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School of Medicine
Archives - A New Day
A New Day
Date: May 14, 2012
After 10 years of planning and six years of construction, The Johns Hopkins Hospital’s new clinical building—dual, 12-story towers—has become reality, sprawling over 1.6 million square feet on five acres of land. On the eve of their opening, writer Mat Edelson spoke to eight people whose lives and work will shape the culture of care in this impressive edifice, just bursting with potential…
Photos by Chris Hartlove
New Front Door
Internist Charles Locke, who sees patients at Green Spring Station in Baltimore County, says he’s historically had a hard time convincing some suburban patients to make the trip downtown to Hopkins Hospital. Halfway through giving complicated directions to find the hospital’s Wolfe Street entrance, he’d be cut off by patients who held up their hands and said: “Just forget it, I’m going someplace local!”
Such resistance may well be a thing of the past, says Locke, as he notes the new football-field-sized entrance to Johns Hopkins Hospital, which is attractively lined with trees, flowers, fountains, and an adjacent meditation garden. Conveniently situated off a major thoroughfare (Orleans Street) with ample parking directly across the street, and all buildings accessible via skywalks, “this is a main entrance in keeping with the best hospital in America,” Locke says.
Similarly, internist Steve Kravet, president of Johns Hopkins Community Physicians, says he sees alluring patient amenities everywhere he looks, from the 500 pieces of art in the new towers to the 560 private rooms, “At-Your-Request” food service, and welcoming family lounges. “Creating a nurturing environment adds to healing. The aesthetics create a positive experience,” says Kravet. Patient safety gets a boost as well: “Complications and infections are the single biggest risk when you refer [patients], but with private rooms you can maintain isolation. That’s a tangible benefit.”
Getting buy-in (and referrals) from community physicians should also be easier now, says Locke, since the wait for appointments and procedures is expected to improve dramatically. Both Locke and Kravet are optimistic that the hospital’s 33 new operating suites and expanded endoscopy suites should greatly relieve the previous logjam. In the old set-up, “someone got admitted and they’d have to wait a day or two to get an endoscopic procedure done. The endoscopy suite occasionally ran out of slots because endoscopy was shared with pulmonology and gastroenterology. In the new building, says Locke, “they’ll each have their own areas.”
Windows of Welcome
The vibrant, patterned glass that envelops the new buildings is the work of artist Spencer Finch, who drew inspiration from Impressionist Claude Monet. Among Finch’s “alphabet” of 26 colors (predominantly blues for the Children’s Center and greens for the Zayed Tower):
• Antique Moss
• Berry Jam
• Dutch Iris
• Leap Frog
• Lemon Grass
• Rubber Ducky
• Pacific Pine
Space to Play
Hospital stays are inherently stressful for young patients and their families. Patrice Brylske and her Child Life Services team seek to reduce that anxiety by utilizing what’s familiar and welcoming to kids: namely, play. “Play is their natural modality for communication,” says Brylske. “If we can make them feel safe with familiar toys in that unfamiliar environment, we can build a trusting relationship. It’s fundamental to helping kids cope with hospitalization.”
The “Great Room” in the Charlotte R. Bloomberg Children’s Center provides an expansive new setting for sick kids—and in some cases, their siblings—to blow off steam, with its two-story gym, complete with a full-sized basketball hoop, spanning Floors 11 and 12. There’s also space here for life-sized games of Connect Four, checkers—and even bowling, with ball release ramps specially designed for kids in wheelchairs.
Each floor in the Bloomberg Children’s Center has an additional playroom—a design feature that was no accident. “When a parent asks, ‘Can you make it 10 feet to the playroom?’ that’s a lot different than going on an elevator and going outside the unit,” says Brylske. “An elevator jiggles, and you may have an incision that hurts a lot when you’re jostled. Also, many children and parents want to be on the unit when their doctor stops by.” For kids too sick to leave their rooms, there are bedside XBoxes and programs and games to play on closed circuit TV.
Spacious, private patient rooms with refrigerators and family lounges with fridges and microwaves on each unit allow parents to bring kids’ favorite foods from home. Comfortable overnight beds have replaced sleeping chairs that rarely afforded a good night’s slumber for mom and dad. The floor-to-ceiling windows (with pictorial window shades), the playful sculptures of oversized animals dangling from the lobby ceiling, the plentiful displays of children’s books and related original art ... everything possible has been done to make the Bloomberg Children’s Center family-friendly, Brylske says, right down to the elevator ride. “There are two video monitors for those over four feet,” she says, smiling, “and two for those under.”
Books + Healing
Seven displays with whimsical animals, fish, and butterflies—reading and being read to—dot the hallways of the Bloomberg Children’s Center featuring artwork by Jennifer Strunge. Highlighted books include:
• Goodnight Moon by Margaret Wise Brown
• The Phantom Tollbooth by Norton Juster
• The Secret Garden by Frances Hodgson Burnett
• The Swiss Family Robinson by Johann David Wyss
A Hybrid with Heart
Jon Resar, head of Interventional Cardiology, looks to Transcatheter Aortic Valve Replacement as the future for the replacement of aortic valves damaged by disease. Unlike conventional valve replacement surgery, which usually involves opening the chest and requires use of a heart-lung machine, TAVR can be done by threading a catheter to the heart through arteries in the groin or arm, or through a small incision in the chest.
But Resar couldn’t completely gear up a TAVR program in his old operating rooms here. “The physical plant was prohibitive. The existing imaging and the room size were not optimal,” says Resar. That’s not the case anymore. In the new Zayed Tower, Resar has what he calls his “hybrid” OR suite, with state-of-the-art imaging capabilities, which allows him to perform TAVR in conjunction with a cardiac surgeon.
The team approach becomes necessary when patients qualify for TAVR but have arteries that are too narrow (or diseased) to allow valves to be delivered via catheter through the leg or arm. In these cases, Resar’s teammate, often cardiac surgeon John Conte, will perform either a mini-incision in the sternum or the chest wall “to access the ascending aorta,” says Resar. From there, Resar and C0nte can go to work, jointly guiding the catheter into place to release the new valve.
Though TAVR is still considered investigational in the U.S. (FDA approval has been given for only a small subset of potential patients due to concerns over post-surgical stroke risk), Resar says the new cardiac hybrid set-up will invite better observation of many emerging techniques. He notes that Hopkins electrophysiologists, who have a suite adjacent to the hybrid room, are looking at imaging changes that offer better safety for patients and practitioners. They’re working on catheters that would be guided by MRI instead of the ionizing radiation used in CT scans and other imaging.
“For brief procedures, radiation exposure is minimal and acceptable, but more complex procedures require lengthy exposure. Some take hours. In young people, that increases their risk of developing malignancies. There’s a great sensitivity to avoiding that risk in medical therapies, so if we can do that, it can be a potential advantage for patients and operators,” says Resar.
Standing before the round gaping mouth of the powerful MRI in the neurosurgery OR, Henry Brem smiles and says, “This is the 21st-century medicine that Hopkins should be doing.”
Brem, internationally renowned for his success in removing challenging brain tumors, is rightfully excited about the surgical opportunities that the interoperative MRI newly makes possible. Once Brem and his team believe they’ve successfully removed all of the cancer in a patient’s brain, they can check their work mid-surgery, when the powerful MRI extends from its holding bay to encompass the patient. If imaging shows additional tumor activity, Brem knows precisely where to focus his efforts once the MRI retracts and surgery resumes. The MRI bay is positioned between two ORs, allowing two surgeries to unfold at the same time.
While such state-of-the-art neurosurgical procedures—as well as intraoperative CT and biplanary angiography—all give neurosurgeons a far more precise road map of blood vessels, tumors, and tissue than ever before, they require considerable OR square footage and miles of wiring, as well as linking in functional MRI and fiber tracking to better delineate actual brain function. Similarly, given the multidisciplinary approach of modern neurosurgery, every member of the team, from anesthesiologists to nurses, brings along their own tech demands; a laptop here, a monitor there … it was a space demand the designers of the Meyer building had never anticipated. “We had a lot of old-fashioned operating rooms that were very small and you just can’t fit all this equipment that we currently use into those rooms,” says Brem.
That isn’t the case in the Zayed Tower, where 14 spacious ORs are outfitted for handling neurosurgery and general surgery. In addition to real-time brain imaging equipment, each operating room is equipped with multiple large-screen TV monitors on the wall, which display what the surgeon sees in the operating field, allowing the entire team to offer input. “That increases safety,” says Brem.
Another nod to safety and efficiency: All neuroscience services (including a 24-bed Neurological Critical Care Unit with private rooms) are together on the third floor. Patients won’t need to be put on an elevator until they are moved out of the unit, lessening the chance of lines being disconnected or pumps becoming tripped by movement.
It’s clear that Brem is pleased with his new environment. “With the improved layout and larger space,” he says, “we expect better outcomes.”
A New Era for the NCCU
Patient rooms in Hopkins’ new NCCU are 90 square feet larger than those in the previous unit, giving care providers 50 percent more space in which to maneuver—crucial for today’s “must have” therapeutic devices, such as multiple IV poles, cooling and warming blankets, and dialysis equipment. Each patient room is also equipped for videoconferencing—communication vital for providing consults with other medical centers and preparing patients for transfer.
If there’s one word that best describes Leo Dorsey’s life, it might be this: Shiny. Very, very shiny.
It’s impossible to spend 10 seconds in Dorsey’s subterranean 30,000-square-foot culinary world—deep beneath the Orleans Street Garage—without being dazzled by brand-new stainless steel technology. Huge cook/chill tanks can handle 90 turkeys at once, and prepare them in half the regular time. Spacious prep rooms are home to a platoon of prep chefs, all working in 57-degree F temperatures that keep the food (and, presumably the chefs) crisp and fresh. Hulking dishwashing machines can accommodate 6-foot-high meal transportation carts, which get pushed right in and sanitized in one fell swoop.
If it all seems a bit extreme, consider the gargantuan task facing Dorsey (above, right), the director of food and clinical nutrition: Serve more than 13,000 meals a day, drawn from more than 125 specialized diets. Keep the hot meals hot, the cold meals cold, the food nourishing and tasty, and the patrons fed in a manner that makes them forget—at least for a moment or two—that they’re in a hospital.
Delivering that kind of quality has been eight years in the making, as Dorsey and executive chef Jake Fatica (left), who came on three years ago, wrestled with the best way to execute a multimillion dollar transformation that will eventually quadruple the size of the former kitchen facilities. With that capacity comes the win-win of building recipes from scratch instead of buying pre-packaged products such as dressings and salad fixings.
Also newly available: an “At Your Request” room-service- style meal plan that provides patients with food made to order. “We’re limited only by the patient’s health,” says Fatica. “You can have breakfast four times a day if you want, and I’ve had many patients comment that [the quality] ‘is just like the restaurant I go to!’”
The food delivery system is also whiz-bang. Some meals are auto-delivered to 19 galleys around the entire institution by a pully track system, with RFID chips controlling whether each cart heads either hither or yon. A fleet of hand-driven electric vehicles delivers other meals, which are held in shiny stainless steel (what else?) hot/cold carriers that plug in on each floor, ensuring that Mr. Johnson’s tomato soup will be held and delivered at exactly the right temperature when he returns from his MRI.
No More Crowding in the NICU
For many years, the cramped quarters of the Neonatal Intensive Care Unit (NICU) at Hopkins made an already trying experience for parents even more stressful—as nurses, doctors, parents and equipment all vied for space around seriously ill preemies.
The lack of privacy didn’t escape the eye of longtime NICU nurse Christy Richter (foreground). Recently, she needed to find space for a new mom to bathe her baby for the first time. “I basically had to push another nurse out of the way, and move all my supplies in front of mom, who was essentially on display in the middle of the room. There was nothing private or personal about that moment for her,” recalls Richter. “I told her, ‘Just you wait a few more weeks … in the new building, you’ll have a whole room to yourself and it’s not going to be like this.’ And she smiled.”
Indeed, the NICU has been designed to maximize the care and the comfort of both infant and parent, from the moment the baby is born. Labor and delivery is now connected to the NICU via a hallway that contains the Obstetrics OR, meaning minimal transport and greater safety immediately after premature births. Each of the 45 beds is now in a private room, complete with a recliner, nearby overnight sleeping lounges, and easily accessible food. “The family can order, go back to the family lounge and eat, and still be near their baby,” says Richter. “They’ll be more calm at the bedside, and present enough to hear what we’re saying.”
Also new: Front-of-the-house customer service reps, who greet family members, oversee hand-washing, and deliver visitors to the baby’s room—a task that nurses previously handled. Other systems also aim to keep NICU nurses closer to their patients. “The goal is that 95 percent of what [a nurse] needs will already be in their patient’s room,” says nurse manager Sue Culp (background). Medication is delivered to the room. It’s a nice safety feature. Formula and breast milk are delivered to the room.”
Taken as a whole, the new NICU is one big stress-buster. “Just look at this place!” exclaims Culp, staring out her eighth-floor window. “It makes Baltimore look fabulous, whatever direction you look!” *
Peace and Quiet
Newborns and their tired moms can look forward to a much quieter recovery in the new hospital, thanks to a variety of noise-busting innovations, including:
• a sound-engineered nurse call system that eliminates overhead nurse pages
• decentralized nursing stations, which diffuse the din that occurs when staff converge at a single station
• high-end acoustical ceiling tiles and rubber floors
that absorb—and reduce—noise