A New Health Plan

Later this month an era will end—and another will begin—at the 120-year-old Stamford Hospital campus on Shelburne Road. In what’s been planned as a down-to-the-minute, precision move, the doors of its old emergency room will shutter as ambulances and walk-in patients are directed to a new one.

On the same day inpatients will be transferred from the white relic of a building that has housed them since the 1950s into a gleaming, glass-faced $450 million, eleven-story tower crowned by a shiny steel helipad—a giant of reimagined thinking about the future of community medicine.

Three years of construction, plus several more of painstaking planning by doctors, nurses, executives and former patients, are concluding with the completion of the new cutting-edge facility. From the spa-like patient rooms to the custom-order dining menus, this is a place that’s been conceived to put patients and their loved ones first. “The biggest and most transformative difference here is that every patient will now have their own private room,” says Brian G. Grissler, president and CEO of Stamford Hospital and Stamford Health.

Besides the 200, all-private patient rooms housed in the hospital tower, many other changes are in store for medical practitioners and patients. These include eight cutting-edge operating rooms, a massive emergency department that includes a separate wing for pediatric patients, a state-of-the-art Heart & Vascular Institute and healthy amenities such as in-room massages and a take-out Freshii outpost in the lobby.

Before the new hospital officially opened its doors, Liz Longmore, a registered nurse who is director of operations for critical care and new hospital activation, led a behind-the-scenes tour that revealed some of what’s in store.

THE EMERGENCY DEPARTMENT

The new emergency department (ED) was designed to treat the 150 patients it averages on a typical day with the philosophy that kids and adults, the sick and not-quite-so-sick, want and deserve different kinds of care. The vast real estate in this area—48,000 square feet—has been divided into leveled treatment zones, reflecting the credo that a one-size-fit all approach to medical emergencies is antiquated. “The philosophy is that if you’ve got a sprained wrist, you don’t want to be worried about catching the flu from someone sitting next to you,” says Dr. Arun Nandi, chair of the department of emergency medicine. “And if you are that person with a sprained wrist, you are not in the same area as someone who has come in with a heart attack and is being resuscitated.”

This reconsidered approach to emergency care begins with the first set of eyes that sees each patient. An experienced emergency medicine nurse—not a medical receptionist—will be a patient’s first contact as they enter through two sets of doors, one for ambulances, another for walk-ins. “It’s a nurse because those are the eyes of experience,” explains Liza Maltese, assistant nursing manager, emergency department.

The new trauma hub has been divided into green, yellow, red zones. Just like traffic lights, those zones denote the level of medical urgency each patient presents. So, where a sprained ankle might be assigned to the green zone, symptoms of appendicitis might head to yellow (because tests are in order) and injured survivors of a car wreck might go directly to red.

One goal the ED team hopes to achieve: faster care. For when someone is sick or in pain, “a five-hour visit to the emergency room can feel like ten,” says Dr. Nandi.

To accelerate the pace of treatment further, there is CT Scan room on the premises. And individual treatment rooms have been built with lots of space, allowing for diagnostic equipment to be brought directly to a patient’s bedside and eliminating unnecessary transfer to other areas of the hospital for tests.

There’s also been considerable effort put into cultivating a less stressful treatment environment. “ERs tend to be fishbowls, and anxiety-provoking, and we are trying to change that from the minute a patient comes through the door,” says Dr. Nandi.

Hence, the separate treatment areas for cardiac emergencies and serious traumas (think car crashes and the victims of violent crimes) as well as mental health patients. Dr. Nandi calls this a sensitive, pragmatic approach to keeping patients with relatively minor concerns as protected as possible from more upset.

Kid Zone
The separate wing within the ED dedicated to pediatric emergency patients is the first of its kind in Fairfield County. And the differences young patients experience here could be profound, as children and teens are directed by an emergency nurse to a nautical themed unit to one side, while adult emergency patients turn to the other, explains Liz Longmore.

This unit was conceived to be much more than theme-park cute. “For kids, hospitals can be scary places and if this is their first visit we want it to be as pleasant as possible, under the circumstances,” says Kathleen Silard, the hospital’s executive vice president and chief operating officer. Walls papered in seagrass and an aquarium stocked with colorful fish are soothing decorative appointments, but the biggest changes here are not the aesthetic ones, Silard notes. This unit will be staffed with a team of trained pediatric emergency specialists, part of a broader effort to expand existing children’s medical services throughout the hospital. “We are building an entire program around children in areas like radiology, anesthesia and surgery,” Silard explains.

In what’s sure to be welcome news for moms and dads, these pediatric upgrades will mean many of the region’s youngest patients can now stay closer to home for treatment.

THE PATIENT ROOM

The first question patients often ask Carolyn Kasov, a nurse practitioner who is part of the hospital’s complex heart-valve replacement team, is, “Can I please have a private room?” The question is sometimes asked with a wink and a grin, as if Kasov, who often works with some of the hospital’s frailer and elderly patients, could invoke a special favor. “Now,” she says, “I can give that room to everyone who asks.”

What the hospital’s 180 new private suites (plus twenty more in the intensive care unit) mean for patients goes far beyond allowing them to change the TV channel without asking permission. Doctors and nurses say generously sized rooms—approximately the same square footage as the old hospital’s two-patient double rooms—will promote patients’ emotional well-being and recovery. The healthy bonus? The generous spaces give doctors and nurses ample room to do their jobs with more ease and efficiency, they say.

“When you’re in the hospital, it’s the exact time in your life you want and need privacy,” says Dr. Michael Bernstein, associate director, pulmonary and critical medicine. “No one checks into the Marriott and says to strangers in the lobby, ‘Hey, let’s share rooms,’ but we’ve been asking sick people to do that for years.”

As a hospitalist director who manages the care of inpatients, Dr. Maher Madhoun says the old hospital’s cramped, double rooms made it difficult for him to pull up a chair to sit down for a chat, something he considers essential to the doctor-patient relationship. Clinical studies have shown that patients who have these face-to-face bedside consults, as brief as sixty seconds, report much higher levels of satisfaction with their care than they do when they speak with a doctor “standing over them.”

“The patients develop the sense [that] you are more concerned and engaged when you are sitting by their side,” says Dr. Madhoun. And eliminating a roommate from the doctor/patient dynamic will inevitably promote more candid discussions about serious health matters, he predicts. “It may seem like a little thing, but for a patient, it’s a big deal.”

Besides offering privacy, the patient suites and floors have been designed to be ultrasafe and sanitary while boasting the features of a well-appointed home. “Everything we did was designed to keep people safe in unfamiliar surroundings when they are sick and quite possibly medicated,” says Liz Longmore.

The expansive nurses’ stations, gently curved, boomerang-shaped pods, allow caregivers a nonintrusive view of twelve patient rooms at a time. Strategically placed nightlights safely lead patients to their private bathrooms. Showers have no lips, so patients can walk in and out with ease. Gone are curtains, known harbingers of germs, and expanses of windows fill rooms with natural light. There are sinks and supply stations for nurses in each room. And all that space allows for diagnostic equipment to be moved bedside for tests. “It’s a lot less disruptive when nurses have everything they need at their fingertips, and patients don’t have to be moved for tests,” says Kasov.

Also, in the twenty-bed ICU, two elevated booms can be placed near to—or away from—patients’ beds to better manage the medical-equipment clutter that can make moving patients cumbersome. The ICU rooms also have specialized patient lifts, allowing for easier movement of the critically ill.

Every room has a sofa and plenty of space for families to spread out and feel at home. Encouraging families to stay close, rather than relegating them to visitation schedules, has real benefits for patients recovering from serious medical events and procedures, says Michelle Watson, a nurse manager in the critical care unit/ICU and the catheterization lab. Being comfortable and supported can lower stress levels, which helps with recovery, she notes.

“Everything we’re doing is more homelike,” says Watson, who was actively involved in the new hospital’s design. “Because, when you think about it, no one really wants to be in the hospital. They want to be home. So we’re doing everything we can to reimagine the healing experience and make it more like the patient is being taken care of in a family setting. In some ways, it goes back to the time when doctors made house calls, except we have all the resources and technology we need to heal here.”

SURGICAL, DIAGNOSTIC & TREATMENT SPACES

The size and efficiency of the hospital’s eight new operating rooms might not make a big first impression on a patient who spends time there in the haze of anesthesia, but for doctors and nurses, they’re game changers.

The layout of the operating suites was tweaked and re-tweaked by the hospital’s medical team in simulated surgical spaces mocked-up in a warehouse on Long Ridge Road. (That same approach was taken with patient rooms.) Throughout the preconstruction process, medical staff was encouraged to give the thumbs up—and down—to critical design elements. These included seemingly small items like the placement of electrical outlets, which turned out to be not so small to practitioners anxious for more elbow room and modern, adaptable facilities. “If there were oops and mistakes, we course-corrected during the planning,” explains Kathleen Silard.

There was also a focus on building more state-of-the-art, specialized medical facilities. Dr. Michael Bernstein says lung specialists are thrilled to now have a room dedicated to bronchoscopies, a procedure used to diagnosis lung cancer and other serious pulmonary disorders. In the past, bronchoscopies were performed in a standard operating room. A dedicated space is “great for the doctors, but safer and more efficient for patients.”

The 27,000-square-foot Heart & Vascular Institute (HVI) brings an array of cardiac services—a vascular and interventional radiology lab, two catheterization labs and a dedicated electrophysiology study lab—into a new, full-service environment. For years, those services and its medical team had been spread out, some as far as New Canaan.

“For someone like me, an open heart surgeon, to have everything lined up and in position, exactly where it’s supposed to be, that makes an incredible difference,” says Dr. Michael Coady, the hospital’s chief of cardiac surgery and codirector of the HVI. “When I look at what we have now, I think, ‘There’s nothing missing.’”

 

 

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