Final Banners for Thesis Prep

For thesis prep, I stayed mostly in the theoretical. Rather than focusing in on the design of a whole hotel for travelers with healthcare needs, I decided to direct my attention to one aspect...namely the a spa that would also function as a medical clinic. I have done some preliminary work looking at programming, adjacencies, and layout, but I didn't get into the final design. I have been working creating a design language to guide me in the design. I am basing in on genetic coding, which I consider to be at the forefront of medical innovation.

Clearwater - Proposal for an Urban Dialysis Center

Building from Franklin Street

This is Clearwater, a hemodialysis center implemented in a modern building in a dense urban area. As patients with end stage renal disease typically require hemodialysis three to four hours three times per week, I wanted to implement a unit close to home and/or work. In addition, I felt that patients should have the opportunity to use their treatment time to do activities that they might otherwise be doing, such as relaxation, work, or exercise. Evidence shows that patients have less stress and higher satisfaction if they are given choices regarding their care and are provided with positive distractions. In the design of Clearwater, patients have the option of treatment in more open areas with equipment available for exercise or treatment in semiprivate space set up to allow work on a computer. I took advantage of the open floor plates to flood the space with natural light. All treatment areas have a view of a window. Plants are incorporated throughout the space and water elements are present in the lobby garden. As exercise has been shown to have a significant effect on clinical outcomes in patients on dialysis, I allocated two thirds of the treatment area to have the option of exercise during treatment. I also included mobile nursing units to incorporate best safety practices. This gives the nurse constant access to an electronic medical record and the ability to barcode scan all medications at the point of delivery. Both of these practices have been shown to dramatically reduce medical errors.

Several issues related to healthcare design impacted my ultimate design. Hemodialysis requires the delivery and drainage of significant amounts of water. Including adequate plumbing stacks required that I abandon my original choice of the historic Inland Steel Building. Instead I designed a new building inspired by the footplate of the Inland Steel and found an alternative location within the Chicago Loop. Aligning the treatment spaces along plumbing walls while maximizing views encouraged me to abandon the idea of an area configured to encourage socialization amongst patients. Material choices were largely based on the need for infection control. I chose sheet rubber flooring and film veneers to minimize seams and to permit easy cleaning. In order to have light passing through the entire space, I chose systems furniture for the office area. Patient exam rooms were walled with smart glass to give privacy.

Selected Materials and Colors

Floor Plans

Lobby Atrium  - Franklin Street Elevat

Lobby

Exam Rooms

Quiet Treatment Area

Treatment Area with Exercise Equipment

Colors and Selected Materials for Clearwater

Marathon Advantis Rubber Sheeting
American Biltrite

Bio Foil
LG Hausys

My Studio Environment
Herman Miller

Smart Glass
The LTI Group

Floor Plans for Clearwater

Proposed Site in Chicago Loop

First Floor - Lobby Garden

Second Floor - Exam Rooms, Office & Conference Space

Clearwater is a proposal for a dialysis center in a dense urban area.  The proposed site is at the corner of Franklin and Washington in the Chicago Loop.  The building is a four story modern building inspired by the Inland Steel Building.  Each floor is approximately 12,500 square feet

Third & Fourth Floors - Treatment Areas

A new home for my building

Thank goodness for Google Earth.  After freaking out about the unsuitability of the Inland Steel Building for my project, I have found a new site for my semester project at the corner of W Randolph and N Franklin.  This allows me to remain in the heart of the Loop, which is critical to my concept.

I have created a mirror image of the Inland Steel Building to serve as the pattern for my new building.  The views won't be quite as good, but beggars can't be choosers.  Also, now that the main core will be part of the design, I will only need to work on the interiors of four floors instead of five.  I think that is a good thing....but not sure yet.  I am almost caught up to where I was before the meltdown.

A few steps backwards...

I freaked out earlier this week.  I met with a dialysis nurse to gain a better sense of how the dialysis machines actually work.  Wow....a lot of plumbing is involved.  Of course, I knew that from my case study, but it is still a bit overwhelming.  I also was thinking about a drug-resistant organism infection rate of about 20%, and she was thinking more like 80%.  As I started to thinking about this in the context of the Inland Steel Building and I just couldn't make it work.  I started panicking!

I met with my professor on Tuesday to discuss just how the plumbing would have to look to make my ideas work.  We confirmed what I suspected...it really cannot work in the Inland Steel Building and maintain the historic design of the building.  However, at this point it would be near impossible to start from scratch.

So, I'll be working on the Inland Steel Building, but not.  I will reimagining the building as a lower rise building using the same floor plates.  I still need for this to be an urban project, so I need to pick a new site for this "new building" in the Chicago loop (looking for empty lots).  I then need to review all the work I've done so far in terms of space planning, especially the use and location of the cores.  I guess it is better than starting from scratch.

Putting Research Into Action (sort of)

In Specialization Studio, we are to take what we have learned from our "case study" earlier in the semester and apply it to a design.  I had prepared a study, looking at evidence-based design for hemodialysis units.  The three factors that seemed most compelling to me were:

• giving patients choices
• opportunity to exercise during dialysis
• positive distractions

I have chosen to the Inland Steel Building in Chicago as the site of my design.  It is a stunning building in the Chicago Loop, the first skyscraper built after the Depression.  It is known for its open floor plates.  The primary core is located in an adjacent tower.

Hemodialysis centers are often located in medical centers or in less densely populated areas.  I liked the idea of situating one in a dense urban area.  As people who require dialysis may need to be there 3-4 hours at a time, 3 times per week, it makes sense to me to locate a center close to wear people work and live.  In addition, I wanted to tackle the problem of implementing a complex medical program in a building that is neither a medical building nor new.

Evidence Based Design: Hemodialysis Unit Case Study

Hemodialysis is a medical procedure where the blood is removed from the body and filtered of impurities prior to being returned to the body. Hemodialysis is most commonly used for patients with renal (kidney) failure. While on occasion it is used on a temporary basis for patients with acute renal failure, hemodialysis is frequently used as a long-term treatment for patients with end stage renal disease. Patients receive the treatment multiple times per week. It is required indefinitely unless the patient has a kidney transplant.


Healthcare design has long integrated the principles of evidenced base design. Clearly, many factors can be influenced by design in the healthcare environment. Design can influence the experiences of patients, visitors, clinicians, and staff. Processes, such as waiting times and turnaround times, can be greatly affected by design. Perhaps the most important outcomes that can potentially be improved are clinical variables. The intent of this case study was to evaluate the elements of design that can affect clinical outcomes in an ambulatory hemodialysis center.


The research for this study involved collective information from a variety of sources and then triangulating the data to arrive at conclusions for design solutions. The public health literature was reviewed for statistics regarding end stage renal disease and usage of hemodialysis in the United States. Patient support online chat resources and medical literature were reviewed to delineate issues regarding patient experience. In addition, the medical literature also provided information about important clinical outcomes for hemodialysis. Standard texts in healthcare design provided typical current issues for hemodialysis unit design. The design literature was consulted for information about design elements that can impact patient clinical outcomes.

Findings:

1. The incidence and prevalence of people requiring hemodialysis more than doubled between 1900 and 2004.  In 2004, there were 295,000 people requiring hemodialysis, with 88,500 of those being new cases that year.
2.  In general, a person with end stage renal disease will require hemodialysis three times per week.  Each session can be from 3-5 hours duration.  Upon arrival, the patient will be weighed and have blood drawn.  This determines the current fluid and electrolyte balance, influencing the duration and parameters of the daily treatment.  The patient is then placed in a recliner chair and hooked up to the dialysis machine.  Access to the vascular system is either through a catheter or through an arterio-venous fistula implanted in the forearm.  If a fistula is used, the patient will have limited use of that arm during the treatment.  During the treatment, the nurse will monitor the patient’s vital signs and the settings on the machine.  On some occasions, the patient may meet with the physician, dietitian, or social worker during or after the treatment.  Following treatment, the patient is weighed again before leaving.
3. Hemodialysis units can vary greatly in size based on the number of treatment stations.  Each patient treatment station requires a minimum of 80 square feet.  In addition, space will be required for reception, nursing station, preparation and storage of dialysis materials and medications, patient education/counseling, and laboratory.  Special areas of particular concern for a hemodialysis unit are patient privacy, infection control, and plumbing.
4. Patients generally do not consider hemodialysis to be a good experience, especially initially.  They report feeling tired and sometimes ill during the treatment.  They also report a sense of social isolation and boredom.  Patient satisfaction has been found to have strong influence on levels of staff burnout.  Staff satisfaction was influenced by access to information, professional accomplishment, and patient satisfaction.
5. A wide variety of clinical outcomes are regularly followed in hemodialysis units, including adequacy of filtration, serum albumin (protein) levels, fistula use, metabolic bone disease, hospitalization rates, blood pressure, and mortality rates.
6. In a variety of hospital settings, design interventions have been shown to reduce stress and blood pressure.  These design elements include giving the patient sense of control, access to support, positive distractions (e.g. nature), and lack of negative distractions (e.g. television).  Exercise during hemodialysis has been shown to improve filtration, improve sense of quality of life, and reduce requirement for antihypertensive medication.

Hemodialysis units are a common component of the health care system. Given that patients who require hemodialysis will have too many hours at a unit multiple times per week, the opportunity for design to have a cumulative impact on various healthcare outcomes is great. A typical unit is not set up in a manner to allow the patient to have many choices about how to spend time or to be able to socialize. It is not unusual for a patient to spend the four hours of treatment watching television. Based on available evidence, I propose to design a unit addressing these issues. The design would include patient access to environmental controls for each treatment station. The treatment stations will be set up to allow the patient to have visitors during treatment. Patients should have more options during treatment. Areas of the unit will be set aside to allow patients to socialize and to exercise. Based on these interventions, I anticipate that patients at the unit would report a greater quality of life and require less antihypertensive medication. Patients who regularly exercised during the treatment would have improved filtration and ultimately require less time for each individual treatment. While not the direct subject of this case study, these interventions should have positive impact on patient and staff satisfaction as well.

 Bibliography

Argentero, Piergiorgio, Bianca Dell'Olivo, and Maria Santa Ferretti. Staff Burnout and Patient Satisfaction With the Quality of Dialysis Care. American Journal of Kidney Diseases, 2008: 80-92.

Clinical Outcomes. http://www.davita.com/incenterhemo/clinicaloutcomes/ (accessed online: October 2010).

Daul, A. E., R. F. Schafers, K. Daul, and T. Philipp. Exercise During Hemodialysis. Clinical Nephrology, 2004: accessed online.

Himmelfarb, Jonathan, Arnold Berns, Lynda Szczech, and Donald Wesson. Cost, Quality, and Value: The Changing Political Economy of Dialysis Care. Journal of the American Society of Nephrology, 2007: 2021-2027.

Kidney Patient Guide. http://www.kidneypatientguide.org.uk/site/PStory.php (accessed online: October 2010).

Skaggs, Ronald L. Ancillary Departments. В Building Type Basics for Healthcare Facilities, editted by Stephen A. Kliment, 132-136. Hoboken: John Wiley & Sons, Inc., 2008.

Ulrich, Roger S. Effects of Interior Design on Wellness: Theory and Recent Scientific Research. Journal of Healthcare Interior Design, 1991: 97-109.