The Heart & Vascular and Neuromedicine Hospitals: Part 3 - How Vacated Space Will Serve Our Patients

Our new hospitals for patients with neuromedicine, heart and vascular conditions will not only enhance our ability to meet the growing needs of those who have these illnesses, but will also allow us to meet the expanding needs of patients with a wide variety of other conditions. It has long been recognized, for example, that the care of rehabilitation patients and those who require long-term acute care should be provided in a more coordinated manner. Moreover, a number of inpatient services - including obstetrics and gynecology, pediatrics, internal medicine, otolaryngology, plastic surgery, organ transplant and the intensive care units - are currently housed in wards that would greatly benefit from renovation and modernization.

Anticipating the opportunity to address these needs, on April 22 department chairs, administrators and UF Health leadership met to explore the possibilities for using the inpatient space in our legacy UF Health Shands Hospital that will be vacated when the new hospitals open:

• Neuromedicine ICU (30 beds)
• Cardiothoracic ICU (30 beds in “pod” configuration)
• Neuromedicine medical/surgical floor (24 beds)
• Cardiovascular medical/surgical floor (36 beds)
• Approximately 50 additional beds for patients with cardiovascular or neuromedicine diagnoses scattered throughout the hospital.

In addition, other space will become available after the relocation of the adult heart station, adult cardiac catheterization labs and recovery space, eight to nine operating rooms, two interventional radiology rooms, adult neurodiagnostic testing, and a significant amount of faculty practice space (neurology, neurosurgery, cardiology, cardiac and thoracic surgery, vascular surgery).

Ideas were requested in advance and 17 proposals were presented at the planning retreat. These proposals took a number of factors into consideration, including enhancement of the patient experience, improvement in other quality objectives, specialized space and technology needs, trajectory of growth in demand for clinical service, projections for future growth, and a business plan that took into account the future stream of incremental costs and revenues.

Many of these ideas are still being discussed and refined. At this point, however, we can convey the following plans for inpatient space renovation that will be implemented in 2018 once the new hospitals are open:

Obstetrics

UF Health Shands performs approximately 2,900 deliveries annually as well as 7,000 acute-care evaluations in the Labor and Delivery triage unit. Although the obstetrical triage unit was renovated and expanded in 2012, L&D itself has not had any extensive renovation since 1980. At any point in time at present, four to five LDR (Labor-Delivery-Recovery) rooms are typically occupied by non-laboring, late-gestation patients who need fetal monitoring, thus reducing the number of LDRs available to patients in labor.

The first phase of renovation and modernization of L&D will construct eight state-of-the-art LDRs, additional nursing and physician work space, and physician call rooms in the area recently vacated by the old neonatal intensive care unit (and incorporating part of unit 35). Postpartum patients will be relocated from Unit 35 to Unit 95, which was renovated into all private rooms in 2010. The remainder of Unit 35 will then become an antepartum unit capable of monitoring high-risk, non-laboring patients. In future phases, the existing LDRs and operating rooms on Unit 34 will be renovated and modernized. Once completed, the total obstetrical unit will have the capacity to perform over 3,500 deliveries a year in modern facilities that will be comfortable for patients and their families. Birthing rooms will be included, as well as LDRs with relaxation tubs for laboring patients. These renovations will create an ideal patient experience for obstetric patients with all levels of care available, from a low-risk midwife delivery experience to the highest-intensity obstetrical care for women with complicated pregnancies.

Long-Term Acute Care Unit

Once patients receive the care they need at UF Health Shands, subsets of patients may benefit from continued care in a post-acute setting, such as a skilled nursing facility, home care services or a long-term acute care, or LTAC, facility. One of the circumstances we identified as a contributor to “gridlock” was the inefficient transition of patients ready for transfer to a post-acute level of care. Regarding LTAC transitions specifically, there was concern about transfer to a facility that might provide care below the desired level. Moreover, the local LTAC was inconvenient for faculty to actively participate in the care of patients.

To address these issues, we solicited input from our faculty members, nurses and case management staff. These discussions pointed to an ambitious goal: Locate the LTAC inside UF Health Shands, and establish quality standards and expectations. To this end, a plan was presented to the UF Health Shands Board of Directors to work with Select Medical - the owner of the local LTAC and owner of over a hundred LTACs in the United States, including many at distinguished academic health centers - to relocate the local LTAC from its free-standing location on Archer Road into vacated space in UF Health Shands Hospital after the new hospitals open. It also established a quality committee that would elevate the standards of care at the LTAC. Lastly, the partnership called for a multi-year plan to have our UF Health Shands Rehab Hospital achieve national stature through improved and enlarged facilities, establishment of a physician training program (i.e., a residency) in physical medicine and rehabilitation and a focus on research that complements the outstanding science in the College of Public Health and Health Professions in the field of physical medicine and rehabilitation. In a future OTSP, more details will be provided.

Starting last fall, UF Health actively has participated in the quality efforts at the local LTAC. In doing so, we have observed improvements in several metrics. From a facility perspective, it is expected that the LTAC will be relocated to units 54 and 55 to create a 48-bed LTAC by the end of the summer of 2018.

Expanded MICU/IMC to be located on Unit 82

Unit 82 at UF Health Shands Hospital underwent a major renovation in 2008 to become a 30-bed neuromedicine ICU. When these patients move to the new UF Health Neuromedicine Hospital in December, 82 will be repurposed as a Medical ICU, or MICU, to address a tremendous current need for increased MICU capacity. Not only is our current 24-bed MICU on 11-4 essentially always full, but many patients currently housed in the intermediate care unit have significant medical problems that could be addressed in a more focused manner in an MICU. In addition, the gridlock caused by a full ICU, as discussed in Part 1 of this newsletter, can cause a back-up of patients in the emergency room, extending the waiting times for patients to be transferred to the ICU. An ICU at capacity can also constrain our inability to accept hospital-to-hospital transfers.

In view of these considerations, a pilot initiative was undertaken in spring 2016, in which we added six MICU beds on Unit 24. This action cut ER waiting times for an ICU bed in half, thus confirming the need and value of additional MICU beds, which will now be fulfilled by devoting the entirety of Unit 82 to MICU and intermediate care patients.

New Burn Unit

The current burn unit, an eight-bed service on the seventh floor, is at capacity almost every day. Adjacent to the unit is the primary burn surgical suite. These facilities, first put into service in the 1980s, were originally designed for 100 admissions per year. We currently have over 600 burn admissions per year and could accept more patients if we had additional space. Moreover, patients whose burn severity does not require critical care are currently admitted to the 10th floor.

To address these issues, we will construct a 23-bed, modern burn unit with dedicated staff on the second floor of UF Health Shands Hospital, in the area now devoted to the cardiac ICU. In this location, the burn unit will be adjacent to the operating rooms, allowing for flexibility and staffing efficiencies by OR staff and anesthesiology. In addition to the burn patients, individuals who have complex reconstructive surgery will be monitored in this new unit. Thus, when completed, we will have a modern burn unit with easy access to the OR that can accommodate all of our current patients (as well as many burn patients throughout the state whom we cannot currently accept), while also adding capacity for surgical critical-care beds.

Newly Constructed Perioperative Services Dedicated to Pediatrics

The Children’s Hospital has experienced substantial growth over the past five years, including patients requiring surgical procedures. The preoperative and postoperative care children require special approaches and attention. The addition of a pediatric-focused preoperative area near the ORs on the second floor, as well as renovated space for postoperative recovery that is specially designed and exclusively dedicated to the pediatric patient, will make children and their families more at ease throughout the surgical process. When completed, we expect that more than 4,000 patients per year will be cared for in this new area.

As we move forward with these initiatives, we are also working to refine the implementation of many other proposals to use vacated space - in both inpatient and outpatient areas - in a manner that will best serve the health care needs of our patients. Stay tuned as these plans roll out across time.

The Power of Together,

David S. Guzick, M.D., Ph.D. Senior Vice President for Health Affairs, UF President, UF Health