Eilish hardiman planning and designing the new children’s hospital
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Planning and Designing the new Children’s Hospital
Eilísh Hardiman
CEO
National Paediatric Hospital Development Board
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Planning the new Children’s Hospital
• What is best for children’s health?
• Why do we need a new children's hospital?
• What makes a children’s hospital comparable
with the best children's hospitals in the world?
• Can planning the new children’s hospital
contribute to healthcare reform?
National Healthcare Conference 2011
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Designing the new Children’s Hospital
• How can design make a difference to quality
care (clinical outcomes and patient
experience)?
• How can design drive efficient operations in a
hospital?
• How can children and young people influence
the design of the new children's hospital?National Healthcare Conference 2011
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What is best for children?
The sickest children have better clinical outcomes if treated in a hospital that has a high caseload volumes (scale) requiring a ‘critical mass’ of clinical specialties and sub-specialties (over 25 sub-specialities), combined with advanced medical technology and ICT, an integrated approach to education and research and evidence-based designed facilities.
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Critical Mass and Better Clinical Outcomes
Trent versus Victoria study
• Trent healthcare trust in UK: several small PICUs
• Victoria, Australia: single large PICU• Population based study• All children from each region admitted to PICU
in a 12 month period
Pearson et al. Lancet 1997; 349:1213-7National Healthcare Conference 2011
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Trent Victoria
Population < 16 years 833,000 1,011,000
Child ICU admissions* 1014 1194
Per 1000 < 16 year* 1.22 1.18
Died* 74(7.3%) 60(5.0%)
SMR* 1.75 1.00
National Healthcare Conference 2011
*Neonates: including cardiac cases (excluding others)
The excess ICU mortality accounted for 11% of all child deaths in Trent
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Critical Mass and Better Clinical Outcomes
“Many studies of neonatal care have shown a lower mortality rate in hospitals with higher volumes of patients”
Phibbs et al. New England Journal of Medicine 2007; 356: 2165-75
National Healthcare Conference 2011
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<1500g, adm/yr, OR mortality (N = 48,237)
Level 1 Level 2 Level 3 Level 4
≤ 10 2.72
≤ 10 2.53
> 10 2.39
11 – 25 1.88
≤ 25 1.69
≤ 25 1.51
> 25 1.22
26 – 50 1.78
26 – 50 1.30
> 50 1.80
51 – 100 1.19
> 100 1.00
National Healthcare Conference 2011
Phibbs. New England Journal of Medicine 2007; 356:2165 - 75
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Critical Mass and Better Clinical Outcomes
• Bristol Royal Infirmary Inquiry 1984 – 1995 (children’s cardiac surgery) – Kennedy Report
• 30 – 35 children died that might have expected to live after cardiac surgery
• Cardiac surgery split between 2 sites, no dedicated cardiac intensive care beds, no full time paediatric cardiac surgeons, too few cardiac paediatric nurses
• Children’s acute hospital services should ideally be located in a children’s hospital, as close as possible to an acute adult hospital
National Healthcare Conference 2011
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Critical Mass and Better Clinical Outcomes
“Children’s specialist acute services should be co-located with adult, maternity and neonatal service”.
The Scottish Review of Paediatric Services 2004
Yorkhill Children’s Hospital, Glasgow, a tertiary children’s hospital, currently co-located with a maternity hospital, is in the process to moving to the Southern General Campus where adult, maternity and paediatric services will be tri-located
National Healthcare Conference 2011
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Critical Mass and Better Clinical Outcomes
1.Quality is driven by volume, with higher volumes / larger scale resulting in improved clinical outcomes
2.Quality is dependant on a ‘critical mass’ of sub-specialities (over 25 sub-specialities)
3.Minimum population of 3.5 – 5 million required to support a tertiary children’s hospital.
National Healthcare Conference 2011
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Critical Mass and Better Clinical Outcomes
• McKinsey & Co (2006) Children’s Health First– Ireland’s population can only support one world-
class tertiary hospital– Located in Dublin, ideally be co-located with a
leading adult academic hospital – Provide secondary care for the greater Dublin area– Central component of an integrated national
paediatric network– Incorporate outreach capabilities at key non-Dublin
hospitals and an adequate geographic spread of emergency-type facilities in Dublin
National Healthcare Conference 2011
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McKinsey & Co (2006) Children’s Health First
• Review of 17 leading children’s hospitals in Australia, Canada, Scandinavia, UK, USA and New Zealand (15 out of 17 co-located with adult hospital)
• Highest quality of care (outcomes and patient experience)– Scale / Volume of caseloads – Breath and depth of services (critical mass of sub-specialists)– Access– Efficient use of resources– Attract and retain high calibre staff– Teaching and research fully integrated in to service provision
National Healthcare Conference 2011
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Tri-location
Children’s Hospital
Maternity Hospital Adult Hospital
Neonates
Mothers
Staff
Staff
Adolescents
Staff
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Paediatric activity in the Dublin children’s hospitals
Some Facts
National Healthcare Conference 2011
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Volume of Paediatric Activity 2009
National Healthcare Conference 2011
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Where do children attending the three Dublin children's
hospitals come from?
National Healthcare Conference 2011
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Dublin Children’s Hospital’s Activity - 2009
Greater Dublin AreaDublin, Meath, Kildare, Wicklow
*2009 Figures
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Dublin Children’s Hospital’s Activity - 2009
National Healthcare Conference 2011
DONEGALIn-patients 1.35% Day care 1.30%
GALWAYIn-patients 1.45%Day care 1.63%
LIMERICKIn-patients 1.07%Day care 1.22%
CORKIn-patients 2.15%Day care 2.18%
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Emergency CareAttendance Patterns
National Healthcare Conference 2011
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National Healthcare Conference 2011
Temple Street
Crumlin
Tallaght
New Children’s Hospital
Ambulatory Care Centre
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H
H
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Children’s Hospital Infrastructure
National Healthcare Conference 2011
National Children’s Hospital founded at
Harcourt Street
Children’s Hospital opened at Buckingham
Street and move to current site at Temple St
Our Lady’s Children’sHospital
Crumlin opens
National Children’s Hospital moves from
Harcourt Street to Tallaght
Children’s Hospital of Ireland at Eccles St. and
A&UCC at Tallaght
1821 1872 1956 1998 2015
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Planning the new children’s hospital
• Sickest children have better clinical outcomes in hospitals with high caseloads and a critical mass of specialities and sub-specialities
• Tri-location is the optimal model of service provision
• Highest volume of paediatric services (>90%) are ambulatory (OPD, ED and Day care), warranting localised access (Ambulatory & Urgent Care Centres) and outreach clinics
• Existing infrastructure is unsuitable for contemporary health care
National Healthcare Conference 2011
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2006 Policy Decisions and Reports
FebruaryMarchJuneJuly
McKinsey Report published, endorsed by the three children’s hospitals Report adopted as Government policyJoint HSE / DoH&C Task Group Report published on hospital locationReport endorsed by Government
2007
JanuaryMayNovember
RKW High Level Brief commenced Development Board establishedHSE Board endorse RKW Report
2008
July HSE commissioned an independent review of maternity and gynaecology services in the greater Dublin area
2009
July Development Board facilitated the development of National Model of Care for Paediatric Healthcare Services in Ireland, which was endorsed by the HSE
2010
July Project Brief for the new children’s hospital at Eccles Street and Ambulatory & Urgent Care Centre at Tallaght is approved by the HSE with the prior consent of the Minister for Health and Children
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Designing the new children’s hospital
National Healthcare Conference 2011
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Accommodation Hospital onEccles St
A&UCC, Tallaght
Activity ForecastYear 2021
In-Patient Beds 392 0 27,207 discharges
Operating Theatres (in-patient) 9 0 -
Day Care Beds 53 28 28,303 discharges
Operating Theatres / Procedure Rooms (Day Care)
6 4 -
Out-patient rooms 58 26 223,438 attendances
Short-stay beds Emergency Department / Urgent Care Centre
12 8 122,438 attendances
27
Projected Activity and Capacity
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Design Brief for the children’s hospital • 445 beds (392 in-patient of which 62 critical
care & 53 day care, 75 C/E rooms in OPD)
• 100% single rooms – ensuite, with parent area
• Advanced diagnostics and theatre facilities
• Parent accommodation for critical care
• Parent / family accommodation adjacent to the
hospital
• Play areas, external gardens and courtyards
• Therapy area with hydro pool & gym
• Hospital school
• Education Centre and Research Centre
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Evidence Based Design
National Healthcare Conference 2011
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Fable Hospital™ Project• The Center for Health Design (US)• The need to balance one-time construction costs
against ongoing operating savings and revenue enhancements.
• Analyzed the operating cost savings resulting from – reducing infections, – eliminating unnecessary patient transfers, – minimizing patient falls, – lowering drug costs, – lessening employee turnover rates, – improving market share and philanthropy
• Compelling case to build better, safer hospitals
National Healthcare Conference 2011
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Evidence Based Design Design Intervention Quality and Business Case Benefits
Single patient rooms Reduce infection, increase privacy, increase functional capacity, reduce errors, increased patient satisfaction
Adequate space for family to stay overnight
Increased patient and family satisfaction, reduced patient and family stress
Acuity adaptable rooms Reduce intra-hospital transfers, reduce errors, increased patient satisfaction, reduce unproductive staff time
HEPA filtration for immunosuppressed patients
Reduced airborne infections
Decentralised nurses stations
Increased time spent on direct patient care
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Evidence Based Design
National Healthcare Conference 2011
Design Intervention Quality and Business Case Benefits
Efficient way finding Reduced staff time giving directions, reduced patient and family stress
Natural light in patient / staff areas
Reduced anxiety and depression, reduced length of stay, increased staff satisfaction
Positive distraction (images, music)
Reduces stress, reduces pain and medication use, reduces sedation
Artwork – virtual reality, images
Reduces staff and patient stress, reduces pain and medication use
Noise reduction measures Reduces staff and patient stress, reduced patient sleep depravation, increased patient satisfaction
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Pet ScannerImaging Artwork
Play Room
Play Installations Artwork and Positive Distraction
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Getting children and parents to influence the
hospital design
National Healthcare Conference 2011
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Consultation with children and parents
1. Children and young people:– 8-18 year olds – 2 day event in
Dublin Castle, Dec 2009
– Youth Advisory Panel
– 5 – 8 year olds – research in the children’s hospitals
2. Family Forum –parents & illness support groups
3. Others – illness support groups, patient advocacy groups
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National Healthcare Conference 2011
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Sliding Glass Doors Patient Views over Dublin Personal Social Space that incorporates Privacy
Ward Concept Plan
Ward Concepts
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38
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National Healthcare Conference 2011
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Thank you
National Healthcare Conference 2011
www.newchildrenshospital.ie