Kuwait Crime Evidence Headquarters

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Healthcare Trends and Challenges and the High
Performance Healthcare Facility Daniel R. Beney,
PE, LEEDAP, EDAC
Accelerating Innovation in Medical
Care Engineering Society of Detroit
ConferenceApril 28, 2009
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Daniel R. Beney, PE, LEEDAP, EDAC

• Professional Engineer
• 30 years of healthcare experience
• 15 years as a Biomedical Engineer in a
  healthcare setting
• 15 years as Medical Planner and Architectural
  Engineer
• LEED Accredited Professional
• EDAC Certification
• Currently employed at Harley Ellis Devereaux
  (Southfield, Michigan)

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Transforming the Design and Construction of
Healthcare Facilities

• Agenda
• Review leading healthcare trends and challenges
• Propose a highly efficient and adaptable system
  that we can strive to emulate when designing and
  constructing healthcare facilities
• Provide system examples that demonstrate the
  multidiscipline knowledge needed to design and
  construct high performance healthcare facilities

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Healthcare Trends and Challenges

• Caregiver shortages and aging population

• Average age of a nurse is 47-years-old
• By 2010 40 of nurses will be over 50-years-old

• By 2050, three times as many people in the world
  age 60 years and older
• More patients, less caregivers

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Healthcare Trends and Challenges

• Health Information Technology
• EMR and much more
• Electronic Medical Record
• Surgical Information System
• PACS
• OR Integrated A/V System
• Video Archiving Network
• Nurse Call System
• Staff Auto Wireless Comm.
• Biomedical Monitoring System
• RFID Asset Management
• Telemedicine
• Remote Robotic Surgery
• Inventory Management System
• Building Management System
• Fire Alarm and Security System

IT implementation can improve quality and patient
safety (IOM 2008)
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Healthcare Trends and Challenges

• Cross Pollination of Imaging Modalities
• PET/CT SPECT/CT
• Intra-operative MRI
• Image guided surgeryComputer assisted
  navigation
• Vascular hybrid OR (Interventional or open
  surgery)
• Dual source/multi-detector CTReduced radiation
  exposure
• Total heart scan less than 1 second

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Healthcare Trends and Challenges

• Minimally Invasive Surgery
• Laparoscopic surgery
• Robotic surgery
• Reduced patient stays
• Faster healing
• Reduced scarring
• Increased precision

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Healthcare Trends and Challenges

• Facility Sustainable Design
• LEED Certification
• Reduced environmental impact
• Reduced energy cost
• Healthy environment for patients and staff
• Model for healthy living
• Proactive preventive care

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Healthcare Trends and Challenges

• Evidence Based Design
• Decisions based on credible research
• Achieve the best possible patient outcomes
• Inboard or outboard toilet rooms
• Views of nature and the healing process
• Decentralized or central nursing station

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Healthcare Trends and Challenges

• Public Focus on Quality and Safety
• Increased transparency hospital compare
  website
• 238,000 preventable deaths between 2004 -2006
  (IOM)
• Medication errors 1.5 million/year (IOM)
• Hospital-acquired infections CMS will now
  withhold payment
• Infection control focus onhand
  washing/disinfectant disp.
• Staff stress increase in technology,staff/patie
  nt ratios

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The High Performance Health Facility

• These healthcare trends and challenges are
  transforming the design and construction of
  healthcare facilities...
• How do we design and construct high performance
  facilities that have a positive impact on these
  trends and challenges?

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The High Performance Healthcare Facility
Multidiscipline Project Team
Facility Team
Design Team
Construction Team

• Administrators
• Physicians
• Clinical staff
• Support staff
• Risk management
• Infection control
• Architects
• Engineers
• Medical planners
• Consultants
• Construction managers
• Construction estimators
• Experienced trades
• Equipment vendors
• Commissioning

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The High Performance Healthcare Facility
Our healthcare facilities must invigorate human
emotion and emulate human systems
Invigorate human emotion
Emulate human systems
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The High Performance Healthcare Facility
Invigorate Human Emotion

• Aesthetic Appeal
• Stimulate human emotion
• Inviting environment for staff, patients and
  visitors
• Less institutional
• Materials and colors that reduce stress
• Views of nature

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The High Performance Healthcare Facility
Invigorate Human Emotion

• Psychological Well Being
• Healing gardens
• Preventative medicine
• Reduced stress
• Reduced patient stays

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The High Performance Healthcare Facility
Emulate Human Systems

• Circulatory System

Multiple system fluid and gas distribution
Heart, arteries, veins
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The High Performance Healthcare Facility
Emulate Human Systems

• Skeletal System

Structural integration with vital systems
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The High Performance Healthcare Facility
Emulate Human Systems

• Nervous System

Communication backbone for efficiency and quality
improvement Real time response to patient and
staff needs
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The High Performance Healthcare Facility
Emulate Human Systems

• Respiratory System

Distribution of air to vital organs, patient/staff
comfort and environmental air quality
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The High Performance Healthcare Facility
Emulate Human Systems

• Muscular System

Physical capacity to perform routine and
emergency tasks. Emergency generators, fire
protection pumps, boilers
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The High Performance Healthcare Facility
Major Systems Feed Vital Organs

• Intra-operative MRI
• Vital Organ Requirements
• 50 to 60, 000 BTU/Hour heat load (MRI)
• 480 VAC three phase 150 amp load (MRI)
• 30 to 45KVA load (OR)
• 1,200 to 1,600 sq. ft. space requirement
• Minimum 25 air changes/hr OR and MRI
• 10 foot finished ceiling height OR and MRI
• RF shielding required in MRI
• Magnet shielding in strategic locations
• 150 foot candles (per MDCH) OR and MRI
• Structure steel support for ceiling booms
• Multiple A/V and low voltage distribution
• And more.

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The High Performance Healthcare Facility
Vital Organs

• Digital X-ray
• Vital Organ Requirements
• 480 Vac, 3 phase, 100 amp load
• 9-6 finished ceiling height
• Universal uni-strut ceiling
• X-ray shielding (exam room)
• 4,500 BTU/Hr heat load
• Dimmable lighting
• Sink/countertop/storage cabinets
• And more.

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The High Performance Healthcare Facility
Vital Organs

• Vascular Hybrid OR
• Vital Organ Requirements
• 480 Vac, 3 phase, 100A load
• 25KVA load (OR Equipment)
• 150 foot candles (MDCH)
• 45,000 BTU/HR heat load
• 25 air changes /hr. min. (OR)
• 750 to 850 sq. ft. space req.
• 9-6 finished ceiling height
• Uni-strut support (strategic locations)
• Structural steel support for ceiling booms
• X-ray Shielding
• Medical gas distribution
• And more

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The High Performance Healthcare Facility
Vital Organs

• Surgical Learning Center Mock Operating Room
• Vital Organ Requirements
• 45 KVA electrical load
• 150 foot candles
• 700 to 800 sq. ft. space req.
• Low voltage distribution for simulation, medical
  and OR integration equipment
• 35,000 BTU/Hr heat load
• Medical gas distribution
• 10 finished ceiling
• Structural steel support for ceiling booms
• And more .

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In Summary

• There are many healthcare trends that are having
  a huge impact on the requirements needed to
  design and construct healthcare facilities.
• Design and construction of healthcare facilities
  requires a multidiscipline design and
  construction team.
• There are multiple systems and vital organs that
  must be planned, designed and constructed to
  create a High Performance Healthcare Facility.

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Discussion and Thank You