Stanford Medicine Newsletter Updates For the Local Community

Hospital design addresses needs of older patients

Stanford University Medical Center Renewal Project

 

Rita Ghatak, PhD, director of Stanford’s Aging Adult Services, is helping to incorporate the needs of older patients like Frank Koplowitz and Rita Brown into the new hospital design.

   

Rita Ghatak, PhD, is continually talking with aging patients at Stanford Hospital to find out what they would change if they could.

“They tell me that walking down a long hospital corridor to the patient units is difficult,” she said. “They tell me about a family member who fell in his hospital room because of the layout of the room—because a door didn’t open the way he expected it to.”

As director of Aging Adult Services at Stanford University Medical Center, Ghatak has helped meet the health care needs of more than 4,000 geriatric patients since the program was launched in 2004. She and her team of 12 provide services that range from supporting caregivers to making home visits.

Ghatak also is involved in planning for the care of aging patients in the new Stanford Hospital, which is projected to open in 2015. Built during the Eisenhower era, the current hospital presents significant challenges, with rooms that are too small for today’s services and equipment. The new hospital will comprise almost 1 million square feet to house the equivalent of three acres devoted to interventional services, an enlarged emergency department and an overall capacity of 600 beds.

Ghatak and George Tingwald, MD, AIA, director of medical planning for the hospital renewal project, have been meeting with community groups in recent months to describe how the new hospital is being designed to meet the needs of older adults.

Growing needs

Adults 65 and older make up 12 percent of the U.S. population, utilize one-third of health care services and occupy half of physician time. So the demand is clear, and it is only going to grow. “The aging population and its need for health care is very real,” Tingwald said. “It’s not going away, and we’re going to have to deal with it.”

Tingwald, who is both a licensed physician and an architect, brings a singular perspective to the job of designing a hospital that will address the needs of an unprecedented population of older patients.

“Because of healthier living, the aging population didn’t jump into the elderly health care group as quickly as we thought they would,” he said. “Instead of inundating the health care system at age 60, they waited 10 years. And now that they are 70, 80 and 90, we’re suddenly seeing this incredible volume of issues related to aging.”

Solutions for aging adults’ health care needs already are being tested in the existing hospital, including four patient units where earplugs are helping patients sleep more soundly and new pulse-oximeter probes have replaced older models that used to sound loud alarms.

A new protocol for addressing postoperative delirium in aging patients is now a hospital-wide initiative.

“If you’re at risk, you are screened by nurses after surgery,” Ghatak said. “And if you manifest any symptoms of delirium—like confusion or disorientation—the medical team addresses them immediately.”

Ghatak’s program distributes an informational packet, “Resources for Older Adults,” to every person 65 or older who is admitted to the hospital. It includes helpful tips, such as encouraging family members to stay overnight with patients who have severe confusion to remind them where they are and why.

Designing for health concerns

As Tingwald reviews plans for enhanced lighting and flooring materials that will help to prevent falls in aging patients, he also is overseeing construction of full-scale mock-up rooms. The first round of construction is done with foam-core material that can be easily reconfigured and trimmed. “We’re testing the rooms for clearances and views through windows,” Tingwald said. “If we want a door to be 42 inches instead of 48, we can take a blade and cut off six inches.”

The next round involves a Sheetrock model with painted walls, lighting fixtures and window treatments. Construction teams are building one acute-care room, two intensive-care rooms, an operating room and an emergency department examination room.

Tingwald notes that all of the rooms in the new hospital will be designed for single-patient occupancy, adhering to national guidelines for hospital construction. “It’s the standard today,” he said. “Studies show a much lower rate of cross-contamination and hospital-acquired infections when patients are not cohorted. There’s less spread of disease when there’s only one person in a room.”

Moving and relocating patients to double rooms has been shown to take up to 40 percent of nurses’ time, he added. “Every time you relocate a patient, which involves transferring medical records and medication programs, the rate of errors goes way up.”

Single-patient rooms in the new hospital also will resolve one of the recurring complaints Ghatak hears from the older patients she interviews. “They tell me they don’t want to share a room with another patient, because they prefer a quiet environment and a lower risk of infection.”

To learn more about the plans for the medical center, see the project’s Web site at stanfordpackard.org.

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