Hospital seeks to remedy facility constraints
When architect Forrest McMullen checked himself into Tahoe Forest Hospital for a night in September 1998, it wasn’t because he was sick.
As the principal architect designing the plans for the hospital’s new western addition – a $13 million, 36,000-square-foot expansion for 25 medical/surgical beds, an Intensive Care Unit replacement and an outpatient “medical mall” – McMullen wanted to complete the assessment of existing conditions from a patient’s point of view.
“The patient’s perspective – on your back, listening to your roommate and looking directly at the patient across the hall – is far different than the one from a drafting table,” McMullen said.
The hospital district hired McMullen’s firm, Map, to develop a plan to help TFH evolve with Truckee’s growth, increasing tourism and advances in medical technology and the health-care environment. The western addition represents the most immediate, short-term project.
The need for expansion was first identified when the California legislature passed a law requiring hospitals to meet stricter seismic regulations.
The current building that houses the ICU and med/surg patient rooms was built in 1950 and does not meet the new regulations and cannot be retrofitted to qualify, said hospital staff.
The other major driving force for expansion is that existing space is extremely tight. Increased equipment in small rooms has resulted in a congested work environment and a number of work related injuries, said hospital officials. Patients have specified discontent with the rooms as well – 20 to 30 percent of recent patient satisfaction surveys noted dissatisfaction with the med/surg unit.
“Literally, every closet, nook and cranny in this place is full,” said Ann Delforge, director of inpatient services. “One of our challenges is to have bigger patient rooms so they (patients) can have privacy in asking about their medical needs.”
The hallways in the med/surg unit are cramped with equipment and patients being shuffled from room to room. There are currently 22 patient beds in 12 patient rooms in the unit. All rooms are semi-private but one. The rooms are tight, the beds separated by a curtain and in some cases four patients share one bathroom, said Delforge.
The plans for the western addition include 25 bigger patient rooms, with 15 being private rooms and 10 doubles. Each room will most likely have its own bathroom and shower.
“We always hear from our patients when they leave how excellent the care was … and then they tell us about the rooms,” said Delforge.
The other concern is providing adequate and comfortable space for the visiting family members of patients. When a patient leaves the hospital, it will be the family members giving the care. The family needs adequate space and privacy to ask questions and learn about the patient’s needs.
“Involving the families more is something we’ve always wanted to do and when you have tight space, that’s a problem,” she said.
TFH district boardmembers have been working with McMullen and hospital staff in helping to identify project needs and goals.
Board president Rob Eskridge sees the new addition as not only important, but necessary.
“We are fortunate to have a breadth of physicians and a level of medical services which would be expected in a larger metropolitan area. And the level of patient care provided is well beyond what can be found in almost any larger hospital today. But the setting of the hospital’s facilities lags behind, and it’s time to move ahead on that front,” said Eskridge.
“Every one of us, or our families, are likely to to need an overnight stay in the hospital during our lifetimes. We ought to be able to provide facilities which are as good as the care that is offered. And we should provide facilities that are flexible enough to change as technology makes medical care less invasive and as family involvement in care becomes even more of an economic necessity,” he said.
Eskridge agreed with Delforge that it is very difficult to involve families in care and teach follow up care in the small and tight patient rooms. From experience, he cited one of the biggest pressing needs is to have a facility that accommodates families in patient recovery.
“With managed care a reality, whenever we have a family member in the hospital, education on care at home is becoming almost as important as the acute treatment itself.”
McMullen’s evolution plan addresses long term needs for project in the next five to 15 years. The western addition is just phase one and the $13 million project will most likely not break ground for two more years, said hospital officials.
Besides larger and more private patient rooms in med/surg, the new addition will include a six bed ICU , easier parking access and the “medical mall.” According to Delforge, the medical mall will be a patient resource that includes such services as a lab draw station, radiology unit, a breast help center, alternative medicine center, biofeedback and financial counseling.
TFH Administer/CEO Larry Long said the plan is ultimately being driven by board design goals and directives, which were identified earlier this year. These goals are:
— Build new med/surg and ICU inpatient rooms which meet state law and seismic regulations and allow expansion of outpatient surgery rooms, the diagnostic laboratory and relocation of the inpatient pharmacy.
— Design modern patient rooms that allow privacy for patients, their physicians and families. Provide space to accommodate families in the learning process so that they may provide continuing care to patients after they are discharged from the hospital.
— Design the building addition to maximize efficiency of staffing and operating costs without compromising patient care and while maintaining fair market-based wages and benefits for employees.
— Fully accommodate current and emerging medical technology.
— Design access, parking and exterior appearance in order to improve convenience while maintaining an aesthetic quality that blends well with the Truckee community.
— Accommodate future growth, including peaks and valleys of seasonal admissions, population growth and future changes in health care delivery.
McMullen, Long, hospital staff and boardmembers are requesting input from the community as the project continues. The most recent blueprints of the western addition are enlarged and hanging in the hospital cafeteria, and there is a sketch pad for comments.
“We’re asking for input from the community,” said McMullen. “It’s a district hospital – it’s serving this community. It’s going to be a costly, lengthy process.”
Because these changes most affect the community and the evolving infrastructure, all involved in the planning and design say feedback as critical.
“We need the community involved. Tell us what works and what doesn’t work. These decisions are big dollar decisions and we have to make each decision very carefully,” said Delforge.
“Typically the work of special districts must look much longer term than planning in a business or a family. We’re building the infrastructure that citizens depend on. And longer range planning for health care is at least as important as water mains or sewers or bridges or parks,” said Eskridge.
For public comments or input, contact McMullen at 587-8387 or Long at 582-3529.
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