Stem-cell therapy is often the only line of defence for many who are diagnosed with blood-related cancers like lymphoma, leukemia and other hematological disorders. Hamilton’s Juravinski Hospital received funding to expand its stem-cell therapy unit to a 30,000 SF facility, featuring 15 additional in-patient beds, as well as out-patient clinics and a pharmacy expansion. Parkin’s Evidence-based Design Accredited and Certification (EDAC) team developed a design that positively supports therapy and healing.
Cancer care facilities must accommodate a complex spectrum of needs for patients and their loved ones, as well as staff, researchers, doctor, and caretakers. For example, while many stem-cell therapy patients are cared for on an out-patient basis only, immunocompromised patients may need to spend months in positive pressure rooms―isolation rooms that reduce the risk of airborne transmission of infection. EBD informed our design of in-patient bedrooms and lounge areas in the new stem-cell therapy unit in creating a healing environment that reduces stress and provides patient- and family-centred care.
The EDAC team completed a review of the latest CSA standards, in which designs for in-patient rooms are referenced as isolation rooms with an anteroom format. While the standard is functionally sound, it doesn’t offer adequate support for longer-term patient care, since it’s difficult to maintain direct observation through multiple rooms and screens. To tackle this problem, the team surveyed similar facilities throughout North America to determine the most effective unit configuration. That research influenced the final design concept of the Juravinski stem-cell unit; it offers a more regular room setup―with pressurization monitors and full glazing, along with a specific patient bed orientation―that provides improved direct monitoring of patients from bedroom entrances.
The purpose of the design is to balance patient comfort with the need to maintain a sterile environment for immunocompromised patients who may need to stay in isolation for up to 100 days. The early design development included consultation with former patients who provided input as to what they found stressful during their treatment, and what measures could improve the treatment experience. Patients requested practical elements that could help reduce stress, as well as in-room mini-fridges for storing home-cooked meals, and remote control of lighting and blinds from the bed. Many patients also prefer to have access to reliable WIFI service rather than cable, so they can use their own devices.
The patient consultation provided the team with a list of typical stressors such as:
- Light pollution from corridors and outside sources;
- Sound from the movement of equipment, conversations in corridors, equipment monitoring, alarms and paging;
- Sense of smell being affected during treatment by medications or as a result of chemotherapy, or odours from soiled rooms and nutrition prep areas;
- Staff checking patients during nighttime, which can be disruptive to sleep with doors opening, switching on lights, sound infiltration from corridors; and
- Isolation and boredom for patients with longer-term admissions.
Based on these consultations the design includes elements that strive to address common stressors. Rubber flooring is integrated throughout the facility, which not only increases staff comfort but also adds sound absorption properties. Patient bedroom vestibules serve as buffer spaces from the noise of corridor traffic. The vestibules also provide a space where visitors can don gowns and other personal protective equipment that prevent transmission of infectious agents to immunocompromised patients. In addition, the in-patient unit corridors use valance lighting, which diffuses light to provide softer light levels.
To reduce clutter and obstacles, bedroom layouts include dedicated spaces for portable dialysis and IV equipment. The rooms also feature built-in cabinets and shelving to provide ample storage for belongings for longer stays. All bedrooms are equipped with patient lifts to provide improved patient and staff safety. Bedroom hand-wash sinks are sized to accommodate thawing of frozen stem-cells required for treatment. A full mock-up of a patient bedroom was constructed on-site to allow staff to test-fit equipment and clearances, and for patient advocates to review.
The facility features family waiting rooms that contain seating, kitchenettes and dining areas that furnish spaces where patients and families can enjoy meals together, and where patients can experience positive distraction. To this end, graphic murals and artwork create a welcoming and healing environment.