teaching. You have to plan on anything getting wheeled into the operating room of the future that can make a surgical technique faster and better, with a higher quality outcome and less trauma to the patient.”

The details in designing this infrastructure include paying attention to the color of paint and type of flooring and walls.

“Although we don’t hear it as much as we used to, there is something called ICU psychosis,” he says. “When you are under certain kinds of sedation, patterns stimulate neurological responses and people given certain patterns can start to hallucinate. We try to keep the level of patterns to a minimum. I can’t say that certain colors trigger hallucinations, but we try to keep things neutral and keep color in artwork, curtains and those kinds of things that you can still create a calm environment for the patient.”

While Wilson says infection control is not a bigger issue at outpatient centers than hospitals, is also a concern in design.

“As much as I like carpeting because of its sound capability, I tend to go toward hard surfaces, like seamless flooring systems,” he says. “They have good sound soak capabilities, plus you are always cleaning up spills in recovery. If there are stains on the flooring ... it doesn’t look good to a new patient. It is very difficult to stain seamless flooring. There are even products that are stain resistant to Betadyne. Even with the best of cleanable carpets, it is hard to keep biological agents at bay.” Walls can also take a beating in high traffic areas.

“The walls of operating rooms can get beat up pretty badly because of all of the portable equipment that gets wheeled in and out of the room,” he says. “It is good to have the wall protected at least 4 to 5 feet above the floor with seamless wall systems. You don’t see people using ceramic tile as much because of all the seams. The paint coatings above that would be epoxy finishes because they can stand up to the cleaning agents.”

Wilson says the best advice for administrators interested in building a new outpatient center is to plan for the future. An ounce of prevention is worth a pound of cure.

“Design with a high degree of flexibility to be able to integrate new technologies and to accommodate the changing nature of surgery,” he says. “What we know today will be dramatically different in 5 years and significantly different 10 years from now.”