Offering a One-Stop Shop from Pre-Admission through Rehab

Offering a One-Stop Shop from Pre-Admission through Rehab

By Kirk Warden

Today’s consumers of medical services are looking for convenience, state-of-the-art technology and ease of access. Combining services and programs is a growing trend whereby patients can find multiple services at a single site. Bundling of multiple services also creates efficiencies in medical staffing and business operations.

Clayco recently completed a new state-of-the-art orthopedic center in Chesterfield, Mo., for Barnes-Jewish Hospital and Washington University. The 60,000-square-foot facility was built in response to a projected 46 percent growth in the demand for outpatient orthopedic services during the next decade. As the developer and design-builder, Clayco worked closely with the owners and architects to create a well-located facility that would meet the present and future needs of Barnes-Jewish Hospital and the Washington University Department of Orthopaedic Surgery.

The center will serve as the department’s primary facility for sports medicine, hand surgery, shoulder surgery, foot and ankle surgery, and physical medicine and rehabilitation. Comprehensive, one-stop outpatient care will be provided with physician offices, examination rooms, ambulatory surgery suites, diagnostic radiology and rehabilitation, and hand therapy services.

The facility was designed to provide patients with the latest, most technologically advanced orthopedic care. Surgical services include minimally invasive surgical procedures that will allow them to be admitted and discharged on the same day. Within the same facility, patients will have access to a rehabilitation center after surgery. The combination of all of these services in a single location provides a synergistic environment for patient care. Instead of going to a doctor’s office, imaging center, surgery center and rehab facility, patients have access to all of these services at a single site.

All surgeons, physiatrists, radiologists and anesthesiologists at the new center are Washington University physicians. Barnes-Jewish Hospital, affiliated with BJC HealthCare, manages the ambulatory surgery center and the radiology services. These include pre-operative, operative and post-operative services and MRI and general diagnostic radiology. Barnes-Jewish West County Hospital manages the rehabilitative services, and hand services are provided by physical therapists from the Rehabilitation Institute of St. Louis’ Milliken Hand Rehabilitation Center.

Surgical Suites

The surgical suites are designed specifically for orthopedic surgery. They are less intense than an emergency room or trauma operating room in that less equipment is needed. For example, there is only one light boom in each surgery room. However, they are of a similar size and incorporate the same super-clean environment required in a general operating room. This approach to surgical suite design is very economical as it eliminates redundant systems that are not required for orthopedic surgery. Currently there are four state-of-the-art orthopedic surgical suites, and space is available to accommodate an additional surgical suite.

LEED-CS Certification

One of the goals for this project was to incorporate sustainable elements into the design — another growing trend. Clayco teamed with architect ACI/Boland, Washington University and Barnes-Jewish Hospital to pursue certification in the U.S. Green Building Council’s Leadership in Energy and Environmental Design (LEED) Green Building Rating System. Because the plan layout required in the interior of the facility would have made certification of the entire building challenging, Clayco recommended certification for the core and shell of the building.

In order to meet the requirements for LEED-CS certification, which is still pending, Clayco collected and recycled all construction waste, diverting more than 75 percent of the waste from landfills. In addition, recycled rebar, steel studs, structural steel, tile, glass and drywall were used, accounting for nearly 20 percent of materials in the core and shell. Clayco also managed storm water and installed enhanced HVAC systems, lowflow toilets and water-conserving fixtures.

Construction Challenges

The site was the most challenging aspect of the project. Although it is an ideal location with easy highway access and high visibility, it also sits on very rocky terrain. Clayco had to complete months of rock excavation and also build several retaining walls (totaling about 30,000 square feet), with the tallest reaching 40 feet high, to accommodate the parking areas. Clayco also worked closely with the city of Chesterfield to meet requirements for green space and with the Missouri Department of Transportation regarding access.

Another challenge unique to this specific facility was installing the MRI equipment, which was too heavy to move through the building. Clayco’s solution was to provide a watertight, removable section of exterior wall during the shell construction. Then, when it was time to install the MRI, the team opened the wall and used a massive crane to install the equipment. The final step was to seamlessly fill in the gap with the brick exterior skin.

Diversity

In addition to providing a diversity of services at their new facility, Washington University and Barnes-Jewish Hospital were committed to diversity for the construction of the facility and required the selected contractor to submit a 50/50 partnership approach. As a result, for the interior finish, Clayco teamed with Legacy Building Group LLC, a minority- owned firm, in a 50/50 joint venture.

Orthopedic Central

Residents of west St. Louis County are reaping the benefits of this new one-stop resource for orthopedic care. When entering the brick and ground-faced block building, they may not realize the care already taken in considering their needs, but they will understand the ease of accessing all services in one facility.

Q: What is your best advice for promoting a healing environment in an outpatient facility?

A:

• Natural light 
• Designing for good acoustics and minimizing noise pollution 
• Incorporating nature and art — inside and out 

Designing to foster a nurturing staff: 

You want your facility to be a very comfortable and staff-friendly environment, which encourages good patient care and staff retention 
— Sam W. Burnette, AIA, senior designer/principal, Earl Swensson Associates 

A: The overall look and feel of the facility should be warm and inviting. Don’t be afraid to use color since it can greatly enhance the ambiance of your facility.

Floors that incorporate various patterns and colors really pack a visual punch, particularly in clinical areas.

Don’t forget to include artwork in the pre-op and PACU. This makes a sterile environment look more inviting, and can help your patients feel more comfortable and relaxed. There are numerous picture and art options available that are washable to meet infection control standards.
— Peggy Zampetti, RN, senior vice president of facility development, Titan Health Corporation 

A: During the selection process for the A/E team, the client should request that the architect speak specifically to their familiarity with Planetree principles or evidence-based design principles.
— William R. Massingill, AIA, NCARB, chief executive officer, Polkinghorn Group Architects, Inc.

A: We use the Planetree organization’s core components to design our facilities. They include design techniques that enhance a patient’s control, dignity, privacy, and family participation. Designing warm, homelike and non-institutional spaces to reduce one’s anxiety level, and introducing natural colors and features like fish tanks, fountains, light, plants and waterfalls into the interior; these design principles are used for the entire facility and benefit the patients, their family, and of course, the staff.
— John A. Marasco, AIA, NCARB, Marasco and Associates, Inc.