Peter S. Harsh, AIA, CCS Todd A. Gindelberger, AIA Ami M. Bement, Interior Designer E. Lynn App Architects, Inc., Englewood, Ohio

Mary M. Gregory, RN, BA, BSN HealthCare Design Consultant. Cincinnati

Karen S. Herby, RN, MBA, CHE Director, Surgical Services, The Children's Medical Center, Dayton

Reasons for Renovation
The Children's Medical Center is a 155-bed pediatric acute-care facility located in Dayton, Ohio. The hospital is a primary referral center for a 20-county area in west central Ohio, and the Department of Surgical Services is the primary center for children needing surgery within this area. Since the last department renovation in 1989, the volume of surgical procedures had increased 32 percent with a major shift from the traditional inpatient status to outpatient status. More than 9,000 procedures a year are performed in the Day Surgery Department, with about 8,000 of those being outpatient procedures. The increase in volume alone provided sufficient need to renovate the Day Surgery Area.

Additionally, the existing environment consisted of seven separate multipatient open rooms with several entrances. The patient cubicles had limited space, making it difficult for parents, nursing staff, and medical staff to provide quality patient care.

Another negative feature of the open-bay configuration was its difficulty in maintaining proper infection control. When one child had a communicable disease such as chicken pox, a room with six beds had to be closed off and occupied by one infected patient. And if a child underwent surgery before evidence of a communicable disease was determined, all patients and staff present on the day of surgery were potentially exposed to the disease.

In terms of privacy, there were several problems. Separated only by cubicle curtains, sights, smells, and sounds from neighboring cubicles were distracting to patients and parents. Another child's crying could be interpreted as a lack of care. At times crying infants were placed beside teenage patients. During peak hours the open bed units were crowded, which gave the perception of rushed rather than individualized care.

The lack of olfactory privacy was also a hindrance in the open plan. This element is often overlooked in healthcare environments, where patients may have adverse reactions to anesthesia such as vomiting.

Confidentiality was also difficult to maintain, as staff communications with their colleagues and parents were easily overheard and sometimes misinterpreted.

Efficient utilization of space and staff were also a concern in the existing open model design. The multiple rooms required duplication of staff and support spaces. A new model of care was needed to decrease the number of different patient/staff interactions and to provide opportunities to improve the clinical care.

With the proliferation of outpatient surgery centers in the area, the need to design a facility that was customer-focused for children, parents, and surgeons became a necessity from a competitive perspective.