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Concentrating on Kids
The new Children’s Hospital constitutes a milestone in Yale’s long commitment to treating the ailments of the young.
February 1993
by Bruce Fellman
In 1813, when Yale’s Dr. Eli Ives
delivered the first lectures on pediatrics ever given at a medical school, taking care of a sick child in New Haven involved little more than a house call
by the doctor. In serious cases, that might be followed by a visit to his
apothecary shop for a dose of herbal medicine concocted from plants Ives grew
in his garden.
One hundred and eighty years later,pediatric care in New Haven is not so simple. On any given day at Yale–New Haven Hospital (YNHH)—whose forerunner Ives and his colleagues helped start
in 1826—children and parents in need of even basic treatment are forced to
navigate a maze of confusing corridors and widely scattered services in what
has become a sprawling medical complex. The physical and bureaucratic obstacles
have been compounded by the growth in the number of the city’s poor, the easy
availability of guns, and the spread of drug-related ailments and aids. A
visit to the hospital’s emergency room can sometimes evoke images of a war
zone.
While taking a child to the hospital is never likely to be
a happy experience, it will soon become decidedly easier. This summer, YNHH
will open a 221-bed Children’s Hospital adjacent to the present main building.
The 11-story, 450,000-square-foot structure—the biggest by far in the hospital
complex—is physical proof of the growing importance of—and commitment
to—pediatrics at Yale.
The new building, designed by the
Boston architecture firm of Shepley, Bulfinch, Richardson, and Abbott as the
centerpiece of YNHH’s $156-million Facilities Renewal Project, is intended to
consolidate the previously dispersed pediatric operations and “provide more
effective services uniquely directed to children,” says Dr. Joseph B. Warshaw,
a neonatologist and chairman of pediatrics at both YNHH and the Yale School of
Medicine.
New Haven mayor John C. Daniels is
ecstatic about the newest addition to the city skyline. The facility will be
“nothing less than extraordinary,” says Daniels. “Imagine: This hospital will
be the exclusive province of kids. It seeks to offer the most comprehensive
medical treatment in the region, and also sees to patients’ and parents’ needs
by providing that care in a soothing, pleasant, and fun environment.”
Under one roof, there will be plenty
of room for routine treatments: setting broken bones, stitching cuts, and
curing run-of-the-mill childhood ailments. There will also be clinics for such
pediatric specialties as adolescent medicine, endocrinology, hematology,
oncology, and respiratory medicine. In addition, there will be facilities found
in few other places in the country: a heart-lung transplant unit, the renowned
newborn intensive care unit (YAM, March, 1991), and a fetal cardiovascular center.
When the hospital opens, infants,
youngsters, and adolescents will have their own emergency room, thus
eliminating the often nightmarish gauntlet they now have to run. Mothers will
have a new and striking place to deliver their babies, one with a stunning view
of the Connecticut coast, the New Haven skyline, and the surrounding hills. And
with almost all pediatric services—everything from prenatal testing to
adolescent psychosocial counseling—in the same building, Warshaw hopes to
prevent a condition all too common at the moment. “Children can get lost in a
giant institution,” he says, “and a sense of isolation can terrorize them. But
when we’re done, parents will be able to accompany their children almost to the
operating room, and they can be there when they wake up.”
This consolidation means more than
just efficiency and convenience for young patients and health-care providers.
“Bringing everything together creates both a style and an expectation that is
more positive in terms of child health than it can be with everything spread
out,” says Warshaw. “The children’s hospital concept focuses on the unique
aspects of youngsters, from their need to have their parents in the recovery
room to having someone in food services who recognizes that children don’t like
green things and boiled chicken. It’s simply a better idea.”
Warshaw came to this conclusion in
the 1980s during a stint in Dallas as head of pediatrics at the University of Texas
Health Science Center. In 1987, the prospect of establishing a new facility in
New Haven lured him back to Yale, where he had worked as a physician and
teacher. He returned preaching the gospel of a freestanding children’s
facility, and he found a receptive audience.
But pediatrics alone was not the
original driving force behind the building program. “Our primary need was
space,” explains Marna P. Borgstrom, senior vice president for administration
at YNHH and the project’s overall director. “We’ve had an increased demand
for services, and the space we had was ineffective. We knew we had to build
more rooms.”
Borgstrom notes that as medicine has
moved towards more ambulatory care and one-day surgery, the nature of today’s
hospital patients has changed dramatically. “The patients who stay for an
extended period of time are sicker, particularly in university teaching
hospitals,” she says.
Caring for such patients requires
more equipment and more staff, and in parts of the hospital
complex—particularly the aging Memorial Unit with its three- and four-bed
units—the space crunch was frequently overwhelming. Accommodating monitors,
infusion pumps, and the rest of modern medical machinery in rooms designed for
a less technical era posed a formidable challenge. Moreover, the facility
afforded minimal privacy, and was difficult to disinfect.
In 1987, Borgstrom and hospital
officials began weighing options for dealing with the problems, and a year
later the group decided that everyone’s needs would be served best by building
a new facility focused on children. “We figured that they’d benefit by having
that care in one place where the staff, equipment, and environment were
dedicated to their needs,” she says.
The state of Connecticut agreed. In
August 1990, it approved the YNHH “certificate of need” after hearings that,
ironically enough, took place at the same time the Commission on Hospitals
and Health Care was already reviewing a proposal to create an upstate
children’s hospital by merging the pediatric facilities of the Newington and
Hartford hospitals. That certificate has also been approved, but Borgstrom says
there is little chance of a competition for sick youngsters. There, are,
unfortunately, more than enough to go around.
Indeed, in 1991 there were 4,329
pediatric inpatients at YNHH, 5,165 births, and more than 50,000 visits by
children to the emergency room and the specialty clinics. Many of the
hospital’s young patients came from the local area; others were referred from
all over the country and from many foreign countries.
Children will not be the only
beneficiaries of the massive construction project. “The new Children’s Hospital
has been, and will continue to be, a boon to New Haven’s economy by providing
jobs,” says Mayor Daniels.
The hospital complex itself will
also benefit from the addition. Although pediatrics focuses on the young, it
encompasses almost every medical subspecialty. “Enhancing what we do for kids
indirectly enhances everything else we do,” says Borgstrom. “And once we move,
we plan to refurbish much of the area in the old buildings that we’ve been
using for pediatrics and related services like obstetrics and gynecology and
convert it to other purposes.”
For instance, the labor and delivery
rooms, along with the newborn special-care unit, are currently located on the
third floor of the Memorial Building. Moving these, along with the maternal
special-care unit on the fourth floor, into the Children’s Hospital will free
up space to expand such programs as ambulatory surgery, which is desperately in
need of room.
As part of the overall facilities
renewal project, YNHH plans by 1995 to eliminate all of its three- and
four-bed rooms, replacing them with the singles and doubles that are more in
keeping with modern medical requirements. There will also be larger cafeterias,
along with a bigger—and much more inviting—main entrance.
Although the new building was
envisioned as a kind of children’s refuge, officials didn’t, for reasons of
philosophy and economy, want it to be isolated from the existing hospital
complex. The pediatric staff, after all, needed to feel that it was a part of
the larger YNHH medical community, and as Borgstrom points out, “bricks and
mortar are among the cheapest forms of expansion—the cost of operating a
facility year after year is one of the most important factors that drive up the
price of health care.” Linking buildings and sharing expensive operating
systems can significantly lower those costs.
All of these requirements—getting
the kids out of the hurly-burly of the hospital’s mainstream operations,
creating more single rooms, and joining the older hospital buildings with the
Children’s Hospital—presented an intriguing challenge to architect Lloyd Acton
and his team at Shepley, Bulfinch, Richardson, and Abbott. Acton has been
designing hospitals for more than 30 years, and he’s particularly excited about
the New Haven project. He designed the exterior—a combination of smooth and
aggregate pre-cast concrete panels—to create a visual link with the brick and
tile of the existing buildings. A more direct link is provided by the atrium,
which Acton calls the “philosophical heart of the hospital complex.” The
square, 45-foot-high space, which measures 90 feet on each side and is topped
by a skylight, will connect all three buildings while providing an eating and
meeting place for patients, staff, and visitors. Embellished with trees and a
fountain, what Acton terms the “crossroads of the hospital” promises to be one
of the most inviting interior spaces in the city of New Haven.
Acton is particularly proud of his
design for the patient sections of the Children’s Hospital. Working with what
he calls the “clustered-neighborhood concept,” he grouped between eight and ten
private rooms in clover-leaf fashion around a central nursing station.
According to Acton, who pioneered the design in several other hospitals,
including the new Dartmouth–Mary Hitchcock Medical Center in Hanover, New
Hampshire, the “neighborhoods” will function “almost like small, intensive care
units.”
Hospital planners and staff liked
Acton’s new idea for a number of reasons. The single bedrooms allow maximum
flexibility in assigning space, and there is ample room for equipment. Many of
the rooms have eccentric shapes, an arrangement patients in other hospitals
have found refreshingly noninstitutional. The “pods,” as the units have come to
be called, have other important advantages. “Patients can always see—and be
seen by—their caregivers, so they don’t feel as isolated,” explains Karen Camp,
associate clinical professor of medical and surgical nursing and head of the
surgical nursing unit at YNHH.
Although the pod system had been
used elsewhere, it underwent intense review before it was approved for the
YNHH project. “Early on, we formed user groups,” says Camp. “Everyone got
involved to help make Acton’s dreams a workable reality.”
That kind of involvement paid off in
other aspects of the project as well. Harold Mindell, administrative director
of the Facilities Renewal Project, oversaw the construction of the hospital’s
1982 facility, and the process, he admits, had problems. “There wasn’t adequate
user involvement early on,” he says. “I insisted on it this time around, and
not just with the department chiefs.”
This sense of collaboration
impressed Rosalyn Cama, whose New Haven–based firm, Interior Design
Associates, Inc., is responsible for making the inside of Acton’s building a
comfortable, and comforting, place to be. Not only did she, like Acton, spend
considerable time talking to virtually everyone at the hospital from doctors
and nurses to cooks and custodians, but last winter she and a group of
manufacturers’ representatives actually crafted a partial Children’s Hospital
mock-up in a warehouse on nearby Daggett Street. “It was a monumental effort,”
she explains.
Lounge chairs, waiting-room
furniture, examination equipment, even a cafeteria—YNHH staffers got a chance
to test a variety of options and choose what worked best. “We tried to
complement the architecture, as well as the needs of the end users,” notes Cama
about the collaboration. “But equally important, we’re also trying to create a
personality and an environment that address the mission of the hospital.”
In a children’s hospital the
assignment is more difficult than it might seem. Too much Disney turns off
teenagers, and whatever turns on teens is often inappropriate for preschoolers.
Since Mickey Mouse and MTV don’t mix, Cama and her staff decided on an abstract
color scheme of perky yellows, reds, blackberry blues, and teal greens to
lighten the atmosphere throughout the building and pick up on the colorful
toys, posters and get-well cards that inevitably accompany kids to the
hospital.
Wherever possible, the designers
created spaces that emphasize health education, but in the pediatric entrance,
the theme was less didactic. The walls will be decorated with a series of
photographs that conjure up the Connecticut countryside as seen through a
train window; linking the lobby and the waiting rooms will be a wall-mounted
Lucite track carrying a model train.
The money for this ambitious project
comes from a number of sources, including the sale of tax-exempt bonds and
YNHH cash reserves. Individuals and corporations have also responded, in part
because of the work of the “Friends of Yale Pediatrics.” Founded three years
ago by Warshaw and a handful of like-minded citizens, the Friends are an
outreach group dedicated to creating “a safe and healthy world for our
children.” Now 450 strong and growing, the group helps raise both money for the
hospital project and community awareness about such problems as infant
mortality, pediatric aids, the widespread lack of basic immunizations, child
abuse, and the limited access to medical care for New Haven’s poor. The Friends
are now focusing on lead poisoning.
That kind of involvement in the
community makes sense for the hospital at several levels. As Warshaw points
out: “It’s cost effective—we give away nearly $3 million in care a year, and
much of that money goes to treat sick kids who, if they’d had adequate health
care in the first place, wouldn’t need to be here. Take lead, for instance.
It’s the most preventable cause of mental retardation in America. We have kids
here because they didn’t get their shots. There are mothers who don’t get
prenatal care. By collaborating with a group like the Friends, the new
Children’s Hospital can become a focal point, not just for treatment, but for
prevention.”
It’s not exactly house-call
medicine, but Eli Ives probably would have approved.  |
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