39 premature babies move into new NICU – just in time for Mother’s Day

They weren’t supposed to be born yet, and many of them are small enough to fit in the palm of your hand, but 39 tiny babies took an amazing journey Tuesday, May 5 – just a few days before what will certainly be a memorable Mother’s Day for their families.

Designing the new NICU gallery

Getting the details right

During the kaizen to design the new high-risk delivery area, mock scenarios were played out to test the various design concepts.

During the kaizen to design the new high-risk delivery area, mock scenarios were played out to test the various design concepts.

How many corners does a gurney need to turn on the trip between triage and the OR?

What is the best placement of the bed in a patient room to ensure maximum privacy?

Is there a need for refrigeration in the medications room for breast milk?

These and other considerations relating to patient and family comfort and privacy, as well as operational efficiency, represent the final refinements to the high-risk delivery space that will occupy the fourth and fifth floors of the new building.

Dana Nelson

Dana Nelson

“We looked at waiting and reception area flows – that is the family’s first impression,” said Dana Nelson, administrative director of Akron Children’s Maternal Fetal Medicine. “We also wanted to make a very smooth flow for the mothers with as few turns as possible. And we looked for opportunities to bring moms and babies closer together.”

The high-risk delivery space is being designed to accommodate a projected 100 patients annually, but will have plenty of room for expansion as the patient census grows.

The unit will serve pregnancies where the baby, not the mother, is high risk and is expected to need immediate care or surgery after delivery.

Dr. Stephen Crane, director of Akron Children's Maternal Fetal Medicine Division, participates in team discussions about the high-risk delivery space.

Dr. Stephen Crane, director of Akron Children’s Maternal Fetal Medicine Division, participates in team discussions about the high-risk delivery space.

For inspiration, the team, comprised of NICU nurses, representatives from Maternal Fetal Medicine, architects and trade partners, anesthesia, IT and other support services, and former NICU parents, looked at similar high-risk delivery departments at Children’s Hospital of Philadelphia, C.S. Mott and Denver Children’s.

Then they began the now-familiar process, previously used to design the NICU, ER and ambulatory surgery spaces, of mocking up the high-risk delivery space with cardboard as well as actual furnishings and equipment at a warehouse in Akron.

kaizen-team-in-cardboard-seThe mock unit included LDRP (labor-delivery-recovery-postpartum) patient rooms with bathrooms, triage bays, a waiting room and family lounge, C-section/ NICU ORs, a resuscitation room, an ultrasound room, a medications room, an anesthesia work room, consult and conference rooms, a nursery and team work areas.

writing-notes-on-wall-postiDesigned for maximum access, the ORs lead directly into a resuscitation room, where the baby can be stabilized before being moved to the NICU in the adjacent elevator.  Dads can easily move between Mom in the OR and the newborn in the resuscitation room.

When Mom has recovered, she has easy access to her newborn in the NICU via a short elevator ride, instead of being transported from another hospital.

“We also had to talk about those outcomes that aren’t what we hope for,” Nelson said. “We created peaceful, private bereavement space for families.”

Dr. Anand Kantak, director of neonatology at Akron Children's, brings up points about the design concepts.

Dr. Anand Kantak, director of neonatology at Akron Children’s, brings up points about the design concepts.

With team members playing the roles of patients, doctors, nurses and family members, the team continued to move beds, chairs, carts and equipment, until they were sure that the space provided the best patient experience.

At the end of the workshop, team members expressed amazement at the number of details they had to consider in designing a space that was workable for both patients and staff . . .  and the big difference that moving a single door can make in assuring both privacy and efficient treatment.

From houses to hospitals, architect is living the dream

Norio helps lead a kaizen workshop to design Akron Children's new NICU using small scale models.

Norio helps lead a kaizen workshop to design Akron Children’s new NICU using small scale models.

Norio Tsuchiya has dreamed of being an architect since he was in third grade and his best friend in Ecuador told him that some people design houses for a living.

So in 1991 when the opportunity arose, he made the trek to the United States to pursue his passion. He received his undergraduate degree from Letourneau University in Longview, Texas, and went on to earn his master of architecture at Texas A&M University.

He began his career designing upscale, modern homes, but soon realized he wanted to do more.

Norio Tsuchiya

Norio Tsuchiya

In 2007 he joined HKS Architects, where he began designing healthcare facilities around the country that impacted the lives of hundreds of people. Today, he’s vice president and senior project designer of the Dallas-based firm’s healthcare academic and pediatric team.

“In some ways, it has been way more than I was thinking that I would be doing,” said Tsuchiya, reflecting upon his childhood dream. “I’m still doing things that I love to do − to create beautiful buildings, but [I’m designing] spaces that help people heal and feel better. I can’t ask for more than that.”

Tsuchiya is now digging deep into Akron Children’s Hospital’s $200 million “Building on the Promise” expansion campaign. As lead designer, he led the collaborative effort to design the exterior elements of the medical tower, now under construction.

The exterior design was derived from visioning sessions with Akron Children’s leaders, staff, patient families, and the community.

When family members communicated a desire for individual spaces and lots of natural light in the new neonatal intensive care unit, Tsuchiya and his team were sure to incorporate these aspects into the new building.

HKS Architects and Akron Children's sent 1,000 origami cranes to Hiroshima to be placed at the Children's Peace Monument.

HKS Architects and Akron Children’s sent 1,000 origami cranes to Hiroshima to be placed at the Children’s Peace Monument.

In addition, Akron Children’s Hospital President and CEO Bill Considine expressed interest during these sessions to create an inviting and naturally lit front entrance – not only to offer families comfort when approaching the hospital, but also as a wayfinding tool.

Tsuchiya and his team expanded upon that vision, creating a transparent path illuminated with an innovative lighting system to connect the new parking garage to the tower’s main lobby and then again to the existing hospital’s lobby.

Norio Tsuchiya“The building isn’t just a device to create this aesthetic vision,” said Tsuchiya, who, now that construction is well underway, only steps in to problem-solve if issues arise on how the design is conceived. “We’re trying to let the design communicate some of the ways that the building actually works.”

With a mellow personality and soft-spoken nature, it’s no surprise Tsuchiya is making a name for himself designing healthcare facilities — from children’s hospitals to teaching hospitals — that incorporate calm and relaxing healing environments.

“That sort of attention to the patient experience is what I love about doing architecture in healthcare,” he said. “Everybody thinks that you have to plaster it with color and make it really busy. I think I’m able to temper that urge to go crazy and really consider the experience of everybody.”

Where the familiar things are

Abstract design features in the future lobby play into the "things familiar" and backyard ideas. The blue wall represents an abstract fence. The design team is also working on large tree sculptures and a ceiling sculpture element to symbolize a tree canopy of leaves.

Abstract design features in the future lobby play into the “things familiar” and backyard ideas. The blue wall represents an abstract fence. The design team is also working on large tree sculptures and a ceiling sculpture element to symbolize a tree canopy of leaves.

Where does a child’s adventure begin?

The answer: In the child’s backyard.

That answer led to the theme for Akron Children’s new medical tower – “things familiar.”

The idea was to inspire imagination while being comfortable and safe at the same time – like in a child’s backyard.

The theme was a result of a visioning process between HKS Architects and hospital leadership.

The theme meets hospital leadership’s desire to create a place that’s distinctive and serves as a beacon to the community. It also conveys a connection to the natural environment, and inspires creativity and hope.

“A child’s imagination is the most powerful tool we have,” said Becky Baumer, an interior designer at HKS Architects.  “It transports them into another time, another place. It takes them out of their current state and into their perfect future state.  It holds their dreams. It is healing. It is comforting. It is calming. It is playful.  It turns things familiar into magical retreats.”

Each department in the new building will feature a backyard-related design that drives the building’s interior look and feel.

These themes will be reflected in abstract design features appropriate to the departments, and each floor will have an assigned a color, signage and accent walls that fit the themes.

  • ED is “the puddle.” This theme was chosen because water has a calming effect for this high-stress environment. The first floor ED will be blue.
  • The outpatient surgery center is “the sandbox.” Located on the new building’s 3rd floor, outpatient surgery will have a more energetic orange color scheme, reflected in color, texture and pattern.
  • The high-risk delivery area, located on the 4th and 5th floors, will be “a garden,” which is appropriate and restful for this adult audience.
  • The NICU, also occupying two floors (the 6th and 7th), will create the feeling of “a treehouse.”  One floor will be the treehouse at night, using the color magenta and setting the scene for a camp-out or sleep-over. The 2nd floor will be green, to reflect the feeling of spending the day in the tree tops.

“The hope,” Baumer said, “is that as the campus grows and areas are refurbished, this type of theming can be continued.”

Collaboration saves time and money for building project

The Structural Innovation Team is studying the best approaches to constructing the foundation and super-structure.

The Structural Innovation Team is studying the best approaches to constructing the foundation and super-structure.

Collaboration among Akron Children’s design teams for its new medical tower has shaved weeks from the construction schedule and saved millions of dollars, while adding features that will increase patient satisfaction and improve outcomes.

“To deliver the best value for the hospital, seven innovation design teams were created to study as many design solutions as possible,” said Nick Loughrin, production manager for Welty-Boldt. “Working individually and collaboratively, during the entire design phase, the innovation teams have captured ideas that have reduced the overall project budget by more than $30 million, while remaining true to the hospital’s design criteria.”

“…the innovation teams have captured ideas that have reduced the overall project budget by more than $30 million, while remaining true to the hospital’s design criteria.”

Each innovation team includes a cross pollination of ‘thinkers’­ – designers, trade partners and members of the construction management team.

  • The Site Innovation Team is responsible for the design of the underground utilities, landscaping and road work.
  • The Structural Innovation Team is studying the best approaches to constructing the foundation and super-structure.
  • The Enclosure Innovation Team is concerned with the aesthetics of the exterior of the building, like the exterior skin and windows, and air and vapor barriers.
  • The Medical Equipment and Technology Innovation Team includes IT, building security, nurse call systems and OR equipment.
  • The Interiors Innovation Team is working on the interior design and finishes, including wall coverings, flooring and furnishings.
  • The Mechanical, Electrical, Plumbing and Fire Protection Innovation Team is designing the HVAC, plumbing, fire protection and electrical systems.
  • The Production Innovation Team is focused on finding the most productive methods to construct the building.

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Using a decision-making process called “Choosing by Advantage,” the teams look at their options, identify the advantages of each, including cost considerations, and reach a consensus on whether a particular set of advantages are worth the cost.

Nick Loughrin Project Manager The Boldt Co.

Nick Loughrin

Each team’s ideas are then preserved in a log. So far, the process has resulted in a number of improvements in the design and construction process:

  • Initially, the mechanical rooms were going to be located in the middle of the building. The teams knew that the location needed to be convenient for the maintenance staff while providing the most flexibility for possible future renovation, and that the noise needed to be as far from patients as possible. The consensus — the basement provided the best solution to the problem.
  • There will be 69 bathrooms in the NICU. “Instead of building the bathrooms on site, it was faster and easier to prefabricate bathroom pods in a manufacturing facility. The pods will be flown in and set in place, saving nearly three weeks in the construction schedule and approximately $50,000,” said Loughrin.
  • The teams studied lowering the ceiling height from 9 feet to 8 feet 8 inches. This reduced the height of the building, which means less brick, windows and metal.  There will be less wall space to finish, and the duct sizes can be reduced. “Lowering the ceiling, which does not impact the design intent, results in a savings of approximately $190,000,” Loughrin said.

Team planning high-risk birth center has 182 collective years of OB experience

Scott Radcliff, of Hasenstab Architects, leads a brainstorming session.

Scott Radcliff, of Hasenstab Architects, leads a brainstorming session.

Last month, Akron Children’s announced that it would dedicate a floor in its new building to high-risk deliveries – a milestone in the hospital’s 123-year history.

This has long been a dream of hospital leaders like President and CEO Bill Considine, as well as the doctors who head up the hospital’s maternal fetal medicine and fetal treatment centers and neonatal intensive care unit.

Now comes the work to make this dream a reality.

Dr. Anand Kantak has long supported the plan to bring high-risk deliveries to Akron Children's as the ideal family-centered care.

Dr. Anand Kantak has long supported the plan to bring high-risk deliveries to Akron Children’s as the ideal family-centered care.

The first steps in planning the new space, which will be on the 4th floor of the medical building already under construction, took place Aug. 5 and 6.

A team of about 20 doctors, nurses, architects, administrators and Lean Six Sigma experts participated in a kaizen (Japanese word for “rapid improvement”) to give key stakeholders a say in how the space is designed.

A high-risk OB patient also participated the first day.

“Delivering babies on our campus may be uncharted territory for us, yet the doctors and nurses in this room have a collective 182 years of experience delivering babies at other hospitals,” said Lisa Aurilio, vice president for patient services and chief nursing officer.

Chief Nursing Officer Lisa Aurilio has also participated in kaizens for the ER and NICU.

Chief Nursing Officer Lisa Aurilio has also participated in kaizens for the ER and NICU.

The plan is to deliver approximately 100 babies per year when prenatal diagnosis determines the baby to be at risk and in need of immediate medical intervention by pediatric surgeons or other specialists upon birth.

This would include babies with congenital heart and neural tube defects, diaphragmatic hernias, and abnormalities that may affect the airway.

The team began by creating a vision statement for the new center. This was done by participants writing responses to prompts like, “I see…”, “I hear…”, “I think…” and “I feel….”

The input of the team members suggest they want to create an environment that's inviting, comfortable and focused on the highest quality of care.

The input of the team members suggest they want to create an environment that’s inviting, comfortable and focused on the highest quality of care.

Each team member was given 5 blue and 5 red dots to place on photos of the interiors of other birthing centers across the country. The exercise indicated the team is partial to soft rather than bright colors.

“They steered away from primary colors and starkness in favor of wood tones, a spa-like feel and interiors that convey home and comfort,” said Sherry Valentine, a project leader for Akron Children’s Mark A. Watson Center for Operations Excellence.

Sherry Valentine, Lean Six Sigma deployment leader, facilitates a group session.

Sherry Valentine, Lean Six Sigma deployment leader, facilitates a group session.

Other activities focused on issues of patient experience and staff work flows.

They looked at the proximity of operating rooms to patient rooms, how many steps doctors and nurses have to walk, storage space, the size and comfort level of the patient rooms, and the various “points of entry” for patients.

While most of these deliveries will be scheduled through maternal fetal medicine, the team also has to plan for the unexpected, including patients arriving via transport, 911 ambulance arrivals, and even the occasional “walk-in” mother-to-be in labor.

Jennie Evans, a registered nurse and medical planner with HKS Architects, offers insight.

Jennie Evans, a registered nurse and medical planner with HKS Architects, offers insight.

The team will make key decisions for the public/shared spaces, such as the waiting rooms, 3 ORs for C-sections, and 6 labor/delivery/recovery/postpartum rooms, which must also flexible enough to become 2 intensive care rooms and an isolation room, if needed.

Several participants talked about how the team “gelled” instantly and how they feel privileged to have a role in a history-making venture for Akron Children’s.

Drs. Melissa Mancuso and Stephen Crane are two of Akron Children's high-risk obstetricians.

Drs. Melissa Mancuso and Stephen Crane are two of Akron Children’s high-risk obstetricians.

“We are all very invested in this,” said Dr. Stephen Crane, director of maternal fetal medicine. “We have dreamed about this for years. It’s the right thing to do for our patients.”

Dr. Melissa Mancuso, co-director of the fetal treatment center, says the ability to perform high-risk deliveries will, over time, enable Akron Children’s to offer new treatment options, such as laser therapy for twin-to-twin transfusion syndrome, ex utero intrapartum treatment (EXIT) procedure, fetal therapy for cardiac conduction abnormalities and in utero release of amniotic bands.

“Of course the best reason for doing this is it keeps moms with their babies and keeps families together under one [hospital] roof. You can’t put a value on that,” said Dr. Mancuso.

That’s not to say the process will be easy.

“The most challenging aspect of this for our hospital is thinking beyond babies and children as patients,” said Aurilio. “Now mothers will be our patients as well, and that has implications for everything we do from insurance contracts to medical coding to laboratory procedures.”

First high–risk delivery paves way for new service to care for at-risk newborns

Flanked by her medical team, Angela Daniell, the mother of the first baby delivered at our Akron campus heads into the OR for a planned C-section.

Flanked by her medical team, Angela Daniell, the mother of the first baby delivered at our Akron campus, heads into the OR for a planned C-section.

We broke ground on May 30, and as you can see from the giant cranes near Locust and Exchange streets, construction is now well underway for the new ER, NICU, outpatient surgical suites and other amenities that will be housed in our new building.

Now its time to announce yet another milestone in Akron Children’s history.

CEO & President Bill Considine

CEO & President Bill Considine

“After much thought, discussion and planning, we have committed to creating space in our new building for high-risk deliveries,” wrote Bill Considine, president and CEO, in a letter to employees. “The maternal fetal medicine team, with help from our surgical and nursing leadership, performed the first of such high-risk deliveries on our Akron campus on May 10 and the story about this successful birth of a baby boy will be the subject of an upcoming Akron Beacon Journal story.”

High-risk delivery services were identified as a community need by our maternal fetal medicine team in their efforts to provide the best care possible for at-risk newborns.

“Our neonatal transport team is one of the best in the country, but we estimate that each year we have about 100 deliveries where there is an especially high risk in transporting a newborn to our hospital,” Considine said.

Examples include babies identified with congenital heart defects, neural tube defects, diaphragmatic hernias, abnormalities which may affect the airway, and other conditions that require the baby to have immediate access to pediatric specialists upon birth.

Baby Ashton's birth story is one for the history books

Baby Ashton’s birth story is one for the history books

Another benefit is that the labor, delivery and recovery rooms would keep mothers close to their newborns as they would just be an elevator ride away from our new NICU.

“This is a perfect extension of our commitment to family-centered care,” Considine said.

At this time, the plan does not include routine deliveries, or deliveries involving high-risk mothers, which will continue to occur at our partner hospitals in Akron and throughout our service area.

The hospital was involved in preliminary discussions with its Akron partners about moving routine deliveries here earlier this year, but those discussions did not result in a model that all agreed upon.

As with other aspects of the building, the building planning team will organize kaizens for these new operating and labor/delivery/recovery rooms.

Drs. Stephen  Crane and Melissa Mancuso and their teams in maternal fetal medicine and the fetal treatment center will work closely with our center for operations excellence team, architects, engineers and others to design this space.

“We have met with our colleagues at Akron General Medical Center and Summa Health System and they are supportive of this plan, recognizing it is in the best interest of babies and families, and that the previously undesignated space in the new facility presents a golden opportunity to pursue this,” Considine said. “The timing could not have been better. I know you will join me in celebrating this exciting part of our hospital’s history, and an important step to its future.”

Wrapping our latest gift

construction-fence-2

1,200 feet of fencing wraps around two sides of Akron Children’s construction site

Wondering what our new medical tower will look like? We’ve got a big dirt mound here now, but surrounding the construction site is a fence wrapped with pictures of the building.

See the architect’s image of the front of the building, the front of the new Emergency department entrance, the beautiful new lobby, one of the NICU rooms and the same-day-surgery waiting room.

We’re designing this building with the comfort of patient families in mind – along with the best practices for clinicians to help care for your little ones.

The eye-catching fence wraps around the construction site from Perkins Square Park to Exchange Street

The eye-catching fence wraps around the construction site along Perkins Square Park and Exchange Street

construction-fence

The fence along Exchange Street

The fence along Perkins Square Park

The fence along Perkins Square Park

Final design workshop for NICU likened to “speed dating” [Photo Gallery]

Mary Beth Frye, Megan Pollock and nurse Sofiya Lizhnyak participate in NICU simulation

NICU family care coordinator Mary Beth Frye, Megan Pollock and nurse Sofiya Lizhnyak participate in a NICU simulation to test the new design space.

Akron Children’s Hospital’s NICU team began its final design kaizen with an approach that could be compared to speed dating.

The team broke into three small groups that rotated around full-sized cardboard mock-ups that represented patient rooms, medication rooms, team rooms, family and staff quiet rooms, supply and equipment rooms, pod work stations, and remote networking or “touchdown” rooms.

Each group had 45 minutes to review and discuss where every stationary and portable item should be placed in each room.

During a simulation scenario, Dr. Jen Grow and mock patient family test out the design of the new patient rooms

During a simulation scenario, Dr. Jen Grow and Megan Pollock test out the design of the new patient rooms.

The teams took the needs of NICU families into consideration – everything from how to provide coffee and tea service most economically and efficiently to the need for recliners in the quiet room for parents to hold their end-of-life babies.

“It’s been great to be able to give input on everything from the chair position in the patient room to the counter space and cabinets in the bathroom,” said Megan Pollock, a former NICU parent.

In all the rooms, the team discussed the smallest details:

  • How many and what types of seating are required?
  • How many phones and chargers for communication devices are needed?
  • What types of storage work most efficiently in different rooms?
  • Would white and cork boards be useful or compromise patient privacy?
  • What size windows provide the best compromise between visibility, privacy and cost?
  • What’s the best location for the breast milk and formula refrigerator and the meds refrigerator in the medication room?
  • Could crash carts be stored in the medication room?
  • Where is the best place to locate sinks to avoid splashing and possible contamination?
  • Are clutter free counters with storage shelves above the best approach?
  • Who will be responsible for cleaning and stocking items?

After the NICU team agreed on changes, they used simulation scenarios to confirm that they knew where to find what they needed and make sure the newly designed spaces work as planned.

“Participating in the simulations was awesome,” Megan said. “The newborn mannequin made the whole experience feel so real. When I practiced kangaroo care with it, I could feel the heart beat.”

The NICU team will now embark on two years of process refinement during the Critical Care Tower construction, culminating in the move to their new space in 2015.