The Carson Tahoe Regional Medical Center was featured in the October 2006 issue of Health Facilities Management. Amy Eagle authored the story about Carson Tahoe Healthcare’s new hospital, designed by Moon Mayoras, which had its groundbreaking in November of 2003 and opened approximately two years later. The 358,000-square-foot facility encompasses a four-story building that provides expansive views of the surrounding valley. The published article reads as follows:
Most administrators, perhaps once in their lifetimes, will be part of a major replacement project of experience a major governance change. Ed Epperson, the president and CEO of Carson Tahoe Regional Medical Center (CTRMC), Carson City, Nev., has been part of both in recent years. The formerly public hospital, now a private nonprofit institution, has a new governing board, a spacious new campus and a new facility designed to support not only advanced technologies and innovative medical programs, but the people who use those services.
The hospital’s 144-bed replacement facility, which opened last December, was designed by David N. Moon, AIA, FACHA, and Douglas A. Mayoras, AIA, ACHA, principal architects with San Diego-based Moon Mayoras Architects, Inc. It was built by Hunt Construction Group of Phoenix. The hospital’s new 75-acre campus is more than 10 times the size of its previous 7-acre site, which it had occupied since 1949. The campus provides the medical center with increased visibility, ample parking, excellent views and, most critically, room to grow–an important factor for an organization that is clearly not afraid of change.
The hospital’s board had long intended to keep the facility at its original location. But in 1998, the medical center commissioned a masterplan that revealed it would cost upward of $90 million to renovate and expand the building on the existing site. “That really got the attention of the county,” says Epperson. The hospital was then a public entity, though it had always operated without taxpayer support. “[County government officials] weren’t too excited about being park of an eventual capitalization of $90 million that they would of course have to insure,” he says.
And even with that substantial outlay, the results would have been less than optimal. Over the years, the neighborhoods had grown up around the hospital. Epperson says, “We were eventually going to have two four-story parking garages in a little 40-year-old neighborhood. We were obviously going to get very vertical, very congested.”
In 2000, the hospital board made two significant decisions to rectify the situation. One was to privatize the organization, the other was to establish plans for a replacement facility.
Although it was challenging, the medical center’s governance change was essential to making the construction project affordable and feasible, Epperson says. This challenge was mitigated by the fact that the elected county board members moved onto the new, private nonprofit hospital’s board, in accordance with Nevada state statute. The hospital then added six new members to the board, which would not have been possible had it remained a public institute.
This was “the best of both worlds,” says Epperson. “Not only did we get the benefit of the continuity of the original five board members, we were also able to add rapidly the kind of expertise we needed. Even though it was a complicating factor, it was also helpful.”
The project team chose to position the new campus on the north side of Carson City, nearer most of the hospital’s competitors but within the city limits. “You want people to stay in your community and get their health care here,” says Epperson.
A further deciding factor in the location, he adds, “was just the pure beauty of the site.” The undeveloped site’s elevation and its views of the surrounding area, including the Sierra Nevada mountains, made it very attractive to the hospital’s board and administration. The fact that it bordered a golf course added to the site’s open and green appeal.
The golf course developer, a major supporter of the hospital, sold the group one of the main parcels of land that make up the site. Another parcel came from a home for handicapped children that is located adjacent to the hospital’s new campus. The children’s home had refrained from selling this land for several decades. Epperson says, “They were very particular about who their neighbor should be, and they saw us as ideal neighbors, as healthcare providers.” The supportive welcome the hospital received in the area was an added bonus to the site.
Bounded by nature
One of the site’s primary features is Eagle Creek, which winds through the hospital campus. The creek is a designated U.S. waterway; development is not allowed within 30 feet of either side of the water’s centerline. While this was somewhat of a limitation, architects Moon and Mayoras also saw it as a plus. “We thought it was a great opportunity to turn it into a design feature and part of the healing experience,” says Moon.
The architects created what they call a “front porch” for the hospital in the space between Eagle Creek and the main lobby and drop-off point at the facility. This outdoor seating area and walkway, which spans the 20-foot elevation difference between the creek and the hospital’s main floor, provides a place for the visitors to enjoy Carson City’s mild climate practically year-round.
“If you’ve ever waited for a family member for surgery–surgery can go on for hours. You want to be able to meander and experience different things,” says Mayoras. Walking paths also encircle three on-site retention ponds that are designed to protect the area from flooding, even in the event of a 100-year flood.
To orient the lobby windows toward Eagle Creek, the architects located the parking area off to the side of the main entrance, rather that placing the parking lot in front of the building. Positioned as it is, the building also shields the patio area from the noise of U.S. Highways 395, an elevated roadway that runs along the back of the hospital campus.
The creek’s protective status means that even as the hospital grows, the relationship between the lobby and the waterway will always be maintained. “It will never be sacrificed,” says Mayoras.
Just one element
The front porch is just one element of the building meant to improve the experience of patients and families at the hospital. The building’s circulation routes are designed to be straightforward and intuitive. The inherent simplicity not only makes the hospital easy to navigate, it helped lower construction costs, says Moon.
The 300-foot-long main lobby includes seven 30-foot alcoves where families can gain some privacy. The alcoves are arranged in a saw-tooth pattern along the south wall of the hospital.The saw-tooth design expands the surface area of the exterior glass, presenting views of the landscape in two directions. A rotunda on the third floor offers an even greater panorama–a 270-degree view of Eagle Valley and the Sierra Nevadas. As Mayoras puts it: “It doesn’t get much prettier than that.” The patient rooms, with windows that measure 5-feet, 7 inches high by 7 feet, 6 inches wide also provide grand views and ample natural light.
To make it easier for surgical patients’ families to communicate with physicians, consulting rooms were built adjacent to the operating rooms. The architects worked with CTRMC physicians and staff to develop this design, which enables physicians to meet with patients’ family members immediately before and after surgeries. The concentration on patient and family comfort at the facility has paid off in significantly increased patient satisfaction.
One of the most innovative features of the new building is its CardioOne unit. The CardioOne concept is similar to that of the LDRP (labor/delivery/recovery/postpartum) room that has become standard in maternity care–cardiac patients are cared for in one room, by the same medical staff, for their entire hospital stay. They are not transferred to a telemetry or step-down unit.
Epperson says the hospital administration had been considering adapting the LDRP model to cardiac care for some years. “One room, comfortable, spacious, welcoming, same crew–why wouldn’t that work for hearts? The more we studied it, the more we became convinced that’s the right way to take care of patients,” he says. But, he adds, “very few hospitals can do that because you have to retrofit everything. Well here we had a brand-new facility we were drawing.”
The new facility includes eight rooms dedicated to CardioOne care. To accommodate additional medical equipment, these rooms are 20 percent larger than the hospital’s standard medical-surgical rooms, with 8-foor clearance at the footwall. Each room is also fitted with a pair of doors to make it easier to transfer patients to and from surgery.
The initial results of the CardioOne program have been outstanding, says Epperson. “It’s everything we hoped for and more.” Carson City resident Bob Hines, who was addmitted to the hospital for heart surgery in July, has nothing but praise for CardioOne. “I thought it was great because I had the same nurses all the time,” he says. His wife, Rosemary, a retired CTRMC associate administrator, also liked that aspect of the program. “I know who to go to and who to speak with,” she says.
The new facility’s impact on staff was also comforting, she adds. “It really instilled a lot of confidence in us when we spoke to the staff and they were so pleased to be there and so impressed with the quality of the technology, the equipment and the thought that went into designing each room and each nurses’ station,” she says.
The hospital’s standard patient rooms are 15 feet by 22 feet. “They borrow heavily from the hotel industry in terms of how they look and how they feel,” says Epperson. Besides the expansive windows, the rooms feature wardrobes, daybeds and headwall cabinets that conceal medical gases. The facility’s eight LDRP rooms even include microwaves and bathtubs.
Each patient bathroom is designed to accommodate a wheelchair. The showers do not have curbs, so nurses can wheel patients into the shower rather than lifting them. This design also helps prevent ambulatory patients from tripping as they enter the shower.
Outside each room, the architects provided built-in alcoves for soiled and clean materials. These storage areas preserve the facility’s hospitality feel by keeping soiled waste out of sight. “All too often, you go into a patient room and you’ll see that soil bin sitting there with a blue lid and the bag hanging out,” says Mayoras. Storing clean materials by each room, rather than in a central supply closet, also cuts down on nurses’ travel distances. The area outside each room includes space where a counter can be added in the future, for charting purposes. The hospital also has central nurses’ stations.
Says Moon, “We went through this big movement to eliminate the central nurse station because nurses need to be by the patient. What we’ve discovered is, they really need to be in both places”–a central station and the bedside. Central nurses’ stations provide work space for support staff such as dieticians and laboratory personnel, he notes, as well as important socialization opportunities for nurses.
Also looking to the future, the architects designed several corridors to reach directly to the outside stairwells. These can simply be extended outward when additional bays become necessary. The central plant was constructed away from the hospital building and attached through underground piping, to prevent it from interfering with future expansion.
Epperson says that shepherding the project from an undeveloped site to a full medical campus has been “off-the-charts gratifying”–an experience he expects to continue as the facility grows. “I literally walked this property five years ago when it was dirt and sagebush,” he says. “I’m sure 10 years from now it will be even more gratifying to say, ‘Wow, now look what it has become.'”
To read more about the project scope, click here.