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Deep immersion in design yields a new, clinician-informed, “future-proof” hospital at Penn Medicine.
The concept of hospitals as pavilions of fresh air, light, and vistas has its origin in the far-sighted exemplar of Florence Nightingale, whose 1863 Notes on Hospitals urges attention to natural light, air, space and cleanliness.
Emphasizing function over form, Nightingale’s pavilion concept was the principal design for hospitals for a century—until, eventually, hospital design evolved into other configurations where healthcare providers’ needs ceded to administrative practicality or to accommodate technical innovations.
In the wake of rising workloads and the mounting complexity of medical practice—particularly in the post-pandemic world—this constitutes a crisis in healthcare.
And while the COVID-19 pandemic has brought many things, it’s shown that the healthcare industry must be ready to rapidly adapt to emerging needs and threats, and quietly anticipate the need to host an array of new technologies and workflows at a moment’s notice.
Thus, the Pavilion, Penn Medicine’s innovative, 1.6 billion dollar new hospital in West Philadelphia, is a revelatory—and a revolutionary—conception of the future of hospital practice.
A Hospital Designed Through Clinician Simulation
The new 17-story facility, which includes 504 private patient rooms and 47 operating rooms, features a number of exciting design innovations in its clinical spaces.
Through a collaborative process with the clinical and support staff who provide day-to-day patient care, the hospital was carefully conceptualized and meticulously designed to be “future-proof”—with features like modular wall panels in patient rooms that can continuously adapt to changing needs and medical technologies for years to come.
Before a single brick for the Pavilion was laid, Penn Medicine’s building design team invited hundreds of Penn clinicians to simulate daily work activities—both routine and high stakes scenarios—and workflows in a 30,000-foot, life-sized 3D mockup in a North Philadelphia warehouse. The goal was to solicit feedback, and make sure that the hospital’s final design would ensure the best care for patients.
From this experience, the clinical staff yielded qualitative and quantitative data for the building team and identified armfuls of opportunities for design modification—from the location and size of elevators for patient transport, to the thoughtful positioning of restrooms in patient rooms.
In addition to clinician-informed design, the building hosts an impressive number of on-site research labs to provide patients with a true “bench-to-bedside” care model.
Reinventing the Emergency Room
Starting October 30, the HUP Emergency Department (ED) will be officially move to the Pavilion’s state-of-the-art Emergency Department facilities.
The new physician-in-triage model, which was first rolled out at HUP in 2019, starts immediately—right after the patient is registered—allowing the triage physician to swiftly assess the patient, and order tests and medication.
“Wait time is being used is more productively,” said Keith Hemmert, MD, director of Operations for Emergency Medicine. “While the patient is waiting, diagnostic tests such as labs and imaging are underway.”
“The first changes prioritize getting ED patients to see a physician within 30 minutes of arrival,” continued Hemmert.
Striving to exceed the standards outlined by the Society of Academic Emergency Medicine, the new ED will feature a “physician-in-triage” system and the use of a “vertical care” model to ensure that patients see a physician in less than 30 minutes from when they enter the hospital, and to avoid as many “walkaways” (people who enter then leave without being seen) as possible.
Space and resources are more efficiently used, too.
The implementation of a “vertical care” model means that a sicker patient may require an exam room for their entire stay, but that a less acutely ill patient can wait safely and comfortably in a chair after they have seen the triaging physician. Or be fast-tracked to a different part of the hospital, like a “Forward Flow” area, while they await their test results.
Epilepsy Monitoring Unit (EMU) and Human Neurophysiology Research Laboratory
Some of the new neuro-technologies sound like they are straight out of science fiction.
Doubling the capacity of the current Epilepsy Monitoring Unit at the Hospital of the University of Pennsylvania, the Pavilion’s new unit will also host an exciting addition: A Human Neurophysiology Research Laboratory.
This new, dedicated lab space is specifically set for investigators to work directly with patients, and includes state-of-the-art neuromonitoring technology.
“Before, it was going to be a beautiful state-of-art epilepsy monitoring unit, as good as any in the U.S.—but we asked the team and they agreed to add on additional space, dedicated for research,” said Daniel Yoshor, MD, chair of Neurosurgery.
In addition to offering Penn researchers access to the best commercially available equipment, the new neurosciences research space will also function as a testing ground for clinical researchers to develop their own novel medical devices.
“We are delighted to be moving into a 21st century facility to practice 21st century neuroscience,” says Frances Jensen, MD, chair of Neurology.
“And with so many different subspecialties in our department, it allows us to do a lot of interdisciplinary work with great partners including neurosurgery and radiology.”
An Oncology ICU at Penn
A true rarity in the country, let alone the region, the Pavilion will feature a dedicated oncology intensive care unit (ICU).
“It will be adjacent to our inpatient oncology unit on the same floor, which is an added convenience for patients and their medical teams,” explains Lynn M. Schuchter, MD, chief of Hematology Oncology.
This convenient location allows the care teams to respond quickly to a patient experiencing serious side effects from medication or other therapies, and affords the clinical team access to transfer patients to the right level of care at the right time.
This reimagined approach to critical oncology patient management will be, as Dr. Schuchter described it, “transformative.”
Additionally, an exciting advancement is that patients in the Pavilion have expanded access to cellular therapies. Patients can be treated with personalized cell therapy products made “in-house” in a sophisticated manufacturing facility connected to the building—whether for treating cancer or for other diseases being studied at Penn.
Hybrid Operating Rooms
Pavilion providers have access to hybrid operating rooms—which include interoperative MRIs and other equipment for image-guided surgeries—allow surgeons and other providers to work together with more precision.
Another unique feature of the Pavilion’s “hybrid” operating rooms is that they were designed to include natural light. Sunlight flows through to the operating rooms from large windows along the hallways.
The operating rooms were strategically built with the clinical teams’ “future needs” top of mind, including modular wall panels that can be swapped out for installation of the latest technology.
As Penn anesthesiologist and Professor of Clinical Anesthesiology and Critical Care, John Keogh, MD, said, “We of course design hospitals for patients. But this is a hospital that was designed with the staff in mind, too.” He continued, “It’ll be exciting to walk in and work there.”
A Patient-Centric Experience
A number of major changes in the Pavilion’s design were exclusively tailored for the patient’s benefit—from the building team’s use of human experience mapping to make the building more accessible for a broad range of patients and visitors, to inpatient rooms designed specifically for a better night’s sleep.
Proudly at the helm of every patient room in the Pavilion sits IRIS, a 75-inch screen and smart board that allows patients to display info for caregivers and providers along with controlling room functions. All patient rooms are private, and the new, spacious room structure includes pullout beds for caregivers.
Additionally, a Family Caregiver Center will be set up in the Pavilion.
Currently, HUP has a Family Caregiver Center, one of only 22 hospitals in the country with a formal family caregiver facility.
“Caregivers need their own quiet space where they feel heard, supported, and engaged, and we are here to give them that,” explained Karen Anderson, MSN, RN, a clinical nurse specialist in patient and family-centered care who heads the Center’s volunteer program.