For the kids

Pediatric heart patient Will Kohn, 6, was the first to move into the new University of Iowa Stead Family Children’s Hospital.

UI Stead Family Children’s Hospital emerges from input of hundreds

By Katherine House

For a child requiring regular kidney dialysis, the routine can be disruptive, stressful, and tedious. For University of Iowa Health Care patients and their families, it can mean as many as 12 hours or more each week in the pediatric dialysis center, the only one in Iowa. That takes time away from playing with friends or relaxing at home, spent instead inside a typically sterile hospital environment.

Physicians, nurses, families, and patients themselves envisioned a different approach, and their input helped drive the design of family-friendly treatment space in the new University of Iowa Stead Family Children’s Hospital. The Dr. Jean Robillard Dialysis and Infusion Center features quiet, private rooms with patient recliners and two side chairs for family members; sizable windows allowing natural light; large flat-screen TVs; and convenient access to a children’s library, cafe, entertainment, and activities just one floor away in the hospital’s main lobby.

“It’s all designed to decrease stress and improve outcomes,” says Patrick Brophy, MD, director of pediatric nephrology in the UI Stead Family Department of Pediatrics. “Our team worked with the new hospital’s architects and our leadership to find a location that could serve our patients well. We’re very happy with the suite nestled on Level 2 of our new facility. We think patients and families will be, too.”

The opening of UI Stead Family Children’s Hospital caps more than six years of planning and building a facility that focuses on the comfort and care of patients and families at a most vulnerable time. The new hospital also equips the pediatric health care team with state-of-the-art technologies in an environment that enhances workflow. Every aspect of the $360 million, 14-story building—from its distinctive oval shape with oversized windows offering panoramic views, to the thoughtful family amenities and standardized room layouts—is designed to deliver advanced pediatric care in a setting focused on children and their families.

“A community is defined by the way it treats its most vulnerable—children chief among them. With the opening of UI Stead Family Children’s Hospital, we demonstrate to the world that Iowa values and respects our children and the future they represent,” says Jean E. Robillard, MD (’74 F), UI vice president for medical affairs and dean of the UI Carver College of Medicine.

With features that optimize healing—including private inpatient, prep, and recovery rooms—the new hospital consolidates inpatient pediatric care, procedures, imaging, and surgery previously located throughout UI Hospitals and Clinics. By moving pediatric services to a dedicated space, UI Hospitals and Clinics can convert many shared inpatient rooms for adult patients to private rooms as well as increase the capacity of operating rooms and other services for adult patients.

Even for those who may never step into the new UI Stead Family Children’s Hospital, this facility strengthens the hospital’s commitment to serve as the center of a statewide system of pediatric care, by providing the expertise, resources, and capacity to coordinate advanced specialty services across Iowa for all children, including those with special health care needs.

“Opening our new children’s hospital will enhance the level of care and services provided to our pediatric patients and will ensure we continue to deliver the exceptional, compassionate care all of our patients and families deserve and expect,” says Kenneth Kates, chief executive officer of UI Hospitals and Clinics and associate vice president of UI Health Care.

Collecting design ideas

Icons for typical Iowa features, like this barn for Lower Level 2, help visitors to UI Stead Family Children’s Hospital find their way around the 14-floor facility.

How do you start building a new hospital? For this facility, a steering committee including UI Health Care leaders, physicians, nurses, family advisers, and project architects began by touring children’s hospitals around the country to learn best practices that increase efficiencies and effectiveness of care. The committee studied the layout of lobbies that promote smooth patient flow, observed the impact of colors and natural light, and analyzed the design of “onstage” areas seen by the public and “offstage,” behind-the-scenes areas generally inaccessible to patients and families.

“These visits had a huge impact on us,” says Tom Scholz, MD (’88 R, ’91 F), director of the Division of Child and Community Health. At University of Minnesota Masonic Children’s Hospital, for example, the UI team experienced the effective use of an onstage and offstage approach to building design.

“We saw a hospital hall that was solely built for patients and families to use,” Scholz says. “It was so quiet and peaceful. There were no carts, no back-up ‘beeps’ from equipment moving. We could just imagine how calming and soothing an environment like that could be for our patients and families.”

Back in Iowa City, providers, patients, and families were invited to open houses to share their vision for a new children’s hospital. As work progressed, life-size models of patient rooms and prep/recovery rooms were constructed in the lower level of a hospital parking ramp. Each iteration of these mock-up rooms was reviewed by physicians, nurses, staff, patients, families, and other members of the care team. Over time, notes taped to a wall to show the proposed locations of medical gas and electrical outlets, for example, gave way to notes on actual headwalls that would be installed in patient rooms.

No feature was too insignificant to consider. Nurses in the Neonatal Intensive Care Unit (NICU) suggested adding to each patient room a sink specifically for cleaning breast pumps and a refrigerator for storing breast milk. Additional feedback from the children’s hospital Family Advisory Council and Youth Advisory Council helped the project design team decide on family-centered amenities throughout the hospital.

In the end, more than 600 people— including pharmacists, respiratory therapists, and epidemiologists— weighed in on the design, operations, and workflow of the new children’s hospital.

“It’s unusual to have that level of input, right from day one,” says Brophy, who is also vice chair of clinical innovation for pediatrics.

“UI Stead Family Children’s Hospital is special because it’s designed by our faculty, staff, families, and kids for our families and kids,” says Scott Turner, executive director of the children’s hospital and chief operating officer of UI Hospitals and Clinics. “The attention to detail is apparent on every floor. We take family-centeredness to another level. It’s more than words; we ask and engage families.”

Standardized for efficiency and safety

Inpatient rooms, like this one in the Neonatal Intensive Care Unit, include a sofa bed so parents can stay with their child. Photo by © Nigel Young/Foster + Partners.

Architects took maximum advantage of the building’s oval shape, creating a standardized floorplan whose simplicity belies its numerous benefits. Patient rooms, accessible off a single oval hallway, hug the building’s outer core, giving each room a large window that allows for natural light. After a tornado severely damaged a Joplin, Missouri, hospital in 2011, the design of UI Stead Family Children’s Hospital was altered to enhance safety. For example, windows in the new hospital are designed to withstand EF3 tornado conditions. For added safety, the push of a button lowers protective window shades in every room simultaneously—an extra layer of precaution for those inside the building during dangerous weather conditions.

Offstage areas, including patient transport and service elevators, are concentrated in a central core. The locations of key offstage areas—medication rooms, for example—as well as room layouts are standardized, so equipment and supplies are in the same places floor to floor. This reduces the potential for errors and improves efficiencies, especially for employees who work on multiple floors. Nurses, in particular, helped champion the need for standardized patient rooms.

“Same-handed design allows us to ensure standardized processes and eliminate the need for work-arounds in patient care delivery,” says Angela Shalla, RN, DNP, associate director of maternal and neonatal nursing. “It not only increases efficiency but safety as well, because when staff members walk into a room, they always know where patient supplies and equipment are located. Having the sink in the same location ensures staff perform hand hygiene as they enter each patient’s room.”

Inpatient rooms have three distinct areas: a family zone near the window, a patient zone, and a care team zone near the room’s entrance. The family zone includes a sofa bed that sleeps two adults comfortably, TV, phone, closet, refrigerator, and counter space with connections to charge portable electronic devices, “making it easier for families to stay in the rooms,” says Shalla.

“This welcoming environment allows families to participate in the care of their child. It relieves parents’ stress, and that relieves the child’s stress, which helps enhance the healing process,” notes Scholz.

Standardized modular headwalls in most rooms provide access to critical supplies, medical gases, patient monitors, and sinks. Instead of headwalls in the Pediatric Cardiac Intensive Care Unit and Pediatric Intensive Care Unit, there is a boom above each bed that includes surgical lights for in-room procedures, dual monitors, and even a touchscreen TV, the latter suggested by a patient.

To further enhance patient safety and care, a state-of-the- art communication system sends patients’ requests directly to nurses’ HIPAA-compliant, secure smartphones, which improves response times and allows calls to reroute automatically to other care team members if necessary. The nurse call system is tied to a real-time locating system, enabling lights outside patient rooms to signal the presence of staff members in a room.

The lights also indicate a code blue situation so providers outside the room can find it quickly.

Additionally, communication with the care team is enhanced via Oneview, an interactive education and entertainment system available on patient TVs and bedside tablets. Names of care team members appear on the screen as they enter the room, and customized menus allow patients to order only those foods approved by a dietician and based on their physicians’ instructions.

Improved workflow

A Siemens SOMATON Drive CT scanner—the first installed in the U.S.—uses less radiation and operates quickly to reduce the need for sedation.

Designing a hospital from the ground up allowed leaders to rethink operational workflows to optimize patient- and family-centered care. For example, the UI Dance Marathon Pediatric Cancer Center on Level 11—which includes a bone marrow transplant unit—features inpatient beds as well as an outpatient clinic with infusion rooms and exam rooms. The cancer center is convenient for families, giving them a single location for care. It also enhances collaboration among members of the care team, who are specially trained in caring for pediatric cancer patients. The environment also reduces contact between patients with vulnerable immune systems and others in the hospital. For this reason, this floor includes a classroom exclusively for hematology and oncology patients so they can keep up on schoolwork.

Lower Level 2 combines imaging, sedation, procedures, and recovery in one place to improve operational efficiency, provide a consistent standard of care, and foster collaboration among the care team. A Siemens SOMATON Drive CT scanner is the first of its kind in the United States and only the fourth in the world. The dual-source scanner creates lifelike images using minimal radiation and operates quickly, reducing or eliminating the need for sedation.

The new hospital enables expanded treatment options, including MIGB therapy for patients with neuroblastoma who receive radiation treatments in a lead-lined room. Fewer than a dozen children’s hospitals in the country offer this treatment. Outpatient chemotherapy is now available for some patients who previously were admitted for treatment, and dental procedures for patients with complex medical conditions are available.

The Cornish Human Brain Research Laboratory, for monitoring patients with idiopathic epilepsy, is designed to help researchers learn how the human brain develops, potentially providing clues to neurological diseases such as Parkinson’s and Alzheimer’s.

To support these new services, more than 50 pediatric specialists have been hired since construction began on the new children’s hospital in 2012.

“That’s almost a 40 percent growth, which makes ours one of the fastest growing pediatric departments in the nation,” says Raphael Hirsch, MD, chair of the UI Stead Family Department of Pediatrics and physician-in-chief of UI Stead Family Children’s Hospital.

Determining where to locate services in the new hospital was critical to streamlining workflow, not only in UI Stead Family Children’s Hospital but also between the children’s hospital and UI Hospitals and Clinics, where some services—such as the emergency department and some NICU beds, located near labor and delivery—remain. To facilitate access, the two buildings are connected on seven levels, providing quick, climate-controlled paths for physicians, nurses, staff, and families.

Uniquely ‘Iowa’

The colorful Gerdin Family Lobby includes towering sculptures with tops that rotate like wind vanes. Photo by © Nigel Young/Foster + Partners.

Much about UI Stead Family Children’s Hospital is influenced by changing patient demographics and evolving health care trends, which are factors affecting hospitals nationwide.

Rooms for bariatric patients include reinforced fixtures in patient bathrooms, and the NICU has four large rooms designated for twins. To address concerns over emerging pathogens, isolation rooms are included on all inpatient floors. Even the finish on cabinets, the type of flooring, and the design of sinks in patient rooms were evaluated carefully to decrease the potential for hospital-acquired infections.

One factor unique to UI Stead Family Children’s Hospital is its representation of Iowa. Throughout the hospital, artwork showcasing the state’s farmland, prairies, rivers, woodlands, and skies provides a cheerful distraction and celebrates Iowa’s attributes. Elements from these scenes were chosen for 14 icons that represent each floor and assist with wayfinding. Artwork that pays tribute to 12 Iowa communities decorates towering sculptures, known as wind vanes, in the lobby. The tops of the sculptures rotate just like the actual wind vanes that inspired them.

The Level 12 Rooftop offers a spectacular view of Kinnick Stadium and surrounding Johnson County.

It seems only natural that the building embraces its proximity to Kinnick Stadium, home of the Iowa Hawkeyes football team. The Press Box on Level 12 of the hospital offers fantastic views of the stadium and action on the field, providing what is sure to be a sought-after gathering place for patients and families on game days.

“Among the most special features within the new UI Stead Family Children’s Hospital are the panoramic views of Kinnick Stadium,” says Turner. “The ability to gaze into historic Kinnick Stadium will enable kids and their families to dream of the Hawkeyes swarming the field and going in for the game-winning score—essential elements of distraction, which are important in coping and lessening anxiety.”

The relationship between the children’s hospital and the Hawkeyes goes back decades. In 2009, they teamed up to launch the Kid Captain Program, which celebrates the bravery and inspirational stories of pediatric patients. Each football season, a young patient is selected as the Kid Captain for each home and away Hawkeye football game.

“We’ve had a long partnership with Iowa athletics and are grateful to coaches, players, and staff who have visited our patients and families for years. Now the strength of our relationship is on display 365 days a year,” Turner says.