Trying to fit new technology into an old space often presents a challenge for hospitals and their architects. John Muir Medical Center (JMMC), in Walnut Creek, California wanted to replace their oldest Cardiac Catheterization Laboratory within their Angiography/Cardiac Catheterization Suite, with the latest in electrophysiology lab (EP) equipment. After considering the various equipment vendors, JMMC selected Toshiba’s Infinix CSI equipment.

- EP Lab Location: Cardiac Rhythm Center at John Muir Medical Center 1601 Ygnacio Valley Road Walnut Creek, California 94598 Contact: Margaret Simor, RN, BSN, CRN Director, Angiography/Cardiac Cath Labs John Muir / Mt. Diablo Medical Centers EP Lab Statistics: Design/Build Team: Thistlethwaite Architectural Group, San Francisco, California, and Pankow Special Projects, Oakland, California Lab area: Approximately 800 square feet (procedure room, control room, equipment room, scrub sink) Equipment: Toshiba, Infinix CSI - single plane

       The next step in the development of the new EP lab was the selection of the Design-Build team. Design-Build is a project delivery method that involves combining the architect and engineers with a general contractor to not only design the project, but to build it as well. Design-Build provides the Medical Center with one point of responsibility for the project’s quality, cost and schedule adherence. The Design Team included Thistlethwaite Architectural Group of San Francisco, California, and Pankow-Special Projects Division of Oakland, California.
       Once the Design-Build team was selected, they worked with JMMC’s Angiography/ Catheterization Laboratory staff and Toshiba representatives to understand the space needs of the staff and the physical requirements for the new equipment. A space program was created to make sure that sufficient space was provided for all of the necessary functions with the lab, and that the adjacencies of those spaces were appropriate.
       The challenge began with the design to accommodate the new technology within the existing footprint of the previous Catheterization Laboratory — there was no room within the entire Angiography/Cardiac Catheterization Suite for expansion. The Design-Build team developed a design to accommodate the new EP lab. The new lab consists of a 500 square foot Procedure Room, a 200 square foot Control Room, and a 60 square foot Equipment Room (Figure 1).

Figure 1.

Floor plan. Copyright 2005 Thistlethwaite Architectural Group

Design Criteria
       The obvious design criteria included providing the following: unobstructed views between the control room and the procedure room, ample space on both sides of the table to allow for a variety of procedures, sufficient clear floor space to easily transfer a patient from a gurney to the table, enough storage in the procedure room for catheters and other related equipment, adjustable lighting, and an appropriate and flexible workspace for the physicians, radiologists and staff.

Design Features
       In addition to meeting the above design criteria, the design team wanted to create a unique environment that would be interesting for both the patients and staff. This was achieved through the use of curves, color, and a canopy.
       Curves. Several design concepts were used to also provide a greater sense of space and volume in the approximately 800 square feet lab. A concave curved partition separating the Procedure Room from the Control Room visually increases the size of the procedure room. This curved partition is topped by three large lead acrylic panels, which provide the required shielding for the staff in the Control Room. Weighing a total of approximately 650 pounds, the overlapping lead acrylic panels provide an unobstructed panoramic view of the Procedure Room. The curved partition is open at the top, providing a greater sense of volume in both the Control Room and the Procedure Room (Figure 2).

Figure 2.

Photo of the Procedure Room, from the Control Room. Overlapping lead acrylic panels provide unobstructed views of the Procedure Room from the Control Room, and provide radiation shielding for Control Room staff. The curved canopy provides acoustic control, directs light on to the work surface, and reflects light. (Photography by Stephen Fridge)

       Color. Color was used throughout to create a soothing, yet interesting space. Working with a blue color scheme, a light blue was used on some of the walls, and deeper blue was used on the cabinets and curved workstations. The sheet vinyl floor also features a curved design with multiple blue inlays. Blue patterned upholstery on the task chairs in the Control Room complements the color scheme (Figure 3).

Figure 3.

Photo from inside the Procedure Room, looking toward the Control Room. Color, curves and the canopy (shown at right) provide visual interest for the patients, who may be awake during a procedure. The transverse mounting of the overhead physiological monitors (shown at center) was designed to allow the monitors to be easily moved and visible from either side of the table, depending on the specific procedure. (Photography by Stephen Fridge)

       Canopy. A custom canopy was designed to follow the curve of the lead acrylic-shielded partition separating the procedure room from the control room. The canopy is constructed of brushed metal panels and fabric-wrapped acoustic panels, supported from above by wire cables. The design of the canopy allows it to function as both a reflector to bounce additional lighting off the ceiling, and as an acoustic buffer between the two spaces, while adding visual interest and texture to the lab (Figure 4).

Figure 4.

Photo of Canopy from inside the Control Room. The curved canopy above the control room follows the curve of the workstations. Fabric-wrapped panels on the underside of the canopy provide acoustic control, while the polished metal top of the canopy reflects light into the space. Stainless steel cables and connections support the canopy, and provide visual interest for the patients. (Photography by Stephen Fridge)

Additional Design Features
       To enhance verbal communication within the lab, and to reduce unnecessary background noise for the patient and staff, noise-generating equipment was placed in a separate equipment room. Custom stainless steel cabinets were designed to fit under the procedure table to accommodate power and medical gas outlets and physiological monitoring equipment, as well as the myriad coils of cables serving that equipment. To accommodate future technology changes in equipment in the Control Room, the power was routed through exposed conduit, and a cable gutter was provided to manage computers, communications and data cables. For easy access, and to protect the wiring and cables, the exposed conduit and cable gutter were located on the inside face of the curved partition wall, above the floor and below the countertop.

Owner’s Perspective
       "The collaboration with the architect and builder was unlike any I have experienced before on a building project," said Margaret Simor, RN, BSN, CRN, Director, Angiography/Cardiac Catheterization Labs. "The functionality of the spaces and the attention to detail truly reflects the fact that they listened to and addressed our requests, and took the time to understand our workflow and patient care needs." She adds, "We were able to move into the EP lab and begin patient care with no need for fine tuning. There were literally no glitches." Margaret Simor is the Director of Angiography/Cardiac Catheterization Labs for the John Muir/Mt. Diablo Health System, Walnut Creek, California.

Architect’s Perspective
       "It is always a pleasure to work with a hospital that recognizes the importance of involving the end users in the design of a project," said David R. Thistlethwaite, AIA, ACHA, principal of Thistlethwaite Architectural Group. He adds, "JMMC physicians, radiologists, nursing staff, medical technologists, and facilities staff all participated in the design process. They offered their ideas and suggestions to make sure the room would meet their clinical and work environment needs, as well as the patient’s needs, and would comply with the hospital’s facility standards. This collaborative design process resulted in an innovative, well-designed, functional space. As always, we enjoy the challenge of balancing state-of-the-art medical technology with the functional and aesthetic needs of the staff and patients." David Thistlethwaite is Board Certified by the American College of Healthcare Architects, and has been practicing healthcare architecture for more than 23 years.

Builder’s Perspective
       "Pankow Special Projects, L.P. is proud to have been Design-Build contractor, working with Thistlethwaite Architectural Group and the hospital staff to deliver this state-of-the-art project in four months, with one month for equipment installation and calibration," said Shane Magee, Senior Project Manager. "One of the most remarkable benefits of this Design-Build process," he adds, "was streamlining the project review and approval process with the state agency reviewing hospital projects, through the careful development and coordination of the construction documents with the architect, engineers, equipment manufacturers, and our construction team. As founding members of the Design-Build Institute of America, we at Pankow firmly believe Design-Build provides the hospital with the best cost control, schedule achievement and overall satisfaction of any other project delivery method." Shane Magee is Senior Project Manager for Pankow Special Projects, L.P.
       Other systems installed in this project include:
• Pyxis Medication and Supply Modules (4)
• CARTO XP 3-D mapping (EP navigation system)
• G.E. Combo Lab 7000 (Physiological monitoring)
• Toshiba Gateway Network
• Telex Audiocom wireless intercom communication system
• Lutron programmable lighting
• Bloom Electrophysiology Stimulator (4-channel external cardiac stimulator)

       This project was successfully completed with minimal disruption to the other three procedure rooms, offices, and patient recovery areas within the occupied Angiography/Cardiac Catheterization Suite.