In anticipation of a possible facility remodel, the Cook County North Shore Hospital & Care Center board toured the facility June 20 and July 18 in order to understand the needs as seen by staff and administration.
The care center
The care center is a really good place, said Resident Care Coordinator Mark Abrahamson, but improvements could be made to make it more functional. For example, the noise level in the room where meals are served is difficult for some patients. Visitors have a hard time knowing where to go for direction and help when they enter the care center. Nursing staff cannot be with patients when they are making notes on patient charts.
A “neighborhood” concept in which residents would be cared for in small groups by the same caregivers cross-trained to perform multiple tasks would work much better, Abrahamson said.
A smaller, more personal environment would be more peaceful, especially for residents with dementia, Abrahamson said. Residents could use places to sit quietly and visit with family, since most of them share a room.
A neighborhood concept would likely include medication lock boxes outside residents’ rooms or portable medication stations and laptop computers, Abrahamson said, allowing nursing staff to be out on the floor with residents more of the time.
A secure outdoor space for dementia patients would also be nice, Abrahamson said. “It really satisfies something for people to be able to go in and out and not feel locked in.”
The facility has a lot of wasted space in hallways and unused anterooms between hallways and bedrooms. Abrahamson said many of the rooms are lacking sufficient natural light.
Some bathrooms are shared by as many as four residents. When one person is using the shower, three others can’t use the bathroom.
Individual rooms do not have air conditioning and when a window is opened, the building’s air exchange system does not work properly.
The care center has some really positive elements as well, Abrahamson said, such as a “wellness room” for aromatherapy and hand massage and a hair salon. Wellness room therapies and hair care are a couple of the most calming things offered at the care center, Abrahamson said. Artwork is displayed in hallways throughout the care center.
“You’ll notice – does this space smell good?” Abrahamson said. “We smell good.” He said they are proud of the fact that the facility smells clean and pleasant.
Outside, the number of raised garden beds has been growing. Being able to nurture plants has meant a lot to the residents, said Charlie Butter of the maintenance department, who has been in charge of the project. Residents, staff, and visitors have all embraced the gardens enthusiastically. “The response has been really kind of overwhelming,” Butter said.
Administrator Wraalstad said she wants to make sure green space is included as the facility is remodeled.
“The community involvement up here is incredible,” Abrahamson said. While improvements would be nice, he said, “we love where we work, and we work with what we’ve got.”
The last time the facility was remodeled, staff ideas were not included in the design. This time, their suggestions are being sought, Abrahamson said, and that will make a big difference.
The ER
Hospital Nursing Director Bridget Sobieck gave the board a tour of the emergency room. People arriving have a hard time knowing where to check in, and after hours the staff has difficulty seeing people waiting at the door.
While having the lab and radiology near the ER is good, the fact that one public hallway leads to and from the ER is not good, Sobieck said.
When the hospital is dealing with multiple traumas, family members, staff, and patients being wheeled around all mingle in the hallway, and family members outside the ER tend to wait in the hallway rather than the waiting room. The ER consultation room fits only about three people.
Lack of privacy inside the ER is an issue as well. With three patient beds in the room, conversations cannot be held confidentially, and patients being transported to a hospital room must be wheeled past the reception area.
The hospital
Like the care center, the hospital also has a lot of wasted hallway space and is like a labyrinth, a result of additions that took place over the course of time.
Two of the hospital’s rooms are used as private rooms. Medical issues such as contagiousness sometimes require a patient to be moved out of a room in the middle of the night to make way for an incoming patient.
Double rooms share a TV and remote control, and the patient furthest from the bathroom must maneuver around his or her roommate’s bed and bed curtain to reach the bathroom, which may share a shower with the room next door. Some of the showers are small, making it difficult for nurses to assist patients who need help. In some rooms, patients cannot see out the window or turn lights on and off from their beds.
The swing bed rooms, which need recliners for patients doing rehab, sometimes become crowded and difficult to move around in.
A maze of rooms inside the center of the complex is used by hospital staff, including a room for equipment to be sterilized, rooms for staff to sleep and shower, and a sterile processing room where tissue and eye recoveries for transplants can be done by a team of specialists who fly up here.
Remodeling
Hospital infrastructure needs continue to change as health care evolves. Rooms for developing X-rays and storing paper files are no longer needed. New facilities are being built with flexibility for future needs in mind.
Charlie Butter suggested that if the facility is remodeled, extra parts for things like plumbing fixtures be purchased, because parts are usually only available for eight to 10 years. If something breaks after that and replacement parts are not available, a whole new fixture must be purchased.
Butter pointed out that the current boilers are not very energy efficient and cannot be flushed out adequately. Keeping air temperatures even is a continual problem throughout the facility. The steam pipes for the HVAC system are rotting and lose 200-220 gallons of water a day.
Nurse Sobieck said she thinks chemotherapy could be a good source of revenue for the hospital. The hospital stopped offering chemo because it did not have a proper hood. “That would be something I’d like to see us provide,” Sobieck said. “It would be a good community service as well.”
A new hospital configuration could also include a centralized reception area where people could enter the hospital and find staff and directions to the patient rooms, ER, lab, radiology, cardiac rehab, and physical therapy. Ideally, the hospital would have separate spaces and corridors for patients, staff, and visitors.
At the end of the tour, board member Tom Spence wondered if starting over with a new facility on an empty piece of land might be easier.
“Things change. Uses change. Needs change. Technologies change,” Administrator Kimber Wraalstad said. “The one thing you can count on in health care is change.”
In August,M nnesotathe hospital board will discuss potential funding options for remodeling the facility.
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