Building capacity for care in Medicine Hat

Hospital expansion to help residents access treatment close to home
Friday, October 19, 2018
By Michelle Ervin

Consider what a patient who is about to begin dialysis or chemotherapy might be going through, both emotionally and physically. Then add to that the prospect of having to drive three or more hours to access those treatments.

The more than 100,000 residents served by Medicine Hat Regional Hospital are less likely to face that prospect following the completion of a 245,000-square-foot expansion. The six-storey addition, officially opened this summer, increased the capacity of the healthcare facility’s cancer clinic and renal program, among other ambulatory care areas. The addition also introduced a rooftop helipad, expanded the central utility plant, and replaced the hospital’s medical devices reprocessing and surgery departments as well as its labour and delivery suites and neonatal intensive care unit.

Michael Stanford, executive director of capital management at Alberta Health Services, said the province has expanded both of its south regional hospitals — the other one is located in Lethbridge — to alleviate pressure on inpatient beds and speed up access to important outpatient services.

“Adding those outpatient treatment spaces to these programs allowed us to expand that capacity for care within the community,” said Stanford.

Without access to local treatment, patients might otherwise have to travel to tertiary hospitals in Calgary and Edmonton, he explained.

The $274-million redevelopment of Medicine Hat Regional Hospital, which includes an ongoing emergency department renovation, will help to ensure residents can get ambulatory and acute care close to home. The renewal project also emphasized the patient experience while accounting for advances in medical technology and changes in infection prevention and control standards.

Changing standards and technology

Advances in medical technology have introduced new equipment to accommodate and transformed procedures that once required overnight hospital stays into day surgeries. With this shift came a need for more space for ambulatory care, especially in light of the original 1950s-era building’s roots as an acute care-focused facility. The expansion not only brought together and increased the capacity of the cancer clinic and renal program, but also cardio-respiratory, maternal newborn and surgical services.

Increased demand for ambulatory care isn’t the only reason more space was needed at the site, which was last added onto in the 1980s. Greg Colucci, principal at Diamond Schmitt Architects, explained that current infection prevention and control standards prescribe greater square footage per program area.

“Any space where patients are going to be present has generally increased in area, relative to space allocated in the existing hospital, because evidence has shown that one of the best ways to prevent hospital acquired infections is simply to segregate or give more space between patients and isolate patients from soiled equipment,” said Colucci.

These principles can be seen in practice in the new addition at Medicine Hat Regional Hospital in provisions such as dedicated service elevators for clean and soiled supplies, private labour and delivery suites and reception areas that control access to clinical areas.

Patient care drives design

While conforming with infection control and prevention standards was an important part of the project, it was patient care that really drove the design, which was done in joint venture by Diamond Schmitt Architects and Gibbs Gage Architects.

Colucci observed that the notion of what a hospital should be has also changed considerably in the last few decades. Much more than clinical places to treat disease, illness and injury, designed around the work of doctors and nurses, healthcare facilities are now seen broadly as places of healing and well-being, he said.

“The essential here is not to compromise or diminish the importance of operational efficiency, but rather augment it by recognizing the place of the patient, his or her family members, friends, and the community generally,” said Colucci.

Consideration for these groups started at the front door. The addition expanded the footprint of the healthcare facility southward and eastward, providing an opportunity to create a new entrance that shelters visitors from the harsh elements during the winter.

The new entrance rises one-and-a-half storeys, mediating the difference in grade between the addition and the existing building, which share a spine.

The air intake for the existing building was located on the side where the work was set to occur, demanding measures to mitigate dust and exhaust as the hospital remained operational through the course of construction.

“As part of that, we stipulated that large diesel equipment require an air scrubber installed on the exhaust, for example, in order for any equipment to be permitted on site,” said Stanford.

Reflecting the local context

Colucci said masonry was used on the exterior to acknowledge the brick-making that occurred in Medicine Hat for so long and serve as a point of continuity with the existing building. Other materials, namely curtain wall and metal panel systems, were used to segment the sizeable addition in order to prevent it from imposing upon its low-rise residential surrounds, he said.

On the interior, small doses of green and orange — colours Colucci said were drawn from southern Alberta’s landscape — identify the east and west wings of the hospital, fading with each floor ascended. He said the only other hue, yellow, was used to highlight nursing stations in the otherwise bright, white interiors.

Natural light filters into the facility through clerestory windows, not only illuminating the series of atria that Colucci said give visitors visibility to where they’re going, but also reaching into some of the procedure rooms, where he said ceramic frit protects against solar gain and provides privacy.

“When the medical staff come out of surgery spaces, they actually have opportunities to see outside,” added Stephen Mahler, partner at Gibbs Gage Architects. “It’s not very often that you would see that in an OR suite.

“Often, you’re really thinking a lot about the patients and the families, but the caregivers are under a lot of stress as well.”

Recognizing the stress caregivers are under, the addition introduced a well-appointed outdoor space, giving staff a place to escape to that Mahler said was configured to offer a connection to nature and views to the river valley beyond. Visitors can similarly get some fresh air thanks to the provision of a neighbouring outdoor space that is open to the public.

Consideration for patients is even reflected in the rooftop, where a helipad caps the addition, making it possible to airlift patients directly to the hospital. Stanford said that before, patients transported by helicopter faced a 10-minute drive by ambulance from the airport.

Emergency department reno ongoing

With the expansion of Medicine Hat Regional Hospital now complete, work is underway on the renovation of its emergency department, which will increase its capacity to handle major traumas and thus help ensure residents can access life-saving treatment locally when minutes and seconds count.

Michelle Ervin is the editor of Canadian Facility Management & Design.

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