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Introduction

A $147 million facility renovation plan at Sarasota Memorial Hospital sparked an effort to ensure that the newly designed/renovated space would be both effective and functional. Effectively, the space would meet business and operational goals while functionally optimizing the square footage available. Simulation was used to test department design at the blueprint stage. Clarifying operational objectives, gathering and summarizing data into a concise form, and testing the design through simulation, resulted in a project, which realized tremendous savings in construction and operational costs, and improved the patient process.

Background

Sarasota Memorial Hospital is an 885 bed facility. The hospital offers acute medical/surgical, psychiatric, rehabilitation, skilled nursing, and sub-acute services. The continuing shift from inpatient to outpatient services, a growing clientele and the need to stay competitively positioned in the marketplace resulted in a critical need for additional as well as reconfigured space.

The hospital’s management engineering department was invited to join the design team to assist in ensuring that the Facilities Master Plan would indeed address the business and operational issues effectively. The architectural department at Sarasota Memorial Hospital faced challenges found in healthcare institutions across the country:

  • a long drawn-out design process
  • unclear operational objectives
  • uncertainty of space requirements
  • political issues
  • a history of requests for change in design shortly after occupancy by the users

A new approach, featuring collaboration between architects, management engineering, simulation consultants, and department personnel was deemed necessary to solve many of the issues.

Approach

Major projects in the Master Facility Plan were identified as candidates for simulation. The projects were chosen because of

  • potential dollar impact
  • potential of impact on patient service quality
  • uncertainties in the current design specifications
  • benefits to be derived from simulation

Four departments were chosen for the initial evaluation. These departments were: Invasive Cardiology, Perioperative Services, Imaging, and Obstetrics. The team designed the goals and objectives for each of the models and the projects were started at three month intervals.

Invasive Cardiology

Began in July 1996, the purpose of this model was to test the number of prep/recovery beds needed. Prep/Recovery is an area where patients check in, have IV’s started and receive pre-catheterization medication. Following their procedure, the patients return to this area to recover for a period of time that ranges from one to six hours.

Simulation showed that eight fewer prep/recovery beds were needed and the resulting savings in space allowed for an additional cath lab to be built in this complex rather than in a separate building as originally planned.

Estimated savings are of $650,000 in operational costs over the life of the building, $100,000 in capital construction costs and $50,000 in equipment costs.

Perioperative Services 

Perioperative Services is responsible for the outpatient pre and post operatively. This renovation plan involved a structure that was only three years old. The original structure had never worked well, and the manager was taking this opportunity to change both the facility and the patient care process. 

The simulation model resulted in improvement in the proposed patient flow, redesign of one portion of the facility resulting in $60,000 savings in construction costs, assurance that the proposed patient flow would work and that room capacity was sufficient.

Imaging Services

The Imaging Department was out of space and the radiology experience for the patient was not consistent with the hospital’s goals. Waiting times were long, the waiting areas were overcrowded and outpatients and inpatients mingled in the same treatment areas. Other facility renovation plans meant that the department would be absorbing additional outpatients from another on-campus site which was scheduled for demolition.

A $5,000,000 renovation plan was developed which would provide for separation of the inpatient and outpatient population while improving care for both. The simulation models demonstrated that the new facility would be overcrowded from day one and there was no room for future growth. As a result, additional space was allocated and significant redesign of the department ensued.

Uncertainty regarding the required number of antepartum and postpartum beds initiated this simulation project. A whole new tower building of Women’s and Children’s Services was on the drawing board, with many beds designated as multipurpose - e.g. postpartum or pediatric. Large fluctuations in volumes of both services mandated that “dedicated” beds would be an inefficient use of space.

The model was used to predict bed requirements at current and predicted volumes. The impact of HealthCare legislation on patient length of stay and hospitalization rates was also tested in this model.


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