San Diego Business Journal

Art and science, nature and technology merge to create a state-of-the-art healing environment at the recently opened Palomar Medical Center in Escondido.

Sheer size makes the 11-story, 740,000-square-foot medical center a formidable addition to the Escondido Research and Technology Center. Five-star hotel amenities from a three-story grand lobby to concierge-style desks on the patient floors add a human touch.

The driving force behind all the thoughtful features planned by Palomar Health executives, staff, board members, community leaders and volunteers over nearly a decade is maximizing the delivery of medical care.

Gerald Bracht, chief administrative officer for Palomar Medical Center, said while it’s the people and not the building that’s responsible for delivering health care, the infrastructure incorporated in the new facility allows the care givers to deliver health care more efficiently and more effectively.

“Our focus was on the patient,” Bracht said. “Really centralizing the care and the delivery of care around the patient and doing that as efficiently as possible. At the end of the day if the patient is able to leave the hospital sooner that results in cost savings, but that wasn’t the focus. The focus was on patient care.”

Innovative Features

Bracht described several of the innovative features of the new hospital, beginning with the synchronization of medical technology that enables alerts to be sent as text messages to a nurse or clinician’s phone any time the patient monitoring equipment falls out of range. A separate tool, an app called Miaa, brings health record information directly to the clinician, saving valuable time that would otherwise be spent calling the hospital, and locating the nurse and medical records. Another device is a vital signs monitor patients wear on their wrist, called Sentac, which improves patient care by enabling physicians to routinely check the status of such things as blood pressure and heart rate without waking the patient. Other efficiencies are robotic systems that prepare IV admixes and gather medications.

“The pharmacist reviews orders from the physician so there are no drug interactions and they coordinate with the physician and make the necessary adjustments as opposed to spending time counting pills,” Bracht said.

Eleven operating rooms, four cardiac catheterization rooms and three procedure rooms in the new Palomar Medical Center is a step up from the 10 smaller operating rooms and three procedure rooms at the Palomar Health Downtown Campus on East Valley Parkway in Escondido that this hospital is replacing.

Paul Patchen, director of interventional services, said the new ORs come with high-definition laparoscopic equipment used in minimally invasive surgeries, blanket and fluid warmers, as well as automated medication stations. Surgeons in these ORs will have access to radio frequency technology to detect the location of missing surgical instruments and sponges, he said, and video equipment is in place to capture surgeries digitally.

“Down the line if we decide to be a teaching institution or do live broadcasts, then the new technology and the infrastructure are already here,” Patchen said.

Designed for Maximum Efficiency

The 288 private patient rooms are divided between the west tower’s 120 rooms which are built to intensive care unit standards and encompass 320 square feet, and the east tower’s 168 rooms that are 280 square feet each.

Lorie Shoemaker, chief nurse executive who has more than 20 years of experience with Palomar Health, said the room layouts are designed for maximum efficiency with a staff zone and hand hygiene station in the entryway, a patient zone, and a family zone with sofa sleeper designed to encourage family centered care.

“If you’ve seen one room in this hospital you’ve seen them all as they are all identical in design and layout,” Shoemaker said. “This standardization we believe will have long-term effects because our nursing staff and our medical staff will be able to react more quickly in an emergency as they will be able to respond to the patients’ needs because all of the lifesaving equipment is in the same place in every patient room.”

In addition to electronic tools that allow patients to pull the window coverings closed or call the nurse for specific requests at the push of a button, handrails have been positioned between the restroom and bed as a safety feature to prevent patient falls. An electronic ceiling mounted lift is also in every patient room to prevent staff back injuries.

One of the expansive innovations is eliminating the centralized nursing station in favor of a distributed nursing station outside of every patient room.

Nurses in Plain View

“By putting the nurse closer to the bedside we can provide higher quality, safe patient care because the nurse is there to respond to the needs of the patient in a more rapid fashion and quite frankly the patients will feel safer and more comfortable because they have the nurse in plain view,” Shoemaker said.

In addition to the integration of an advanced nurse call system and bedside monitors, Chief Medical Information Officer Ben Kanter said each nurse will be carrying Cisco Systems Inc. smartphones to improve physician-nurse collaboration. The phones can be used not just for transmitting critical events, but for routine communication as well, he said.

“This is not an example of technology for technology’s sake,” Kanter said. “These are technologies we chose to invest in that are targeted to enhance the patients’ experience and improve safety in the delivery of medical care.”

Environmental attributes of the hospital that promote healing are scenic views from the patient rooms, patios that allow patients and their visitors to enjoy a garden setting, and a 1.5-acre green roof directly above the surgery and procedures area on the second floor. All southern facing rooms overlook the green roof that has been planted with drought-tolerant vegetation to help improve energy efficiency to a performance level that is 10 percent better than the state’s Title 24 requirements. San Diego-based Spurlock Poirier Landscape Architects contributed to planting more than a dozen Southern California plant species on the undulating roof.

Return to Basic Principles

Tom Chessum, principal architect for the medical center’s designer CO Architects, said even as far back as the 1800s Florence Nightingale was promoting the need for patient access to daylight and the outdoors. “A lot of that got lost,” he said.

Financing for the $956 million Palomar Medical Center was made available through a $1.05 billion facility master plan that included revenue bonds, working capital and philanthropy and tapped into Proposition BB funds. The $496 million bond measure that authorized financing for repairs of aging facilities and new construction passed by nearly 70 percent of the district voters in 2004.

Dr. Jaime Rivas, director of medical emergency and trauma services for Palomar Health, said an impetus for getting Proposition BB passed was a shortage of space at the former Palomar Medical Center, now called the Palomar Health Downtown Campus. The downtown campus opened with a capacity of 37 beds in 1950 and grew to 301 beds.