eilish hardiman planning and designing the new children’s hospital

Planning and Designing the new Children’s Hospital

Eilísh Hardiman

CEO

National Paediatric Hospital Development Board

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

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

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.

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

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


*Neonates: including cardiac cases (excluding others)

The excess ICU mortality accounted for 11% of all child deaths in Trent


“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


<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


Phibbs. New England Journal of Medicine 2007; 356:2165 - 75


• 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



“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



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.



• 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


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


Tri-location

Children’s Hospital

Maternity Hospital Adult Hospital

Neonates

Mothers

Staff

Staff

Adolescents

Staff

Paediatric activity in the Dublin children’s hospitals

Some Facts


Volume of Paediatric Activity 2009


Where do children attending the three Dublin children's

hospitals come from?


Dublin Children’s Hospital’s Activity - 2009

Greater Dublin AreaDublin, Meath, Kildare, Wicklow

*2009 Figures

Dublin Children’s Hospital’s Activity - 2009


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%

Emergency CareAttendance Patterns



Temple Street

Crumlin

Tallaght

New Children’s Hospital

Ambulatory Care Centre

Children’s Hospital Infrastructure


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

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


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

Designing the new children’s hospital


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

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

Evidence Based Design


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


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

Evidence Based Design


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

Pet ScannerImaging Artwork

Play Room

Play Installations Artwork and Positive Distraction

Getting children and parents to influence the

hospital design


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

Sliding Glass Doors Patient Views over Dublin Personal Social Space that incorporates Privacy

Ward Concept Plan

Ward Concepts

Thank you


www.newchildrenshospital.ie

http://www.newchildrenshospital.ie/

eilish hardiman planning and designing the new children’s hospital

Health & Medicine