by John Fowler
As we get older, the milestones we reach become less celebrated. Becoming a teenager, an adult and turning 21 are all exciting birthdays. By the time we turn 50, nearly everyone will be asked by their doctor, “Have we scheduled your colonoscopy yet?” According to the Centers for Disease Control, colorectal cancer is the second leading cancer killer found in both men and women and this new rite of passage is an important preventative measure in reducing the number of cancers found and the number of people who die from the disease. As the number of procedures needed increases so does the need to increase capacities at endoscopy centers.
When a regional hospital in Massachusetts had the opportunity to relocate and expand its Endoscopy department, Margulies Perruzzi was excited to tackle the challenges presented by several emerging design trends in these clinics. In addition to accommodating the increase in volumes, the solutions led to better access for patients, greatly improved patient comfort and privacy, staff efficiency and reduced patient wait times.
New Scope Processing Technology and Throughput –The heart of any endoscopy center is its scope processing facility. The advent of pass through washers and dryers allowed the design team to rethink the configuration of scope processing rooms. By creating separate soiled and clean scope processing rooms separated by a wall of pass through washers, the risk of cross contamination of scopes is reduced. The inclusion of pass through drying cabinets from the clean scope room to the procedure room corridor allows for increased efficiency and throughput. This design is one of the first in the country and the second largest installation in the world to utilize this technology.
Improved Patient Access and Convenience –Given that most endoscopy patients need to be driven home from their appointments, and more often patients are using alternative means of transportation such as Lyft or Uber, ease of parking and pick up from the department greatly improves the experience. Taking advantage of the former ED parking lot access, the hospital was able to create a dedicated entrance and parking area for endoscopy patients, greatly simplifying access for patient appointments. A cost-effective approach was utilized in repositioning the building’s façade while also creating a covered drop off and pick up zone.
Increasingly Complex Procedure Rooms –Two of the nine procedure rooms were designed for advanced procedures and included fixed fluoroscopic imaging equipment. These procedure rooms are similar in size and complexity to operating rooms and can accommodate a wide variety of endoscopic procedures. The design team at Margulies Perruzzi utilized virtual reality technology directly with the physicians, nurses and technicians that would be using the rooms. This technology assured that the highly complex arrangements of fluoroscopic equipment, anesthesia equipment, monitor booms and patient stretchers would all be positioned correctly for each procedure type.
Workflow Efficiency – The creation of a new endoscopy center presents an opportunity to reimagine the workflow for an improved patient experience and operational efficiencies. The design team and clinical teams utilized 3P process improvement methodologies to create the ideal future state workflow. They then worked together to create the plans that would best suit the ideal state. The overall design concept consists of concentric rings of the scope processing rooms, procedure corridors and procedure rooms with a one-way flow of patients in from the pre-op area and out to the recovery zone.
Patient Comfort and Privacy – The layout of the Endoscopy Center took full advantage of the existing clerestory windows to flood the pre-op and recovery bays with natural light. Research indicates that natural lighting helps to speed recovery times and improves the efficiency and job satisfaction for staff. To improve patient privacy, semiprivate cubicles were utilized at the preoperatory bays where interviews and discussions with care givers most often take place. A sound masking system was employed throughout the pre-op and recovery areas as well as the waiting room check-in area to further enhance privacy. For more in depth and sensitive conversations, a private consult room is provided in the recovery zone.
John Fowler, AIA, EDAC, LEED AP, is an associate principal and associate partner for the health and science studio at Margulies Perruzzi