Recently we brought you the first part of our tour inside the new Humber River Hospital (or HRH), located just north of the 401 at Keele and Wilson. The 1.8 million square foot, 14-storey building is designed by HDR Architects and will be the first "fully digital" hospital in North America.
In the first part, we examined the main building’s parallels to an airport terminal. The large but relatively narrow building, similar to an airport pier design, maximizes perimeter space, allowing for multiple entrances and easy curbside access for vehicles. The entrances themselves act similar to how gates would at an airport, only instead of a departures terminal, visitors will walk 30 feet to a hospital department. To assist with way finding, each department is colour-coded.
Adding to the receptiveness of the building are the two large, open corridors on the main floor that will serve as the concourse area, providing easy and efficient access for patients, doctors, visitors, and staff alike. The corridors will also provide space for retail as well as wayfinding kiosks and information desks.
Today, we travel further into the hospital as we simulate what a future patient may experience, previewing the inpatient departments. We will also examine the mechanical facilities, where the hospital will more closely resemble a robotics factory. As well, we will look at what exactly makes HRH “digital”.
Four million plus working hours have already gone toward the construction of the hospital. Though the building’s exterior looks close to completion, there is still plenty of work to be finished inside. Travelling up one of the many public elevators, we arrive at the seventh floor, one of the floors where the majority of the work has been completed.
Here on the seventh floor, we walk through one of the inpatient medical/surgical units. One thing that was immediately noticeable was the lack of a need for touch. Should you enter a dark hallway, motion-sensitive lights will turn on to reveal your path, and turn themselves off after a certain amount of time with no movement detected. Doors open via a simple wave in front of a button. In a place where infection control protocols and a sterile environment is key, these small features can make all the difference. What’s more, they contribute to energy saving by the hospital.
Energy efficiency is indeed an integral feature of the new hospital. Compared to the three current campuses operated by the Humber River Hospital network, the new facility will cut energy and water consumption by 40 and 35%, respectively. According to standards set by the American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE), the new HRH building will be the most energy efficient hospital of its size in North America, being rated at 42% below the standard (in this case, a lower rating means less energy use, and thus is much better). HRH aspires to save at least $1 per square foot for utilities (and at 1.8 million square feet of space, you do the math).
With 656 inpatient rooms in the building, 80% of which are single-patient, there should not be any concern for overcapacity. Despite the sheer volume of rooms, we found that each single-patient room has a surprisingly comfortable amount of space. In each single-patient room, there will be enough space (and then some) for a bed, a widescreen TV, a private bathroom, and a pull-out couch for visitors.
The bed will have enough space beside it for medical equipment such as a ventilator. Patients will have a bedside terminal with a monitor on which they can order their meals, check their patient charts, browse online, talk to their family via Skype or FaceTime, or even contact their nurse if needed (each nurse will have their own handheld device that allows for video chat with a patient). The 42-inch TV lets patients view movies as well as any kind of medical information (charts, notes, for example) that the doctors would want them to see. Family and friends may be allowed to access their medical records, but only with a patient’s explicit permission. Patients can also control the room temperature from their bed as well.
However, the most advanced piece of technology in the room might actually be… the window! The hospital will be the largest installation of electrochromic glass in the world. Called 'View Dynamic Glass,' the windows tint electronically to eliminate heat and glare thanks to the latest generation of electrochromic technology. The glass is coated with multiple thin layers of metal oxide which is transparent in the absence of a voltage, but after applying a tiny electrical voltage, ions move between layers, changing its structure, and tinting the glass. The darker the tint, the more solar radiation and glare are rejected, resulting in temperature and energy control. No curtains are needed, and the patient will be able to control how much light they would like in their room. At the time of our tour, the electrochromic glass had yet to be turned on.
Most of the bathrooms were pre-fabricated offsite in Mississauga. Like a gigantic game of tetris, units were brought in and neatly placed inside each room. The couch in the room can fold out into a bed, allowing a visitor to sleep overnight in the inpatient room. While nurses should never be more than a video call away, the development team at HRH recognized how important it was for a patient to have family and friends close by—at all times if possible. HRH will allow for 24-hour visiting times, making it convenient for any family member or friend to drop by and stay with their loved one. Think of a distressed patient waking up in the middle of the night, not knowing where they are—and then think of a familiar face sitting right next to them, whispering reassurances that they are being cared for.
As Gerard Power, HRH’s Director of Public & Corporate Communications, explains, “We bring the family into the whole experience, and they feel better because they feel engaged. They feel like they know what's going on, instead of going home and wondering. If you're coming home from work, you can stop by and see Mom. If Mom gives you permission, you can pull up the chart, and you can see the test results, the doctor's notes, the nurse's notes. It's all there for her.” The expanded visiting hours are not only convenient for patients and their visitors, but for hospital staff as well. Any nurse will know that a content patient, surrounded by their family and friends, will likelier have fewer problems. Even then, in the case of high-needs patients, there will be rooms placed directly in front of the nurses’ desks with open “windows”, allowing the nurse to keep a watchful eye.
With the availability of single-patient rooms, the added privacy should ideally give a much better peace of mind for each patient. It is part of a current shift where improving care for the patient means ensuring comfort in all areas, including the physical stay at the hospital. This new focus on the hospital environment is certainly a welcome change from how hospitals were run in the past.
“The hospitals back in those days weren't built that way. Visiting hours were much more regimented. ‘Go here, can't go here. Do this, don't do that.’” says Power. “Things have changed a lot in terms of how we look at care, and we look at more of the entire experience. In the new hospital, you close your door, and it's very much like being in a hotel room.” Two-patient rooms are still present; however, they will be intended for shorter-term care, where patients may stay for one procedure, and then leave after four to five hours.
In the case where a sample needs to be taken from a patient, whether it be blood or urine or otherwise, the hospital’s computerized pneumatic tube system will then come into play. For example, were a doctor to order blood work done on a patient, the nurse would only have to take the blood out of the patient’s arm, put it into a capsule, turn around, and place it into the pneumatic tube system. This will be the only time where human hands will have to touch the sample.
After that, the capsule travels via the tube system through the hospital, eventually arriving at a laboratory on the third floor. There, specialized robot will take the sample from the capsule and place it inside a robotic analyzer. Once the blood work is finished, the results are automatically uploaded to a patient’s chart, and the doctor is notified right away via their personal device. And voilà: a routine process that would have normally taken hours instead takes just minutes to complete, and the doctor could have it all done from the other side of the hospital. If the tests come back with alarming results, the notification will change to a more pressing alert that requires the doctor to respond within a short time frame.
As part of the hospital’s initiative to keep operations as hands-free as possible, 75% of the deliveries in the building will be automated, handled by either robots or the tube system. Controlled by a computer, each capsule will have a unique RFID tag, ensuring that one always knows where a specific capsule is located, what it contains, and for which patient. Revolving exchangers, similar to the mechanism of a revolver, sort capsules as they come in through the many different pipes. Depending on what the RFIDs say, the revolver will rotate the capsule to the next proper tube, and so the capsule continues its journey to its proper location.
This capsule RFID system is only one part of the hospital’s “digitalization”. For one, each patient will wear a wristband with a barcode. A nurse can scan the barcode, and find out whether the patient has received the latest medication, the results of the latest tests, and more. Care teams can also use voice recognition services when charting patients’ data. The personal devices that the hospital staff will use will have video screens that allow for videoconferencing, and direct communication with the patients on their monitors. There will also be a second screen at the top edge of the device, so if the device were placed in your pocket, you would only need to look down to see what the latest notification is all about, once again freeing up your hands for another task.
Once construction finishes in the next few months, what remains is readying the hospital’s staff for opening day. It will take about six months of staggered employee training and orientation, with the first block starting on May 12. If all goes to plan, Humber River Hospital’s new facility will open on October 18, 2015, right at 6 o’clock in the morning.
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