According to a statement, over 700 workers have worked a total of more than one million man hours on the project so far. As is tradition, the top beam had an evergreen tree and flag on it when it was hoisted into position. The evergreen tree symbolizes good luck, growth, longevity, and the construction crew’s pride in their accomplishment.

Initially, the hospital will open about 70 beds, with the ability to open more in the future. The new tower will include additional operating rooms, a relocated Labor & Delivery department, postpartum beds, newborn nurseries, additional intensive care and medical/surgical beds, and space for expanding clinical departments.

Lexington Medical Center delivers the second highest number of babies in South Carolina each year, performs more than 23,000 surgeries annually, and operates the busiest emergency department statewide. With the population of Lexington County growing quickly, Lexington Medical Center needs to expand its facilities to meet the needs of a growing patient base. The 438-bed hospital remains full, with steady growth annually.

Healthcare Construction + Operations News spoke with Brasfield & Gorrie Vice President and Division Manager Michael Byrd, who oversees the company’s Charlotte, N.C., office, regarding the construction of the new patient tower.

Q: When did construction of the project begin, what is the expected completion date, and what is the anticipated budget?

Byrd: Construction began in June 2016. We’re scheduled to complete the new tower in February 2019. The renovation project extends another year into March 2020. The estimated total construction cost is $293 million currently.

Q: Have there been any challenges to date on the construction of this project?

Byrd: Yes, there have definitely been challenges. We’ve experienced difficulty with weather conditions during the course of the job, including hurricanes. In general, the challenges of working on a site this large in the middle of an active hospital campus include having to work around patients, staff, and the public. In addition to the busy hospital, there are active doctor’s offices surrounding the site, furthering the need to consider public safety. Despite these challenges, the project is on schedule.

Q: What will be the key/notable design features?

Byrd: The expansion includes a 550,000-square-foot, 12-story tower and a 70,000-square-foot, freestanding central utility building. It also includes a new parking deck with more than 900 spaces, and 125,000 square feet of renovations to the interior of the existing hospital. We also installed a new bridge to connect the tower to the existing facility.

Q: How will this addition influence/improve patient care?

The expansion will provide more space and updated facilities, enabling Lexington Medical Center to treat more patients and provide the best care possible. The parking facility will support the traffic and parking needs related to increased patient load.

Q: What best practices did you implement while working on this project that you would suggest to others?

Byrd: At the project’s outset, we focused on addressing patient safety, patient access, and allowing staff to continue to do their jobs effectively amid ongoing construction. In the preconstruction phase of the job, we studied how to manage the flow of traffic, the procurement of cranes, and the delivery and offloading of equipment. Our orientation process has been extensive; every time a new employee is hired, they have to receive training so they know exactly what they’re doing, where they’ll be doing it, and what will be around them to ensure they have the knowledge necessary to do their job in a safe manner.

We have also prefabricated select components for this project, including patient room headwalls, select bathroom features, a tunnel that connects the central energy plant to the parking deck and patient tower, and various mechanical, electrical, and plumbing components. The use of prefabrication for these components has aided schedule, quality, and safety, allowing the team to maximize use of the skilled workforce on site. Prefabricating select components off site has also helped minimize traffic congestion on the active hospital campus.

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The competition asked U.S.-based design teams to submit plans for an inpatient hospital room that focused on patient-centered care, creating an environment in which patients, their families and caregivers could actively participate in a care plan that would encourage a positive health outcome.

Along with its partners, the Institute built a full-scale model of Kahler Slater’s winning design — complete with furnishings, fixture and equipment — to put on display during the Healthcare Design Conference on Nov. 3-6 in Phoenix. The model was the site of the conference’s Patient Experience Simulation Lab, a workshop that allowed attendees to reenact real-life patient scenarios. The workshop demonstrated the importance of patient-centered care by getting attendees to play the roles of patients and their family members.

The Kahler Slater team designed the room based on insights from patient focus groups, design principles that improve caregiver efficiency and create a healing environment, and the knowledge from a team made up of architects, an interior designer and a nurse/medical planner.

With these factors in mind, some of the room’s key highlights are a family zone, with a sleeper sofa, refrigerator and desk; large windows that allow for natural light; and “smart” technology that gives the patient control of window shades, lighting and room temperature.

Submissions to the competition were evaluated based on the innovation and thoughtfulness used in incorporating the institute’s 10 principles of patient-centered design. A 10-person jury made up of leaders in the health care design field judged the entries. The judges have backgrounds in evidence-based design research, academic research, hospital facility planning, design innovation, government standards for health care projects, patient-centered care and patient-centered design.

For more information on hospital patient room design, read “Patient Room Design Observations.”

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All three of these fear factors were an issue for me during a recent post-surgical stay at a community hospital in California. As a designer specializing in health care facilities, I used the opportunity to observe how the staff, family and patient interact with each other and with the physical environment. Even though my 1980’s-era semi-private room was not up to contemporary design standards, I took away lessons about patient room functionality that are applicable to private room design today. Through observation, I reached conclusions about the useable space in the room, clearances required in circulation paths, patient and visitor seating, and the location of the family zone.

Usable Space

Functional space is lost in any patient room in which there is a flat wall behind the patient bed. Even with today’s sophisticated beds that retract in order to keep the patient’s head from moving, the patient is still effectively moved farther away from the headwall. Because the patient’s bedside cabinet is often placed next to the bed and against the headwall, it’s not accessible unless it’s pulled away and located close to the middle of the patient bed. This was the case in my situation.

When the bedside cabinet was pulled forward, the nursing staff’s accessibility to that side of the bed was severely diminished. In my observation, the typical patient room configuration has 18 to 20 square feet of minimally useable space at the side of the bed near the headwall. Use of this space is limited to IV poles and medical equipment, such as a ventilator, but even these items are pulled away from the wall to facilitate access by the nursing staff. Current designs lose five to 10 percent of expensive square footage by not recognizing the actual position of the patient’s head and shoulders when the bed is raised. Wrapping the headwall surface around the head of the bed is one option that could be explored to make this area a functional space.

Circulation Paths

Patient rooms move. The beds move, furniture is rearranged and medical equipment is wheeled in and out. These factors can change room clearance greatly at any given moment. The clearance between the normal parked bed position and the footwall of the room — a highly trafficked area — was approximately 4 feet. During my stay, I was confined to a walker for mobility and was always assisted by a physical therapist. While the walker would physically fit around the end of the bed, I found the clearance to be inadequate for maneuvering. The 4-foot clearance at the end of the bed was also insufficient for maneuvering the computers on wheels the hospital used for charting, medication distribution and dietary orders into the room. These factors are why patient rooms should be planned with the high-volume traffic areas of sufficient width.

Patient and Visitor Seating

In this particular room, space for patient and visitor seating was limited. Two side chairs — usually occupied by visitors — were provided for each bed, but the lack of a dedicated “patient” chair was a definite obstacle to patient care. It reduces the opportunity for the patient to sit and have a conversation with visitors and limits the ability for a patient to practice getting in and out of a chair, a necessary skill that will be required upon discharge. As with other elements in the room, these chairs were not static against the wall but were being constantly moved. Because of this, weight and bulk should be considered along with clean-ability and durability when selecting furnishings.

The Family Zone

Including family and friends in the design of the patient room is essential to creating a true “healing environment.” The design of the typical “family-centered” patient room follows a common template. The space between the corridor wall and the bed, on the entry side of the room, is deemed to be the caregiver zone. The space between the patient bed and the exterior wall is determined to be the family zone. Often a sofa or sleeper sofa is provided near the exterior wall. The sofa is the primary seating for the guests and also allows them to stay with the patient overnight.

Various versions of this basic concept have been developed using both inboard and outboard patient toilet and shower rooms. The flaw with this design is that the family zone, anchored by the sofa, is too far from the patient bedside. Patients who are heavily medicated have a limited zone of interactivity around them. My experience was that I felt the most supported and most comforted when my family pulled up a chair and sat at the bedside.

As the patient’s condition improves, their zone of activity extends. Instead of just being at the bedside, they begin to engage family and friends in a more conversational way. While the sofa provides for the overnight stay, a true conversation area is not created by this long horizontal surface. It’s difficult to make a conversation circle with a sofa.

From this perspective of the patient, I realized that the function of the patient room and the healing environment can be improved by analyzing the space. Taking seemingly small things like the placement of a bedside cabinet or a dedicated patient chair into account can make a great deal of difference in the quality of the patient experience.

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Q: What is the state of the market for bedside entertainment and information systems?

Rick Pratt: (RP): Our growth has slowed. Overall, our business is well ahead of last year, but the rapid growth rate that we enjoyed for most of last year has declined. I don’t think there’s any question that the economic turmoil has had some effect on construction spending.

I had an interesting conversation several weeks ago with the people from Vanderbilt University hospital. Vanderbilt uses the proceeds from their endowment for all their construction spending. That endowment, about a year and half ago, was valued at approximately $7.2 billion. A few months ago, it was valued at $5.4 billion. Vanderbilt is slowing its spending, and I think those same type of stories are being repeated elsewhere in the United States.

Gary Kolbeck: (GK): We see the statistics on capital purchases and things that are being cut because of the combination of decreased Medicare and Medicaid reimbursements and the bond market, which funds a lot of capital spending for hospitals.

However, with our solutions, we are adding additional value with operational efficiencies for the hospital. As healthcare providers are looking at cost savings, they are looking at interactive systems to help them save time and money with staffing.

If they are buying a flat-panel TV as a passive viewing device, it is not going to make the budget. If they use the TV as an interactive two-way communication device, they can extend their clinical outreach to the patient and better communicate with the patient. They can see a good return on investment that funds an interactive systems and helps pay for the television.

Due to the economic decline, a lot of hospitals are using the interactive systems to promote outpatient pharmacy, gift shop retail and other services.

Q: Rick, what demands do you see on the hardware side with televisions?

RP: Our television is more like the machine that Gary describes: It is a patient appliance. I resist the name “TV” because it is really an information provider for patient appliances that are very interactive. It makes patients happier and the hospital can be improved through that interactivity.

I don’t know what the traditional hospital TV business is anymore. I think there is the consensus, at least with executive suites, that patient televisions have become a combination of television, Internet access and information access.

Q: A lot of healthcare providers use these types of systems for consultations and to provide medical information. Do your clients often seek that type of information system? What components are most important for your clients?

GK: First and foremost, the infrastructure needs to be in place to support anything that they might want to do in the future. They need to make the right choices for TVs and appliances that are going to be reliable so they can extend some of the clinical elements.

The main clinical element is the ability for patient education. The reporting of how patients view the education can be tracked directly back into electronic medical records. It’s a closed-loop solution for that one element of clinical care.

A lot of other areas where we are seeing demand are more simplistic patient-facing areas of the clinical environment. You can put the names of the care team on a large-screen TV instead of a white board. Healthcare providers can list dining menu options based on the patient’s diagnosis and allergies so they are only presented with the meal options that are appropriate. A patient’s schedule, along with an explanation of different medical procedures throughout the day, can be presented to reduce apprehension and anxiety.

There is also the ability to survey a patient in real time. If there is a complaint, the healthcare organization can take action while the patient is still in the hospital. Service recovery is a large element, as they are trying to drive their HCAHPS (Hospital Care Quality Information from the Consumer Perspective) scores for patient satisfaction.

RP: Related to service recovery is increased compliance. We are moving to an era where reimbursement will be limited to a one-time event and any readmits for a similar problem will not be reimbursed.

If a patient is released and readmitted several days later for noncompliance with a diet or medication regime, if that person is a Medicare patient, reimbursement will not be possible. Strategies that can increase compliance after discharge are extremely important. The patient appliance can be used during the hospital stay, and after the stay to increase compliance.

Q: Patients can still use the system when they are at home?

RP: Exactly, through a Web site or e-mail notifications that can go to the patient home.

Q: Is it easy for an older facility to upgrade from traditional televisions with new systems?

GK: Our solutions can run on coaxial cable, which most hospitals already have, although it may be antiquated. If the facility only has the coaxial cable, it is faced with the decision to make minor updates to run a full-digital or analog system, or to run a twisted CAT 5 or CAT 6 system to be better prepared for IP systems.

If hospitals are going to do new construction or renovation, we recommend coaxial and twisted-pair cable to every television location because the future is on the IP side. Build an insurance policy by using both, but if you can’t do that, we have solutions that will run on either infrastructure.

RP: I disagree with Gary a little bit. I think the reality is most older cable infrastructures are really not suitable for high-definition TV channels that run up in the higher frequencies. Most amplifiers and splitters that were installed more than 10 years ago are simply not suitable for HD.

However, I agree completely with Gary, if a hospital is going to spend money on infrastructure, I think both cables should be installed. I can’t imagine there being a big difference in cost for doing just one or both.

Q: Are there any other issues involved with installation?

RP: It’s really a pretty straight-forward conversion. If you are looking for nothing but standard definition television without interactivity, you can hang any flat-screen TV on the wall and have the benefit of a better picture with less space consumed. If you are going to move to a HD or IP capability, you need to think about that infrastructure carefully.

GK: Another issue to keep in mind is who is going to support the solution after it is installed. That is sometimes overlooked when considering total cost of ownership with a system. If it is a new system, many of the nurses need to be engaged in what the interactive system can do to benefit them. Otherwise, utilization will be low.

Q: What should we expect to see with these types of systems in the near and distant future?

RP: I would put that in one word: integration. I think televisions will become integrated with all types of information-delivery devices. It’s a very useful piece of visual real estate that is pointed right at the patient. It can be integrated into a variety of systems, including the room illumination system and the temperature control system.
Tele-video, where you can watch the television and it will have a camera where you can be watched, is on the immediate horizon is. An ideal application would allow the patient to conduct an audio-video conversation with loved ones regardless of where they are located. I think there will be cost benefits with tele-medicine as well.

GK: I think Rick’s comments are right on track. Another consumer factor is portability. There are more portable media devices coming into the hospital that need to be connected. On the other side of that, your personal health record and electronic medical records are going to become more portable and accessible from any device.

As we move forward, the technology is not the hurdle. It’s processes and methods of adaptation that are going to allow people to understand the technology in an easy-to-use environment.

Lodgenet

Healthcare Information LLC

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