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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.

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.  the end

 
     
   
 
 
 
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