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Research in Action by the Jersey Shore
Jersey Shore University Medical Center’s $300 million expansion and renovation project developed more than just the size and shape of the facility. It improved access, added sustainability components, and incorporated the latest thinking in evidence-based design into the project.
The Neptune, New Jersey-based Medical Center, designed by WHR Architects, includes a state-of-the-art diagnostic and treatment building offers the latest in diagnostic technology, surgical suites, a 144-bed patient care pavilion, a 12-bed intensive care unit for cardiac patients, an emergency department, and a Level I trauma center able treat more than 100,000 patients a year. The total project is comprised of 433,400 sq.ft. of new construction and renovations to existing buildings. At the center of the project is a four-story atrium.
Improved Access
Key to the expansion was a reorientation of the campus to improve access and accommodate future growth. JSUMC now comprises three distinct zones — an in-patient zone, a diagnostic and treatment zone encompassing the ER/trauma, and an outpatient services. A north-south concourse runs like a spine connecting the expansion to the existing hospital.
The in-patient zone includes the new four-story, 213,000 sq.ft. Northwest Pavilion, with an additional 108 private beds laid out in nursing neighborhoods. The diagnostic and treatment zone, centered in the new three-story Diagnostic and Treatment Building, 109,000 sq.ft., includes six surgical suites, catheterization labs, the pharmacy and imaging services. Outpatient services are now grouped in one zone, rather than being scattered throughout the hospital.
Exterior navigation is easier as well. A new, access loop road connects all areas of the hospital and new signage allows visitors to easily find their way around. The main entrance no longer faces Route 33; it has been relocated to the two-story atrium lobby on the west side of the hospital.
Visitors have access to the second floor of the new 966-car parking garage on site, along with several new parking lots. Visitor and emergency room parking lots are located on the north-west side of the hospital campus, while parking for outpatients is located on the east side of the campus. Valet parking is available at each of these entrances.
Sustainability Focus
Emphasizing the health of the planet as well as the local community, Jersey Shore University Medical Center's (JSUMC) administrators decided to focus on greening the facility. Then they realized the facility could pursue LEED certification through the U.S. Green Building Council (USGBC).
The process started with energy efficiency. JSUMC installed two gas-fired co-generation units to convert on-site waste into steam heat, which have resulted in a 32% reduction in energy costs. And the administration to support employees who wanted to save energy. Specifically, the building offers secure storage for bicycles as well as showers and changing facilities for bicycle riders.
Even the building process itself was green. Designers specified approximately 10% recycled content. Indeed, Recycled material accounted for $6.5 million in the project.
The hospital has also implemented a continuous measurement and verification plan to ensure that all the energy efficiency strategies remain realized throughout the building’s lifetime. After the building opens and the LEED certification is awarded, this plan will help the building remain properly calibrated and efficient.
Beyond energy efficiency, Jersey Shore emphasizes water efficiency and fresh air. When it comes to water, the designers have used low-flow products in sinks, showers, and urinals whenever practical, without sparking complaints about insufficient water pressure. As a result, water use has dropped by 30% or approximately 3,600 gallons per day - or 1,314,000 gallons a year.
Bringing outdoor or fresh air into the hospital through mechanical systems was a top priority. While it is cheaper to re-circulate the air, fresh air is healthier, cleaner, and helps reduce nosocomial infections. These days, the hospital uses 100% outdoor air.
The Sheward Partnership, LLC, an architecture and sustainability consulting firm based in Philadelphia, managed certification of the project.
Incorporating Evidence-Based Design
 JSUMC worked with WHR Architects, Inc. to use the best evidence from well-designed research studies to inform design decisions. The project was designated as a "Pebble Project," a partnership between The Center for Health Design and healthcare organizations throughout the United States committed to evidence-based design.
The facility uses all private patient rooms, which are associated with a decrease in infection rate, medication errors, and dietary mix-ups. All private rooms are also associated with an increase in staff efficiency and confidential patient interactions with providers as well as a decrease in length of stay, transfer rates, and patient stress. Some studies also indicate that all private rooms are linked with the reduced use of pain medication.
These private rooms encompass family/visitor space, which is known to decrease patient falls and stress while boosting social support and positive outcomes. In addition, the rooms contain 12-foot-high windows, which add daylight and views of nature; these amenities correlate with enhanced staff and patient satisfaction.
The patient rooms have a uniform set-up, which increases patient safety, facilitates access to medical equipment and supplies, and decreases potential costly errors. Having a sink in the patient room within the clinician’s circulation path improves compliance with hand washing. Having in-room patient electronic medical records is known to improve patient safety by offering immediate access to patient information and ease of care delivery.
And the design of the toilet and bed make it easier for clinicians to monitor and care for patients while also cutting travel distances and improving staff efficiency. When patients see that their caregivers reach them quickly and easily, it makes them feel a greater sense of comfort.
Nor are the patient rooms the only spaces designed with efficiency in mind. The building’s rapid vertical circulation facilitates the relationship among nursing units, emergency/trauma, surgery, and decentralized support such as pharmacy and imaging. These considerations increase the efficiency of the care delivery process.
As extensive as the innovations in this space, this is not the end of the story for Jersey Shore University Medical Center. “One of the biggest challenges in designing the expansion was to keep in mind a footprint for the future," said Tushar Gupta the lead designer for Jersey Shore University Medical Center's expansion project. "We had to not just put up a building, but also allow for expansion. The medical center has a long-range master plan and this is the first phase of that plan."
Meeting Nurses’ Needs
To improve the patient experience, JSUMC focused on enhancing the facility for healthcare professionals who provide the care.
The administrators started with a team of medical, nursing, and other healthcare professionals. Their goal: to create a nursing environment that would be conducive to the delivery of the most competent, effective, and collaborative patient care.
The team recognized that there were two critical perspectives to bear in mind: that of the patient and that of the nursing staff. They knew baby boomers would be more demanding than previous generations. As this cohort has begun to turn sixty, they are already seeking higher levels of care, greater transparency and, at the same time, more privacy. The nursing workforce is aging, too, creating greater need for thoughtfully planned nursing stations that will help to maximize clinical expertise by placing all the essential tools and technology within easy reach.
Once the team was assembled, the next step was research, starting with a review of nursing literature. Then the team did a benchmarking tour of other facilities. While they saw many models that did not measure up, the nursing stations at Memorial Hermann Healthcare System’s hospital in The Woodlands, Texas intrigued them. The team was struck by the in-patient design, which encompassed sets of six-bed areas. This hospital gave them a way to begin rethinking the model of the Jersey Shore facility.
On-going dialogue with the nursing staff and other key healthcare staff kept the focus on the priorities: patient safety, support of the nursing staff, and advancement of the academic mission. What evolved was a model that supports “controlled decentralization” by giving everyone enough room to perform at peak and brings nurses closer to the patient.
The inpatient floors, consisting of 36 beds, were organized into three nursing neighborhoods with 12 single beds, providing flexibility for staff. Even the smallest unit is not isolated; as the nurses requested, there is “no bad neighborhood.” Each neighborhood is a self-sufficient unit that minimizes walking distances for the nurses. The nursing stations feature a central station as well as four decentralized work areas outside the patient rooms for charting, consultation, and discussion. Decentralized supply rooms and closets for soiled linens keep the halls free from clutter.
At the circular central station, ample workspace for eight nurses promotes socialization, yet can readily accommodate up to 15 people when required for research or teaching. Also conveniently located at the central station is a pneumatic tube that allows for rapid delivery of specimens to the central lab. Flat screen, wireless computers at each station allow direct access to both the internal information system and the Internet.
To “road test” the new model, JSUMC built a 12,000 sq.ft., drywall mock-up of the nursing station and several patient rooms, as well as the ICU, adult and pediatric exam rooms in the emergency department, the operating room, and pre-and post-op recovery rooms, in an old grocery store near the site. To encourage the staff to engage with the planning process and to get “real time” feedback on the proposed design, the JSUMC team planned a celebration, a milestone in the design process, at the mockup site. Over several weeks about 700 professional staff visited the room and made suggestions. The WHR design team also had the opportunity to observe the new model at full scale.
As a result of staff comments, dozens of details were revised, among them: reversing the swing on the bathroom doors to allow for better access; relocating the pneumatic tube to the clinical side of the nurses’ stations; moving the alcohol dispenser from the sink area to the entrance of the room; and adding hooks in the bathrooms to accommodate IVs, enema bags, robes, at the nursing station for IV priming, and in the ED patient rooms for patient clothing. An important change made by the design team changed the location of the sink in the patient room, rotating it on a 45-degree angle so the medical staff never completely turn their backs on the patient.
One of the busiest medical centers in the state, Jersey Shore has experienced an average growth in patient volume four times the state average. Also, as a university medical center affiliate of UMDNJ-Robert Wood Johnson Medical School, Jersey Shore is home to extensive teaching and research programs, which include several medical and surgical residency and fellowship programs for physicians, advanced education opportunities for nurses, clinical trials, and academic research projects.
JSUMC’s new nursing neighborhoods and the innovative care model they support respond directly to the positive pressures of the hospital’s growth and success. As Jersey Shore president Steve Littleson says, “This project is about growth, but also about improving upon the whole patient experience, which we will accomplish through evidenced based design, advanced technology, and incredible customer service.”
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