Cardiovascular Design

What impact do cardiology trends have on facility planning and design? EHM asked Charles Siconolfi, Director of Health Care Planning and Design for HOK.

As a key clinical program, contributing significantly to patient volume, community health and the economic viability of the hospital, cardiovascular medicine is an important part of the future of healthcare. At the core of cardiovascular programs is innovative technology, evolving techniques and a rapid progression in scientific research for the prediction, prevention, diagnosis and treatment of coronary and vascular disease.

Trends

• Evolving protocols for percutaneous coronary interventions, including: cardiac catheterization and electrophysiology
• Potential introduction of advanced CT for cardiac diagnostics has the potential to replace portions of cardiac catheterization volume
• Advancing technology and protocols, such as magnetic resonance-guided catheterization
• Potential application of patient genotyping and phenotyping to expand awareness, risk evaluation and information on treatments
• Outreach for risk evaluation, education and wellness programs
• Desire to establish notable expertise in the marketplace
• The necessity to create full-spectrum services for the cardiovascular patient

Design implications

• It is increasingly desirable that all services be collocated as part of a Cardiology Center of Excellence affording patients a one-stop point of access for all disease specific activities.
• While collocation is the goal, there may be times when program size and volumes suggest cost-savings and efficiency may be achieved through sharing of certain resources, such as the surgical platform. To maintain the patient’s perception of one-stop service, access to all Cardiology services can be through a Center of Excellence or a Cardiac Hospital, yet, behind the public realm certain key (and expensive) services are shared.
• The changing nature of diagnostic and interventional procedures in cardiac care requires new ways of looking at short-stay settings. Short stay settings must accommodate a range of functional requirements – from gowning to pre-/post-procedure preparation to sedation and recovery. Further, the spaces must meet rising patient expectations for privacy as well as accommodation of caregivers and family.
• The ever-increasing pace of technological and protocol displacement requires early planning and analysis of potential near-term and long-term changes. Correspondingly, this drives the need to re-evaluate patient volume base on new modalities to best derive the appropriate number of clinical spaces or key rooms. (Catherization, EP, CT, Nuclear Medicine). The mix and distribution of spaces will vary from historical norms.
• New facilities lean towards the use of a contiguous group of modular, adaptable clinical spaces for all modalities; connected by a central work core. These modular spaces preserve the cohesion of the Center of Excellence as new modalities are substituted for older ones.
• Highly specialized technologies like magnetic resonance-guided catheterization, which require a patient draw from large catchment areas due to low volume, may benefit from being planned as part of future facility expansions. As such, these expansions, and other similar expansions, must be considered for accommodation as part of the design process.
• Early planning and programming should evaluate the extent to which cardiology patients can benefit from predictive and preventive medicine programs. While larger programs may suggest inclusion of the services as part of the Center of Excellence, smaller programs may be best served by sharing these services with other departments. This is particularly true where the possibility exists to combine with other programs relying on similar genetic, and patient profile studies. These services may serve as the backbone of predictive and preventive medicine serving multiple disciplines. Irrespective of which service line the program is part of, this function needs to be public, accessible, friendly and oriented to well populations as well as those seeking treatment.

As cardiovascular disease becomes better understood, treatment programs and environments will continue to change significantly in coming years. HOK will continue to be a leader in anticipating this change and driving design that is responsive for hospitals and health systems specializing in cardiology.