New Stanford Hospital Aims to Meet the Needs of Older Patients

By Diane Rogers

Rita Ghatak is continually talking with aging patients at Stanford Hospital, to find out what they would change if they could.

“They tell me that walking down a long hospital corridor to the patient units is difficult,” she says. “They tell me about a family member who fell in his hospital room because of the layout of the room--because a door didn’t open the way he expected it to.”

Rita Ghatak
Rita Ghatak, PhD, director of Stanfordís Aging Adult Services, is helping to incorporate the needs of older patients like Frank Koplowitz and Rita Brown into the new hospital design.

As director of Aging Adult Services at Stanford University Medical Center, Ghatak, PhD, has helped to meet the healthcare needs of more than 4,000 geriatric patients since the program was launched in 2004. A specialist in dementia management, she contributed a chapter about family meetings to make healthcare decisions to last summer’s Care Managers: Working With the Aging Family, by Cathy Jo Cress (Jones & Bartlett Publishers). Ghatak and her team of 12 currently provide services that range from supporting caregivers to making home visits.

Ghatak is also involved in planning for the care of aging patients in the new Stanford Hospital that is projected to open in 2015. Built during the Eisenhower era, the current hospital presents significant challenges, with rooms that are too small for today’s services and equipment. The new hospital will include almost one million square feet to house the equivalent of three acres devoted to interventional services, an enlarged emergency department and beds to provide an overall hospitality capacity of 600 beds.

Ghatak and George Tingwald, MD, AIA, director of medical planning for the hospital renewal project, have been meeting with community groups in recent months to talk about how the new hospital specifically is being designed to meet the needs of older adults.

At a time when adults 65 and older are 12 percent of the U.S. population, consume one-third of healthcare services and occupy one-half of physician time, the demand is clear. And it’s only going to grow, says Tingwald. “The aging population and their need for health care is very real, it’s not going away and we’re going to have to deal with it.”

Tingwald, who is both a licensed physician and an architect, brings a singular perspective to the job of designing a hospital that will address the needs of an unprecedented population of older patients. “Because of better, healthier living, the aging population didn’t jump into the elderly health care group as quickly as we thought they would,” he adds. “Instead of inundating the healthcare system at age 60, they waited 10 years. And now that they are 70, 80 and 90, we’re suddenly seeing this incredible volume of issues related to aging.”

Solutions for aging adults’ health care needs already are being tested in the existing hospital, including four patient units where ear plugs are helping patients sleep more soundly and new pulse-oximeter probes have replaced older models that used to sound loud alarms. In addition, a new protocol for addressing post-operative delirium in aging patients is now a hospital-wide initiative. “If you’re at risk, you are screened by nurses after surgery,” Ghatak says. “And if you manifest any symptoms of delirium--say, confusion or disorientation--the medical team addresses them immediately.” 

Ghatak’s program distributes the informational packet “Resources for Older Adults” to every person 65 or older who is admitted to the hospital. It includes a sheet of “helpful tips” that encourage family members to stay overnight with patients who have severe confusion, and to keep reminding patients where they are, and why.

As Tingwald reviews plans for enhanced lighting and flooring materials that will help to prevent falls in aging patients, he is also overseeing construction of full-scale mockup rooms. The first round of construction is done with foam-core material that can be easily reconfigured and trimmed. “We’re testing the rooms for clearances and views through windows,” Tingwald says. “If we want a door to be 48 inches instead of 42, we can take a blade and cut off six inches.” Then comes a sheet-rock model with painted walls, lighting fixtures and window treatments.

Construction teams are building one acute-care room, two intensive-care rooms, an operating room and an emergency department examination room. Tingwald notes that all of the rooms in the new hospital will be designed for single-patient occupancy, adhering to national guidelines for hospital construction. “It’s the standard today,” Tingwald says. “Studies show a much lower rate of cross-contamination and hospital-acquired infections when patients are not cohorted. There’s less spread of disease when there’s only one person in a room.”

Moving and relocating patients to double rooms has been shown to take up to 40 percent of nurses’ time, he adds. “Every time you relocate a patient, which involves transferring medical records and medication programs, the rate of errors goes way up.”

Single-patient rooms in the new hospital will also resolve one of the recurring complaints Ghatak hears from the older patients she interviews. “They tell me they don’t want to share a room with another patient, because they prefer a quiet environment and a lower risk of infection.”

About Stanford Hospital & Clinics
Stanford Hospital & Clinics is known worldwide for advanced treatment of complex disorders in areas such as cardiovascular care, cancer treatment, neurosciences, surgery, and organ transplants. Consistently ranked among the top institutions in the U.S. News & World Report annual list of "America's Best Hospitals," Stanford Hospital & Clinics is internationally recognized for translating medical breakthroughs into the care of patients. It is part of the Stanford University Medical Center, along with the Stanford University School of Medicine and Lucile Packard Children’s Hospital at Stanford. For more information, visit http://stanfordmedicine.org.

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