Cayuga Medical Center at Ithaca DEA 453 Prof

Cayuga Medical Center at Ithaca DEA 453 Prof. Frank Becker

Cayuga Medical Center Med/Surg Unit

ScOtt Brenner Vanessa del Aguila Claire Ganley “Why is it the way it is?” Medical Surgical Unit ‘Med/Surg’ p1

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Table of contents

p1 Cayuga Medical Center

p2 CMC History

p3 Med/Surg Unit

p4 Location

p5 Renovation Process

p7 Renovation Results

p16 What is Absent?

p17 Healthcare Aims

p18 Final Thoughts

p19 Works Cited

Cayuga Medical Center

ur mission is to provide the residents of our service area with Ocomprehensive health care services of a preventive, curative, and educational nature at a cost reasonable to both patients and the medical center. Further, our mission is to supplement community services in order to meet the needs of the community by providing mod- ern, efficient, and economically feasible programs, personnel, equipment, and facilities.

s a state of the art facility home to 800 healthcare pro- Afessionals and a medical staff of 180 physicians, Cayuga Medical Center at Ithaca (CMC) has provided care for Ithaca and the greater Finger Lakes community for more than 100 years. With 204 beds, over 150,000 patients use CMC’s acute care and outpatient care each year, taking advantage of their cutting edge diagnosis and treatment service. The hospital is accredited by the Joint Commission on Accreditation of Healthcare Organizations, the world’s leading independent, not for profit, healthcare accrediting organization. As a tech- nologically advanced institution, CMC ensures that patients benefit from the latest diagnostic and treatment capabilities available and works to guarantee that physicians can provide the best healthcare possible. Hospital Main Entrance

1 Med/Surg Unit Cayuga Medical Center CMC History

he hospital has undergone a becoming outdated, so Cayuga programs, infrastructure, and a Tlot of changes since it moved Medical Center was built to be a renovation of the interior. In 2004, in the 1970s to its current location state of the art health care leader renovations were finished in two overlooking the western banks in upstate New York. Since the of the three Med/Surg Units, the of Cayuga Lake. The Tompkins 1970s there have been renova- first floor lobby and gift shop, the County hospital’s services and tions to the building, such as the medical staff lounge, and the facility were strained and quickly recent upgrade of the hospital’s Garden Café.

CMC Values

We will deliver high quality, comprehensive, cost-effective local health care in partnership with our community.

Clinical Excellence Customer Service People Financial Integrity Community

We value our ability We value customer We value each other We value financial We value our part- to provide the very service—as we take as colleagues and integrity while striving ners in the local

best results to you, care of our patients mentors, and we to meet community health commu-

right here in your and their families, in value you—our neigh- needs through invest- nity, spanning the own community. our relationships with bors, friends, and ments in state of the spectrum of care

our doctors, and in community partners. art equipment, reno- from acupuncture - our interactions with vations to our facilities, to wellness, from

colleagues. and development of prevention to pallia- new programs and tion, and from acute services. care to life care.

Why is it the way it is? 2 Med/Surg Unit

Medical Surgical Unit

Med/Surg Unit Hallway - Patient Room - Nurse’s ‘Pod’ - Central Nurse Station.

he Medical Surgical Unit of CMC is the unit where adult patients recover from serious illness, orthopedic prob- Tlems, and major surgery. Cared for by physicians, nurses and allied health care professionals, the patients in the Med/Surg Unit are often patients that are recovering from the entire scope of acute illness.

Patients in the Med/Surg Unit are typically recovering or suffering from: Important Numbers Pneumonia Stroke CMC Total Patients Served Complications of diabetes (Inpatient and Outpatient in 2004) 167, 408 Cancer Dialysis Chronic Obstructive Pulmonary Disease Med/Surg Unit Inpatient Discharges (2004) 4,952 Joint repair and replacement surgeries Trauma surgery General surgery Med/Surg Unit Average Length of Stay (2004) 4.4 days Transfers from ICCU Continued care

3 Med/Surg Unit Cayuga Medical Center Location

Cayuga Medical Center Site Cayuga Lake he Med/Surg Units are located on the third and fourth Tfloors of the medical center and the building is also oriented to face Cayuga Lake. The Med/Surg Unit is parking intended to be a place for patient recovery. Located on the top most floors and having most of the patient rooms facing the lake, patients are able to enjoy the calming

entrance views of nature.

parking he parking lot at the Cayuga Medical Center evenly Tsurrounds the building. A visitor is able to easily access every entrance of the center from the parking lot. This is

parking important because falling short in this regard can cause unnecessary stress for patients and visitors (Malkin 114). elevator Route 96

4th floor Med/Surg Units 3rd floor Med/Surg Unit 4N Patient Rooms 3N Patient Rooms ypically, the third floor 4S Patient Rooms TMed/Surg Unit handles patients recovering from surgery. Usually the 4S Med/ Surg Unit houses patients recovering from a wide range of acute illnesses, and the 4N wing is for patients under-

going cardiac telemetry. elevator elevator lobby lobby

Why is it the way it is? 4 Renovation Process

he Med/Surg Unit underwent jor improvements since the late space unsuitable for patients or Tmajor renovations early in the 1970s when it was built. Over ap- staff. Together, the administration, new century, with each unit’s trans- proximately 20 years, the unit had staff, and architects underwent a formation completed by August begun to deteriorate, with leaks, renovation process that ultimately 2005. Prior to the renovations, the outdated systems, no room for new produced the Med/Surg Unit that is unit had not undergone any ma- technology and had become a at CMC today.

Situation Motivations Not suitable for patients, visiting families or staff. A renovation needed to take place to bring the Med/Surg Unit - Had not been renovated since late 1970s into the 20th Century. - Leaks - Improve communication systems - Outdated systems and design - Change physical design of the space to improve - Deterioration of the interior service to patients - Improve how the Med/Surg Unit fits into the CMC infrastructure

Pre Design Constraints People Involved - Could not change the footprint A CMC committee was set up to discuss the of the unit because of equipment new unit’s design. hookups located in patient rooms - Hospital Administration - Had to be a compromise be- - Nurses (on all shifts) tween all parties - Aides - Required to meet health codes - Ward Secretaries and government standards for - Case Managers patient care and hospital design - Physicians (not very involved) - Money - Architecture Firm

5 Med/Surg Unit Cayuga Medical Center Renovation Process

verall, the design process for the renovation was full of discussion from all people involved and compromise Ofrom all parties.

CMC group Architect Design presented archi- presented a num- CMC group tect with all of ber of possible provided feedback Architect presented Process their needs and designs to the on each design. finalized paper plans wants for the new CMC committee. unit’s design

This back and forth design feedback step between the architect and CMC happened a few times.

Influences Final Product Re-Assessment - Research the architect gathered from litera- -Once the design was agreed -After using the newly renovated units, CMC ture and from observations of CMC and the upon, each of the three Med/Surg staff requested a few changes. Med/Surg Unit units underwent renovation on a - For example, they had all of the automat- staggered schedule. ic faucets on the unit changed to manual - Visits to other recently renovated hospitals control faucets because they could not to see their design, such as: - The 3rd floor unit was the first to get the water hot enough with automatic - Anne Arundel Medical Center, Maryland be completed, which allowed the controls. - Lehigh Valley Hospital, Pennsylvania group to assess their design. - Based on visits to other hospitals, they saw - They were able to make changes Problems the following in practice and included them and improvements. in the final Med/Surg renovation - For example: they changed - Faucet control - Wireless phones to enhance com- the wall height in the doc- - Because they could not change the footprint munication tor dictation area of the main of the unit based on pre-existing equipment - ‘Nurse Pod’ layout for unit floor plan nurse station to increase hookups, the nursing staff was not able to have - Computerization of charts visual access in the unit. the open layout with visual access to all rooms - The needs of each of the different groups - All renovations were complete in that they had requested. involved in the Med/Surg Unit August 2005. - Took time for staff to adjust to new design.

Why is it the way it is? 6 Renovation Results Med/Surg Unit Today

he Med/Surg Unit underwent extensive renovations as a result of the design co-created by the architect and the TCMC committee. From this transformation, many of the elements of the unit were improved in an attempt to deliver patient centered and evidence based design. The following are some key aspects of the new design and the reasoning behind the decisions to implement them.

Layout ccording Linda Crumb, RN, BSN, dividual, are located on each corner Athe staff originally asked to have of the floor. The location of the pods the Med/Surg Unit redesigned so serves as support to the nurses in the that the nurses’ station would be in nurses’ station who may be too pre- the center of the patient rooms and occupied to immediately tend to a oriented in a circle. This would make patient or an emergency. This creates it easier for the nurses to visually moni- an efficient layout. tor all patients at one time; however, the footprint of the unit could not be changed. To compensate for this, the outer most workstations were designed to face the patient rooms so they can see as well as hear activity on the whole wing. These four nurses’ pods, which are more private and in-

Waiting Areas

Nurse Pods

Central Nurse Station Central Nurse’s Station with the Pod Layout 4th Floor Med/Surg Units Unit Corridors Visual Access

7 Med/Surg Unit Cayuga Medical Center Renovation Results Med/Surg Unit Today

Corridors here are certain design there are often times in such Tfactors of the corridors in units where a large number the Med/Surg Unit that make of people, including nurses, them very useful in this set- doctors, and patients fami- ting. First of all, sheet-vinyl lies, need to get to and from flooring was used to line the rooms in a quick fashion. Pod Nurse Station hallways. This material cre- The width of the corridors is a ates flooring with little to no tremendous factor in allow- sheen, which is known to ing such timely movements. reduce glare and thus the number of slips and falls on Smaller Waiting Area the surface (Malkin, 120). n all four corners of the Also, the large width of the IMed/Surg Unit wings, there corridors is important. In ad- are smaller waiting areas dition to being able to fit the that are adjacent to the patient rooms. These spaces Main Nurse’s Station patient beds through them, serve the function of allowing In addition, a tube sys- patient visitors to step outside tem is used to transport the room and still be near hospital materials from their loved one. Whether the nurses’ station to the the visitor wanted to make a laboratory and pharma- phone call, read a maga- cy and vice-versa. This is zine, or just give the patient a time-saving and con- some time to themselves, venient way to commu- they could be comfortable nicate with other units in and close by while waiting in Med/Surg Unit Corridor 4th Floor Corridor the hospital. these smaller lounges.

Why is it the way it is? 8 Renovation Results Med/Surg Unit Today

Signage and Wayfinding

Examples of signage found throughout the Med/Surg Units Examples of wayfinding design in the Med/Surg Units

his may be one of the nage, one must keep in had an additional label A unique aspect of the Tmore important, and mind the users of the space. stating, “Staff Only”, which wayfinding was done with often overlooked, aspects Since this is a unit where clearly indicates to patients color schemes on the floor of designing a Med/Surg the majority of the visitors and visitors that they do on the wing. Near the pa- Unit of a hospital. Given the are elderly individuals, it is not belong in these areas. tient rooms, there were mul- nature of a hospital, if things important that the signage As far as for aiding visitors tiple small, colored boxes are not clearly readable font be large, clear and coming out of the eleva- that lead to the entrances and easy to find, many er- there be a lot of it. These tor, there was a clear sign of each patient room. As rors could occur. Therefore, criteria were met in this that pointed to where the one got nearer to the en- it is important that the loca- wing. Almost every door numbered patient rooms tranceway of the room, tion and directionality of all was labeled in the hallways, were located, which makes the squares were grouped areas in the wing are clearly including the storage rooms, it very easy for a visitor to together to form long rect- marked. nurse stations, and patient locate their loved one when angles, literally pointing the When creating the sig- rooms. Also, some rooms coming to the hospital. way into the room.

9 Med/Surg Unit Cayuga Medical Center Renovation Results Med/Surg Unit Today Patient Rooms he patient rooms in the hospital are of a standard size in a rectangular shape and are Tdesigned to hold up to two patients at a time, and each room has a private bathroom. There is a sliding curtain that serves as a partition between the two beds (when needed). Each room was designed with the intention of being both a single or double patient room, yet the priority is to have every patient in their own room. Depending on the available space, sofa beds can be added to the room for visitor sleeping.

Storage in Patient Rooms for Personal Belongings - The Communication Board with Information for Patient and Staff - The Patient Room Interior

here is also a good amount of such as band-aids, medicine, and there was a communication board Tstorage furniture in each room, cloths. In the lower potion of the for each of the patients in the room, such as a cabinet, which are used cabinet was a laundry bin where which was a dry-erase board that to contain the patient’s clothes and the nurses would place the patients told each patient who their nurse personal items. Just outside the main used clothes. This was done to keep and doctor were for the day, along door to each patient room, there is the odors of the dirty laundry out of with what their goal should be for the a full-length cabinet divided into two the patient’s room, and also so the day, such as taking a walk through parts. The upper part contained a nurses could gather the dirty laundry the corridor. This helps to facilitate storage unit full of everyday items the without having to disturb the patient communication between patient nurses would need for each patient, in their room. Lastly, in each room and staff.

Why is it the way it is? 10 Renovation Results Med/Surg Unit Today

ccording to Ulrich et. al., “Noise is a much greater problem in multi- than single-bed Arooms.” Also, they show that the uncontrollable noise by one roommate has been shown to cause more stress than noise that is controllable (Ulrich et. al, 39). Lastly, Ulrich et Al explains that research strongly suggests that visual access and exposure to nature creates a significant emotion/psychological and physiological recovery from stress within a matter of minutes (Ulrich et. al, 46). In the rooms observed there were views of Cayuga Lake, which provide important views of nature for the recovering patients.

Window View from Patient Room Storage

torage is an important issue for the Med/ es and doctors would need in treating their SSurg Unit of the hospital while the renova- patients. The rooms do not have a lot of inner tions were taking place. There are individual organization, so some contents are messy. storage rooms that are located along the main hallway walls throughout the Med/Surg Unit. To make them easily visible, there were clear signs on the rooms that said “Storage.” Also, one of the storage rooms labeled ex- actly what pieces of equipment were in that room, which makes a nurse’s job much easier. Instead of having to search each room to see where things are located, a quick glance at the sign can let them know what is where. Each storage room is intended to provide

easy access to a variety of items that the nurs- Lighting on the Med/Surg Unit Storage Unit Outside each Patient Room Inside a Storage Closet

11 Med/Surg Unit Cayuga Medical Center Renovation Results Med/Surg Unit Today Windows

atients often feel fearful and nervous research shows that viewing nature not Pin a hospital setting and it is the job only reduces stress, but eases patient of the designer to create a therapeutic pain” (Ulrich 47). Each patient room in environment. Installing many windows is the Med/Surg Unit has one large window. a design measure that provides views of Some rooms are fortunate enough to be nature that can help reduce stress. Strong facing Cayuga Lake.

Window View from Patient Room

Lighting here are two types of light- worsen the patients’ recovery located behind a partial, plas- Ting used throughout the by limiting the amount of posi- tic covering near the ceiling Med/Surg Unit: natural and tive stimulation they receive and the light was emitted up artificial lighting. In each of daily, which in turn exacer- and over the cove. The latter the patient rooms, there is a bates the negative conditions source of light is good since it good amount of natural light- they are surrounded by (Ulrich, provides a great source of light ing present. The windows are 51). As far as the lighting used within the room and does not large enough so that during in each room, fluorescent was cause any eye harm to users. the day, artificial light is not the source used. There were The controls for the lights are necessary to illuminate the two sources of this artificial light located near the door of the room. The presence of such in the rooms. One came from room. They appear difficult windows is very useful in the traditional light squares on the to operate since they have healing process, as research ceiling, and the other came a neutral middle position, as reveals that the lack of win- from a lay-in-light fixture, in opposed to the standard up/ Lighting on the Med/Surg Unit dows in a hospital setting may which the long light bulbs were down, on/off position.

Why is it the way it is? 12 Renovation Results Med/Surg Unit Today Color olor is a very important aspect of designing Cany room, especially a hospital wing. It is known that the use of certain colors can create positive mental states in people (Mizan, 798), which is essential in hospital patients recovering from surgery. In the Med/Surg Unit, there is a dark blue/light blue color theme throughout this wing. Additionally, the designers used curves

with these colors to create a nice aesthetic Artwork from the Med/Surg Corridors presence. By using the blue shades and the curvy lines, the design mimics the nearby water of Cayuga Lake. This color scheme can be seen along the walls in the patients’ rooms, the grounds of the hallways, and in the furniture and Art partitions of the visitors’ waiting area. Also, the ceiling in this waiting area had a matching curve orks of art are a center has its own distinct in it to that of the glass partitions located below. Wmeans of distract- theme. The artwork in ing patients in healthcare Med/Surg Unit has a farm facilities from any pain or theme filled with snapshots worry they may be expe- of barnyard animals and riencing. As indicated by green landscapes. Usually evolutionary theory, imag- hung between each pa- es of nature create more tient room, these images stress-free and restorative depicting nature can truly Colors Found in the Med/Surg Unit environments (Malkin 117). make a difference in the Each floor of the medical recovery process.

13 Med/Surg Unit Cayuga Medical Center Renovation Results Med/Surg Unit Today Acoustics

here there are humming ma- (Ulrich 40). Thus, sound should be Wchines, high foot traffic of nurses controlled and balanced. One of racing down the halls, and patients the most important design measures in pain, there will most likely be noise. to minimize noise levels is to install The sound level poses challenges in “high-performance sound-absorbing a healthcare facility, especially in ceiling tiles that reduce echoing or the unit where patients need a quiet reverberation and sharply diminish environment to recover. Research noise propagation” (Ulrich 40). Each has shown that noise worsens patient patient room in the Med/Surg Unit is outcomes through sleep depriva- equipped with tiled ceilings that ab- tion, awakenings, and the increase sorb any sounds that may resonate of blood pressure and heart rates throughout the patient room. Acoustical Ceiling Tiles in a Patient Room

Materials

arpeting is only used in the nurses’ station to absorb sounds from the Chigh levels of foot traffic. There is a concern that carpeting is not a preventive measure for infection. However the nurses’ station is only used for ad- ministrative purposes and is not susceptible to spills. The floors of rooms such as cleaning rooms, utility rooms, and patient rooms are vinyl. This is necessary to reduce the spread of infection. “Studies have shown that with hard- surface flooring particulates are kept airborne” (Malkin 120). In addition, vinyl floors are easy to durable and easy to clean (Zimring 40).

Materials in the Central Nurse Station

Why is it the way it is? 14 Renovation Results Med/Surg Unit Today Transparency and Barriers

he nurses’ station is comprised door of the Med Room. Before on the fourth floor has a translu- Tof individual workstations that the window was installed, a nurse cent barrier that does not allow are divided with clear, glass barri- entering the room would col- for visual access from either side. ers. While these provide the nurs- lide with another nurse carrying Since the elevators are facing es’ with a sense of privacy with- medicine. This “transparent door” the waiting area, the barriers are out being completely hidden, the is an efficient way to prevent the important to provide a sense of barriers do not visually obstruct spilling of medicine and preserve privacy to the visitors and fami- their view of the wings. Also, a the cleanliness of the healthcare lies waiting to hear news of their glass window was installed in the facility. The larger waiting area loved-ones.

Glass Barriers in the Central Nurse Station - Translucent Barrier in the Waiting Area - Transparent Door on the Med Room

15 Med/Surg Unit Cayuga Medical Center What is Absent?

he renovations of the Med/Surg Unit almost met the expectations of all the parties involved. How- Tever, some design aspects included in the plan seem inadequate. The following are examples that stand out from the others.

Windows Wayfinding Signage

The knob to control the blinds is lo- Despite the helpful signage, all The light switches in the patient rooms cated on the top left corner of the the rooms appear very similar were not labeled correct nor were they window frame. This may be difficult that it is easy to get disoriented. positioned in close proximity to the lights for the shorter patients and staff, they control. This can cause confusion, and even the elderly. especially to the older patients.

Why is it the way it is? 16 Healthcare Aims

ccording to the Institute of Medicine’s article entitled Cross the Quality Chasm: A New Health System for the A21st Century, there are six aims for changing the Health Care System. The design elements within the Med/Surg Unit of the CMC embody those aims in the following ways:

Health Care Must Be Safe Health Care Must Be Effective Health Care Must Be Patient-Centered - Antibacterial foam dispensers - “Patient Info Board” serves located throughout the unit as a means of educating - Allow for personalization - Vinyl flooring to reduce patients about their own -Sofa beds for overnight slippage due to glare health visitors - Handrails in the bathrooms and hallways - Emergency bell in every bathroom

Health Care Must Be Timely Health Care Must Be Efficient Health Care Must Be Equitable

- Tube system transports - Computerized patient - Not applicable to renovations hospitals materials quickly records reduce amount of - Computerized patient unnecessary paperwork records makes it easier to - Use of tube-system increases retrieve productivity - Corridor size allow for easy flowing traffic

17 Med/Surg Unit Cayuga Medical Center Final Thoughts

ccording to John Hughes, Vice President of a Managing Consulting and Investment Banking firm, A“construction put in place for total health care construction will increase almost 34% from $34 billion in 2005 to $45.4 billion in 2009.” The baby boomers of the 1950s and 60s are getting to the age where they need to use more healthcare services. CMC, along with many other healthcare facilities, followed this trend of healthcare construction by either renovating or repairing their current building.

Why is it the way it is? 18 Works Cited

Cayuga Medical Center 2004 Annual Report. Cayuga Medical Center. 2004. 1-36. 22 Sept. 2007 .

Hughes, John. “Healthcare Construction Market Trends.” FMI: Management Consulting and Investment Banking for the Con- struction Industry. FMI Corporation: North Carolina, 2006.

Institute of Medicine (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C.: Insti- tute of Medicine

Malkin, Jain. “Improving Healthcare with Better Building Design.” Designing a Better Environment. Ed. Sara O. Marberry. Health Administration P. 109-124.

Mizan, Jacques. “Changing Buildings; Building Change!” The British Journal of General Practice 54.507 (2004): 798-799. 22 Sept. 2007 .

Ulrich, Roger S., Craig Zimring, Xiaobo Quan, and Anjali Joseph. “Improving Healthcare with Better Building Design.” The Environment’s Impact on Stress. Ed. Sara O. Marberry. Health Administration P. 37-61.

Ulrich, Roger S. “Effects of Healthcare Environmental Design on Medical Outcomes.” International Academy for Design and Health (2001): 49-59. 22 Sept. 2007 .

“Welcome to Cayuga Medical Center.” Cayuga Medical Center at Ithaca. 2000. 22 Sept. 2007 .

Zimring, C. (n.d.) A Guide to Concluding Healthcare Facility Visits. Pleasant Hill, CA.: The Center for Health Design. 30 – 44.

*Photos are from those provided on the Blackboard.Cornell.Edu website and from own personal collection.

Thank you to Linda Crumb, Dr. David Evelyn and John Rudd for their help with this project.

19 Med/Surg Unit Cayuga Medical Center