Saint Thomas Midtown Surgery and ICU Expansion
Healthcare
4 ½ Story Addition to St. Thomas Midtown Hospital including 18 Operating Rooms, 63 Pre/post-op bays, 36-Bed Critical Care Unit, Full Campus Sterile Processing Department, Conference Suite, a 4th floor shell and new hospital entry lobby.
Awards Year | 2024
Project Statement
The Ascension St. Thomas Midtown Hospital’s primary goal for the Surgery Expansion project was to upgrade their surgical spaces while efficiently co-locating the critical adjacencies of Sterile Processing, Pre/Post-Op, and staff support spaces without sacrificing Patient and Staff experience.
The new expansion provided the Hospital with an opportunity to engage and enhance their exterior identity along one of the main city corridors by rehabilitating an underutilized section of their campus. Setting the tone for what the future of this campus may be. Behind the facade, the project includes new surgical spaces with innovative technology that pushes the capabilities for this area into a medical destination.
Patient care begins at arrival and continues through waiting and intuitive wayfinding, emphasizing the patient’s experience. The new drop-off centers around Surgery patients by providing a private entry for Spine Institute patients. The new expansion also incorporated an Innovation and Learning Center that enables staff gathering opportunities ranging from team meetings to organized live surgical learning sessions. The Sterile Processing Department's new location beneath the surgery suite enables efficient instrument flow, preventing cross-contamination by delivering clean instruments directly into the sterile corridor above, but returns used ones to Decontamination. The Third Floor Intensive Care Unit incorporated several pandemic response elements, including 14 adaptable isolation rooms. Finally, the inclusion of an elevator tower and multiple corridor connections maintain the required connectivity to the existing hospital ensuring that staff efficiency improvement to all facets of the campus.
Framework for Design Excellence Narrative
**Design for Integration** - The main design driver for the project was patient experience and patient care from start to finish. They client wanted the facility to provide an end-to-end easy, clear, hospitable experience for patients to have that would help to reduce anxiety and stress as much as possible, when coming in for a surgery. The design team then worked to execute the atmosphere that flowed from one space to another, as the patient was led on their journey through arrival, preparation, procedure, and recovery.
**Design for Change** - The design intent behind the prep/recovery, as well, as the ICU rooms was that they would be able to be flexed throughout the day for optimal efficiency and reduced building square footage in the long run. The hope is to reduce the carbon footprint and energy usage, but creating the flex pre/post operation bays, as well, as ICU rooms that can become standard patient rooms depending on the campus wide need. Additionally, the conference area is designed, not just for internal meetings, but for medical educational programs that can be shared amount multiple campuses.
**Design for Well-being** - In line with the design factor of integration, the key driver was patient care. The design team worked to execute the clients desire for providing ways to increase a patient’s health just from the facility itself. Circadian rhythm lights were provided within the long-term stay ICU rooms, hospitality leaning arrival/drop-off were incorporated to ease the patients anxiety as they enter. Incorporation of clear navigation to reduce stress on how to navigate, typically, maze-like hospital campuses.
LEED/Green Certifications
Photo Captions
2- Site Planning - The project site was situated on the West side of the St. Thomas Midtown Hospital campus, nestled in between 4 structures that were built at varying times between 1955 and 2022. One of the projects goals due to its location was to engage with the street and to communicate a clear pathway for patients arriving for their surgical needs. By extending the Second Floor out to 21st Ave, it provided the "airport or luxury hotel feel" of drop-off and arrival. The amount of program needed on the first two floors also setup the ability for the tower to recess back and not create a towering-impression on the pedestrians walking alongside the project. From the beginning, the Hospital knew that this would be a potential for future growth and change on the campus, thus they requested the structure be able to maintain vertical growth up to the 8th floor as well as future growth towards the East should more Operating Rooms be needed in the future.
3- Exterior Design - Even though this project was requested to push the aesthetic look desired for the campus as it evolves and adapts over the future years, the intent was also for it to coexist and speak to the limestone panel design of the existing. The accents of stone and metal panel were nods back to the original design that allows the project to sit in the transition between the successful years of the past and the innovative years of the future.
4- Exterior Design - The balance of materials and inclusion of glazing, even into a functional space, like surgery, that demands more privacy was a goal of the design team. The desired impact was one that defines the facility as an innovative medical facility.
5- Floor Plans - The layering and stacking of the primary functions to not only help with Patient navigation and reduced travel times within the campus, but also the efficiency for staff and equipment with the Sterile Processing also being layered below the Surgical suite.
6- Drop-off/Entry - Patient Safety and efficiency in arrival and departure was created through the study of Airport traffic flow. Three separate and easily identifiable points of arrival are clearly labeled reducing patient stress through ease of wayfinding. A contrasting and tactile portion of sidewalk adds a barrier both for drivers and patients and staff traversing to the entrances. The stair-stepped design of the ceiling and entrances prevents harsh lighting while creating an uplifting and hopeful arrival experience.
7- Main lobby reception and waiting - The Surgery Expansion and waiting and lobby spaces were crafted to evoke a sense of calm and comfort for patients and visitors alike. The repeated design elements in the public areas form an intuitive grid of wayfinding symbols, signifying arrival and guiding foot traffic. During the design phase, a conscious effort was made to ensure patient circulation, with an ambitious aim to limit patient travel to under 100 steps before arriving at their desired location. The light tile forms a "yellow brick road" that guides individuals from the entrances to destination areas such as elevators, reception desks, and it is extended throughout the facility reinforcing that wayfinding tool. The unique feature of stair-stepped cove lighting along the travel paths and above all reception desks not only brightens the ceiling but also adds volume to the space. Furniture options were thoughtfully chosen to offer a diverse range of seating options and to empower visitors with choices, including lounge seats, worktops, and rocking chairs. There was a deliberate emphasis on the incorporation of local artists and materials throughout the facility. This includes the wood paneling on reception desks, sourced from walnut trees that tragically fell during the Nashville tornado in the spring of 2020. To foster a connection with nature, elements of biophilia are subtly woven into the fabric of the facility, effectively bringing regional outdoors inside. The warm tones of the wood serve a dual purpose - providing a comforting ambiance and marking significant locations such as the information desks and elevator walls. Additionally, the lobby and waiting area features access to the Education Center, public restrooms, private consult spaces, a fully enclosed water feature, coffee shop featuring locally roasted coffee, and interactive artwork by local artisans.
8- Pre/Post Operation and PACU - The implementation of color and pattern not only serves aesthetic purposes but also intuitively guides individuals within the interior of the Pre/Op PACU departments. Much like the communal corridors, the lighter flooring delineates the routes of movement while the vivid blue nurse stations stand as clear landmarks for patients and their families. A number of patient rooms are equipped with sliding glass doors, enhancing privacy.
9- Pre/Post Operation Bays - Natural Lighting was pulled into the Post and Preop Bays at every opportunity. Patient Bays are equipped with black out roller shades and tracks to darken the room for comfort as desired. Special consideration was given to bays designed for "Spine Institute" patients. Each bay and the associated nurse station received the "Spine Blue" paint color for wayfinding.
10- Operating Room Entry and Scrub - The Surgery Unit has been meticulously planned to optimize efficiency. It consists of 18 ORs which are organized into two circular configurations, enabling nine of them to share a streamlined clean core. This core is directly supplied by a clean elevator that originates from the sterile processing department situated underneath. To enhance the turnover time in the operating rooms, eight of these rooms are strategically paired with an OR prep room. These prep rooms serve as uncontaminated spaces for staff to prepare for subsequent procedures while the original room is being sanitized. This not only reduces the turnover times but also facilitates an increase in the number of daily procedures. The corridor, flooded with natural light from exterior views, lead to 10 of the ORs. This natural illumination permeates into the ORs through windows positioned above the scrub sinks and narrow view windows installed at every OR door. To aid in intuitive navigation and establish focal points for staff, accent colors have been used on the flooring and soffit to delineate the entrances. The selection of finishes for the surgical unit provides easy cleaning and maintenance, with longevity being a key consideration. This is evident in the choice of Acrovyn for doors and solid surface surrounds at scrub sinks.
11- Operating Room - Operating Rooms were the driver for the project and the desire was to make these highly innovative and efficient. Each space is design for the patient to be oriented in either direction by allowing instrumentation, medical gases, and technology to be accessible on both sides. The spaces were all designed with prefabricated ceilings to enhance the install but also to provide future adaptability for the future by allowing surgical arms, lights, and mechanical diffusers to be relocated with minimal time and no additional structure. In 9 of the 18 Operating Rooms, the hospital is utilizing lighting with nano-technology, to enhance its cleaning/sterility efforts. The lights are based on occupancy sensors and kick on when the space is vacant for a set period of time. 8 operating rooms are utilizing a Prep Room to help with turnover rates and increase the ability to see all patients. This also affords the staff the ability to reduce work day lengths. In all operating rooms, OR Integration where connectivity from the cameras in the lights, to the touchscreen on the wall, allow the surgeons and staff to analyze, diagram, and collaborate during cases. Multiple rooms are also connected to the Learning and Innovation Center on the First floor, allowing for educational opportunities for staff on or off site to take part in live cases.
12- Intensive Care Unit - The corridors and Nurse stations sought to replicate many of the design elements used in Prep/Pacu departments to build upon the mental framework of intuitive wayfinding that surgery patients and family had already experienced. The nature graphics and subtle gray accent color serve as wayfinding along the long racetrack corridors. Daylighting filters into the staff areas and common core through patient sliding break away doors that are equipped with switchable glass to provide privacy as needed. The wood flooring creates that circulation pathway for users in a comforting wood tone. Patient rooms share a sub-nursing station and nurse server supply cabinet providing views into the rooms and easy access to supplies.
13- Intensive Care Patient Room - ICU patient rooms are typical 315 sf with outboard patient toilet rooms that feature full ADA showers. The design of the Intensive Care Patient Room exceeds requirements by aiming to ensure the utmost comfort and safety for both patients and their visitors. Each room features a ceiling lift, a provision that significantly enhances safety for all parties. In addition to large windows that facilitate daylight and scenic views, the rooms are equipped with circadian rhythm LED cove lights positioned above the beds, serving as an auxiliary means to prevent patient delirium. Among the 36 ICU rooms, 14 rooms are equipped with isolation possibilities, a change learned from the recent pandemic to help with any future crisis. Additionally, all 36 rooms are equipped with the "E-sitter" virtual monitoring system, a crucial tool in the observation of patients with highly infectious diseases. This system enables the delivery of optimal care in pandemic circumstances while ensuring the safety of the medical staff. The rooms are designed with finishes that exude calmness yet cleanable, thereby cultivating a safe and therapeutic atmosphere. The design process of the ICU rooms also took into account the potential necessity for anti-ligature hardware and measures within the casework and furniture design.
14- Staff Respite Garden - Staff wellbeing was a key consideration throughout design, whether it was the implementation of glazing in work areas, proximity and connectivity of staff to all areas of the hospital, prep rooms for reducing work days, or the inclusion of a respite garden. The existing facility had a outdoor staff area, but the location of this new project required its removal. The client and design team knew that space was truly important to the staff, so as a part of the design, a similar respite garden was incorporated planned in. This space also includes a zone for future local muralist to work with staff on a permanent art piece and a brick monument bench made from the original nursing building's brick façade.
