Bakersfield Heart Hospital

Bakersfield Heart Hospital Creating Flexible Space Out of Existing Space September 21, 2011 1:30pm to 3:00pm

Presenters Michael Bell, MBA Vice President, Operations Bakersfield Heart Hospital Phillip Bahr, AIA Associate Principal Cannon Design Joseph Livengood, MD, FACS Acute Care Surgeon Medical Center of the Rockies

Flexible Care Design Change Makers

Learning Objectives Identify patient entry point and flow characteristics unique to the Cardiac Hospital. Evaluate the use of a Flexible Care Unit to serve multiple patient care areas. Identify metrics for critical review when building a Flexible Care Unit. Explore an advanced concept for Flexible Care Design inspired by the Bakersfield project.

Bakersfield Heart Hospital

Bakersfield Heart Hospital Throughput Symptoms 110% at capacity during peak hours LWBS rate increasing Transfer requests turned away due to No Beds ER patient satisfaction complaints increase Related to privacy and comfort Inpatient holds hours increasing

Bakersfield Heart Hospital Prior to 1 st design

Owner s Perspective Michael Bell, MBA VP, Operations Bakersfield Heart Hospital

Hospital Origination and Vision Vision of a team of physician and staff specialists dedicated to fighting one disease heart disease. Physician Led - empowered physician leadership with significant decision making roles for technology. Patient Focused - reduce number of caregivers interacting with patients. Effective: Clinically proven care provided at the right time and way for the patient s needs. Efficient: Services provided are appropriate to the needs of the patient while managing resource utilization. Safe: Care provided that minimizes risk of harm to the patient and staff Patient Centered: Keeping the emotional, spiritual and physical wellbeing of the patient in the center of our care results in a positive patient experience.

Facility Overview 47 private inpatient beds (including 10 critical care beds) 3 operating rooms with complete facilities for heart and vascular surgery 4 cardiac catheterization labs with 1 lab equipped for electrophysiology 20 outpatient and recovery rooms 8 bed emergency department Technologically advanced cath labs Over 228 employees in addition to the medical staff Highly trained, caring clinical staff Over 20 of the leading cardiologists and cardiothoracic and vascular surgeons in Bakersfield

Floor Plans Departments Clinical Operating Room Cardiology Administrative & General Operations Emergency Radiology Dietary Housekeeping Laboratory Medical Records Respiratory Therapy Pharmacy Square Footage 28,685 12,192 10,444 9,806 9,693 4,971 4,662 3,578 1,567 1,172 1,128 1,071 1,031

Service Offerings Bakersfield Heart Hospital (BHH) is a 47-bed acute-care hospital providing care in: General Medicine General Surgery Hematology Nephrology Neurology Medical Oncology Pulmonary Rheumatology Thoracic Surgery Vascular Surgery Cardiology Cardiovascular Surgery Emergency Medicine Interventional Radiology Procedures Supporting Services Inpatient Out Patient Cardiology Diagnostic Angiogram X X Angioplasty X X Drug Eluting Stent X X Intravascular Ultrasound X X Electrophysiology Studies X X Pace Maker Implantation X X AICD Implantation X X Echo Cardiography X X Stress EKG X X Ultra Sound X X Cardiac Surgery CABG on and off pump X Valve Repair X Vascular Peripheral Vascular Angiography X X Peripheral Vascular Intervention X X General Surgery X X Medical Procedures Bronchoscopy X X Endoscopy X X Acute Dialysis X

Payor Mix Trend Payor Mix (based on Admits, budget based on Net Rev) FY2009 FY2010 FY11 June YTD Medicare 53.00% 59.4% 59.4% Medicaid 4.60% 4.4% 5.8% HMO 7.50% 2.4% 2.3% Commercial (Other, PPO, Blue Cross) 10.40% 13.5% 12.8% Self Pay 2.80% 3.2% 3.9% Medicare HMO 21.80% 13.6% 10.4% Medicaid HMO 1.40% 1.9% 2.1% Medicaid Pending 0.70% 0.7% 1.9% Medicaid Outsourced 0.00% 0.0% 0.0% Indian Health 0.00% 0.0% 0.0% Worker's Comp 0.50% 0.5% 0.6% Champus 0.20% 0.0% 0.7%

Architect s Perspective Phillip Bahr, AIA Associate Principal Cannon Design

Campus Site Plan CAMPUS SITE PLAN

First Floor Plan

Second Floor Plan

Schematic Detailed Plan

Change Makers

YouTube Construction Video

Hotel Stacking Diagram

Hospital Level Diagram UNDER 23 HOUR OVER 24 HOUR

Clinician s Perspective Joseph Livengood, MD, FACS Acute Care Surgeon Medical Center of the Rockies

Bakersfield Heart Hospital Post- Design

Patient Care Areas ED OB/Gyn Pre-op PACU SICU CICU NICU TICU Step-Down Telemetry Surgical Post-Trauma Med/Surg Women s Care Oncology Orthopedics Neurology Rehab

Acuity-Adaptable Design A patient space that accommodates the care of patients along a continuum of needs. Universal Room Design Build a space that can accommodate all patients from ICU to Floor Flexible Room Design Build a basic room and bring care to the patient.

Patient Care Areas ED OB/Gyn Pre-op PACU SICU CICU NICU TICU Step-Down Telemetry Surgical Post-Trauma Med/Surg Women s Care Oncology Orthopedics Neurology Rehab

Staff Qualification ICU-Level ED Preop PACU ICU Float Pool?? Floor Medical Cardiology Surgical Trauma Women s Care OR Spine Cardiac General Trauma ENT GYN Robotic Eye

Slide Title

Peri-Operative Area Endoscopy Manager Staff Call Schedule Policies Foreign Body Thursday, 8pm 1 Call RN Pre-op PACU Manager Staff Call Schedule Policies Acute Cholecystitis 1 Call RN Cath Lab Manager Staff Call Schedule Policies LAD 1 Call RN ER OBS Manager Staff Call Schedule Policies Intoxicated Concussion 1 Call RN

Peri-Operative Area Endoscopy Manager Staff Call Schedule Policies Foreign Body Thursday, 8pm 2 Call RN Pre-op PACU Manager Staff Call Schedule Policies Acute Cholecystitis Procedural Call Staff- GO HOME Cath Lab Manager Staff Call Schedule Policies LAD 2 Call RN ER OBS Manager Staff Call Schedule Policies Intoxicated Concussion 1 Manager 1 Staff Pool 1 Call Schedule 1 Policy Set

Peri-Operative Area Endoscopy Pre-op PACU 1 Manager 1 Staff Pool 1 Call Schedule 1 Policy Set Procedural Call Staff- GO HOME Cath Lab 2 Call RN ER OBS ER OBS Unit now staffed 24 hours Off-Loads In-Patient Units Minimizes Reimbursement Confusion

Universal Room Design Benefits Simplified flow Detriments Patient satisfaction Difficult to staff Expensive

Flexible Room Design Traditional room design confines a patient to bed predisposing to preventable complications. The Platform opens up the room to the patient, empowering mobility and improving outcomes.

Barriers to Flexible Design Operational Silos ED Peri-op OR ICU Step-Down Med/Surgery Staff Training Flexible Float Pool Open Unit Overflow

Slide Title? Cardiac ED Cath Lab CCU Telemetry Rehab Trauma ED CT OR/PACU ICU Step-Down Post Trauma Rehab Time 60 minutes 30 minutes 3 hours 3 days 2 days 4 days 3 weeks

Discontinguous Care Units SICU NEURO

Flexible Care Unit

Flexible Design Areas ED Peri-Op ICU - Intermediate - Med/Surgery Med/Surgery

Emergency Preparedness Design and planning should incorporate disaster planning

Expanded Float Pool Organize by skill sets more so than departments

Leadership Behind the Change Strong, committed management team Lean Process (along the entire service line)

Summary

Closing Slide Text?

Contact Information Michael Bell, MBA michael.bell@medcath.com Phil Bahr, AIA pbahr@cannondesign.com Joseph Livengood, MD, FACS livengoodj@livengoodmed.com

Thank You