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What will make a new Children’s Hospital good? Plenty of planning, to start

The chance to build a children’s hospital from scratch rarely comes along, so those planning the $270 million John R. Oishei Children’s Hospital under construction in Buffalo sought to get it right.

On a chilly morning late last year, about a dozen doctors, nurses and others on the medical staff gathered in a vacant Utica Street drugstore outfitted with full-scale replicas of what will be inside the hospital rising on the Buffalo Niagara Medical Campus.

They pushed a gurney past mock-ups of an operating room, neonatal intensive care unit and labor-delivery room. Then they crammed into a mock trauma room, where the medical professionals, step-by-step, went through the motions of resuscitating a young patient. The overhead boom was real, as were some other fixtures. Everything else, from the monitors to the linen basket to the faucet and sink, were crafted out of cardboard, duct tape and paper.

It was all pretend that day, but the consequences of their decisions will be real for decades to come.

The exercise demonstrated how those designing the project want people who will use the new hospital to weigh in on the details – test driving the key rooms before anything gets bolted to the walls.

“You only get an opportunity like this every 100 years or so,” said Jessica Mabie, manager of projects and operations at Women & Children’s Hospital. “The simulation is a way to decide what’s best within the constraints of the building.”

The new hospital at 818 Ellicott St., now 48 percent complete and a bit ahead of schedule, is expected to open in November 2017.

The hospital it is replacing, Women & Children’s, was the first pediatric hospital in New York State, starting with 12 beds in 1892 in a renovated home on Bryant Street.

Today, 124 years later, designing children’s hospitals involves more science and research, adopting findings from studies that show how the physical environment can improve patient healing, reduce stress and increase safety like preventing infections.

Those designing Buffalo’s new children’s hospital incorporated the mock-ups and organized brainstorming sessions examining a day in the life of a patient. They sought observations from staff. Twenty-eight clinical groups including different departments and specialties participated.

They heard from patients and their families, too.

“More than 300 people participated,” said Uma Ramanathan, the principal at Shepley Bulfinch, the Boston firm designing the new hospital. “You don’t want to build and use the hospital, and learn then how you could have made it work better.”

Trauma room test

Inside the former drugstore, the medical professionals assembled in a replica trauma room and meticulously walked through the steps of resuscitating a child as if they faced a real emergency.

Someone grabbed the monitor on an overhead boom. Good spot. Plenty of hookups for technology. Check.

A nurse, positioned where she would work during such an emergency, readily found the area for baskets holding intubation tubes along the back wall. Check.

But then came the question that caused everyone to stop. Is the doorway into the room wide enough for a stretcher?

It seemed like a tight fit when they entered. A discussion unfolded. They looked at measurements. A design team member offered his thoughts. It’s close but should work, they decided.

Then they continued on with the exercise. When the time came to reach for hand sanitizer, everyone looked around, spied the fake dispenser on a wall near the door and then let out a collective groan. Bad idea.

While seemingly a small detail, the location proved awkward. And it’s not a minor matter. A long list of guidelines and rules dictate the placement of hand sanitizers in hospitals to maximize use and prevent fires. The consensus choice: Move the dispenser closer to the sink.

So it went during the drill as the group stopped at each step to hash out the workflow and location of equipment, everything from the positioning of a medication cart to the placement of the paper towel holder.

“We want to figure out how to coordinate our new space and make it more functional,” said Dr. Kathryn D. Bass, director of trauma.

Downsized hospital

The effort inside the vacant drugstore will help medical professionals meet big challenges.

The new hospital – named Oishei after the Oishei Foundation that donated $10 million – will be smaller than the existing Bryant Street facility but must still work better for patients and staff. It also must respond to two trends: more care now provided outside of hospitals and increasingly intensive care for those who need hospitalization.

The current multibuilding campus in the Elmwood neighborhood has 608,830 square feet of space and 200 beds.

The new 410,395-square-foot hospital will have 183 beds, but also gets an additional 93,357 square feet in the adjacent Conventus medical building for the outpatient surgery center.

The Oishei hospital highlights another big change in design: the use of three-dimensional digital prototypes of the building that reveal all the layers of the hospital in stunning detail, from the steel frame and walls and windows to individual nuts and bolts.

When Kaleida Health, which operates the pediatric facility, ordered lights and giant equipment booms that will hang from the ceiling of operating rooms, it knew to a fraction of an inch whether they would fit by viewing them digitally from every angle.

Fran Slavin, a Turner Construction Co. superintendent, sat in front of two 65-inch screens that displayed a 3-D picture of the maze of pipes, ducts and wiring that the fixtures must clear above a ceiling.

“We’re not hanging those booms for two years, but the steel is up. You have to know,” Slavin said.

Simpler and safer

How the building will look – its curbside appeal – is important. But Oishei’s design also attempts to fix major problems that are not about aesthetics.

Think about parents whose children need same-day surgery. In the current hospital, families park in a ramp across the street and walk to admissions on the first floor. From there, they head to the ninth floor to presurgery. After presurgery, they go back down to the second floor to the surgical holding area. After surgery, they head back up to the ninth floor for recovery. And eventually they get discharged on the first floor.

Parents with sick kids get lost.

In the new facility, families will walk from a covered parking ramp into the second floor for bedside admission and all surgical and recovery needs.

Likewise, labor and delivery, especially for high-risk mothers, is currently more complicated than it should be.

In the future, women will proceed from covered parking to a perinatal center and be transported immediately next door for delivery. If the mother needs more intensive care, she will still go to Buffalo General Medical Center, but it’ll be only across the street and the buildings are connected.

The changes underscore how patients’ experiences at a hospital – good or bad – begin as soon as they enter the building. Visitors want to make their way through a hospital with minimal anxiety and aggravation. The same goes for staff. Thoughtful floor layout, patient flow and way-finding through colors, symbols and signs improve efficiency, safety and satisfaction, according to experts.

“Big picture, some of the main things we wanted were coatless connections, care coordination and a sense of healing, a sense of belonging,” said Dr. Teresa Quattrin, pediatrician-in-chief.

Design benefits

In Shepley Bulfinch, Kaleida Health chose a firm considered a leader in the use of research into the link between design and therapeutic benefits.

The new Oishei hospital will feature a neonatal intensive care unit with single-family rooms instead of the current open pods. Studies show single-family rooms add privacy, parental involvement in care and infection control. Families and nurses also can control the temperature, noise and lighting.
The design emphasizes respite spaces and natural light. Research indicates this can reduce stress, use of pain medication and lengths of stay. Views of nature can reduce stress, so the hospital plans an indoor garden.

A hospital visit can frighten ill children, who already are anxious.

The colors and themes in the hospital play a part in diverting attention and allaying fears. But what children want most is to have their parents and siblings with them. Officials said Oishei attempts to make that easier through a design for a more family-friendly place that appeals to a wide range of ages. It’s an acknowledgement that patients today use the facility into late adolescence and their families want amenities like plentiful connections for devices, pull-out couches in rooms and separate places to relax.

If Oishei has a theme, it’s the connection to Buffalo.

“We are looking to capture more of a Buffalo feel,” said Allegra Jaros, president of the hospital.

The blue and green exterior glass echoes the colors of the Great Lakes. The interior will feature a giant mosaic by local artist Brian Nesline consisting of 10,000 self-portraits by patients and others.

Plans call for the floors to involve partnerships with local cultural and sports organizations, like the Buffalo Philharmonic Orchestra and Albright-Knox Art Gallery as well as the Buffalo Bills and Buffalo Sabres.

“One of the biggest pieces of the design is engaging families and making sure the hospital is as comfortable as possible,” Jaros said.