It is estimated that the medical and healthcare construction expenditure in the coming year will reach 99 billion U.S. dollars. Dodge data and analysis‘”Dodge Construction Outlook 2021″, those who are pursuing a new hospital may face decisions about the type of floor plan used in inpatient wards. Some people may seek solutions to bring the care team closer to the patient to improve work efficiency and patient satisfaction. Therefore, they consider adopting an open core model that distributes the care team work area along the corridor in the patient wing. This hospitalization design can support the performance and well-being of caregivers by increasing daylight, visibility and collaboration and reducing travel distance, while also improving the patient experience by making the care team more visible and accessible.
NBBJ In the early 2000s, the first open core hospital was designed at the Great River Medical Center in Iowa. West Burlington’s 144-bed replacement hospital developed an open core layout to create a cluster of wards to provide core support for the intensive care unit (ICU), decommissioning and medical/surgical beds along a corridor, increasing the flexibility of staffing And to minimize the need to transfer patients when the census declines. Since then, the method has been improved in numerous projects across the country, including the next-generation open core design that NBBJ is building. Here, share the insights and lessons learned from these projects to emphasize when the open core layout is suitable for the healthcare system.
What is open core?
When designing the overall layout of a hospital, the most commonly used by healthcare systems and designers is the “race track” design, with the wards surrounding the exterior and the understage functions located in the central block. This decision was mainly due to the historical regulations of the National Fire Administration, which required windows in every inpatient ward, but not in staff support spaces. Open core is a fundamentally different solution. It meets the window requirements, but challenges the racetrack paradigm by moving the main support functions (lounge, staff lockers, meeting rooms, offices, and all elevators) to a centralized hub connected to multiple patient wings.
Although most support areas are concentrated in the center, some of the items most frequently visited by staff, such as medicines and medical supplies, are systematically deployed along the wings. Specifically, the wings are equipped with wards on both sides of the central corridor. The standard 8-foot wide inpatient corridor was increased to 16 feet to accommodate the circulation on one side and the clinical area on the other; the clinical area was equipped with decentralized team workstations and supply/equipment niches. Each caregiver workstation usually has two sitting positions and two walking positions, which provide direct line of sight to the four wards and maximize the clinician’s visibility to patients and each other.
Advantages and trade-offs
The open core concept has obvious advantages over traditional track design in terms of employee performance and well-being and patient experience. For example, the nurse station is designed around enhanced sight lines, and the open core creates a high-performance environment that allows nursing staff to see the entire wing at any time. This enhanced visibility supports rapid team response in emergencies and facilitates team collaboration during normal operations by making work areas and caregivers easier to access each other.
Given the increasing prevalence of burnout and isolation among nursing staff, employee welfare is a key factor and an important focus of open core design. The off-site support area, which is usually a windowless space in the track design, benefits from daylight and views through the building perimeter located in the support center. The open core layout also reduces the distance traveled by nurses by placing patients and critical supplies near their work area. Most importantly, the open core allows nurses to spend less time walking and more time to provide direct care to patients.
Equally valuable is that an open core can enhance the patient experience. As the care team becomes more visible and closer to the ward, patients in the open core hospital have more confidence in their care and are confident that their caregivers are nearby.
However, the open core is not suitable for every hospital. With these advantages comes certain trade-offs that hospitals need to consider. For example, although the open core layout is usually no larger than the race track layout, the shape of the open core floor is inherently more slender in the race track design and usually requires about 15% more external surface area than the race track layout. This increased outer surface provides more daylighting opportunities for the patient and staff area, but it also requires greater investment in the outer cladding.
In addition, although open core projects can be completed using standard structural layouts, structural systems are often transferred to non-orthogonal grids to further improve the sight of caregivers. In a new construction project, the cost and return on investment calculation of this transition will vary depending on the building materials (such as steel and concrete) and the type of procedures under the hospital floor stack, but it can lead to more expensive structural systems for the race track. If a non-orthogonal grid is used above and floors with orthogonal grids are stacked below (such as operating rooms and emergency rooms), a set of transmission beams must be combined to resolve the differences between the two grid systems. In addition, the open core is usually not suitable for retrofit projects because it may have difficulty accommodating the grid.
In the past 20 years, NBBJ’s open core hospital design approach has been continuously evolving by building previous project experience and meeting specific client needs. From these experiences, we can draw some lessons and key considerations that are critical to the success of the model.
Open core not only introduces layout changes, but also introduces major operational changes that affect the nursing team as well as material management, pharmacy, diet, electronic medical records, and housekeeping. The success of this method is related to the effective alignment of each workflow. Using a full-scale room model can help get detailed input on ward and workspace design options from each department, and create hands-on ownership and support around the design direction. This is especially useful for open core designs, as employees may not be familiar with many of these elements. For example, staff often expect that the open core cannot achieve ICU-level patient visualization, but models can help illustrate line-of-sight performance.
Since the ward is close to the work area, the open core also requires the hospital to review and resolve visual and auditory privacy issues. Compartment curtains can be used for visual privacy, but have little effect on acoustic privacy. Unless disinfection is continued, it may be a hygiene problem. Ward doors can achieve acoustic privacy, but visibility requires them to be transparent or glass. A layered approach may be an effective solution, such as the use of disposable compartment curtains and glass doors, or doors with integral shutters or opaque electronic glass to provide visual privacy.
Another key design consideration for the open core is the location and content of the personal protective equipment cabinet and the case workload in the ward, which will vary from institution to institution. NBBJ’s experience shows that setting up adjacent supply niches outside each ward can reduce the backlog and hoarding of supply in and around the ward.
Depending on the direction and design of the facility, the increased daylighting as an open core feature may also require additional design measures. For example, a matte floor may be required to reduce the potential glare caused by extra sunlight on the patient’s flanks. The use of daylight modeling in the design process can help determine such considerations.
What is the next step in opening the core?
The projects of the past 20 years have proved that an open core can have a positive impact on employees, patients, and performance. Whether the open core is meaningful for a particular hospital project depends largely on its location, needs, and goals-but it turns out that this layout is useful for a range of projects from community hospitals to academic medical centers to major veterans affairs facilities They are all very useful. With the development of the healthcare sector and the design of new projects, we see the open core continue to adapt to meet the challenges and opportunities faced by caregivers.
Ryan Hullinger AIA, NCARB, is a partner of NBBJ (Columbus, Ohio) and a global healthcare practice leader.He can be in [email protected].