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What you need to know for 12/13/2017

Ellis commissions master plan, considers significant changes

Ellis commissions master plan, considers significant changes

Overhaul would include more private rooms, larger parking garage
Ellis commissions master plan, considers significant changes
Ellis Hospital has fallen behind the industry trend toward single-bed private rooms for patients.
Photographer: MARC SCHULTZ

Ellis Medicine has begun the planning process for a potentially major overhaul of Ellis Hospital, with more private rooms, a larger garage and a new entrance as the biggest changes.

Ellis on Tuesday announced that it had commissioned a new master plan from E4H Environments for Health Architecture, a Burlington, Vermont, firm with extensive experience in the health care industry.

In comments to The Gazette, hospital officials emphasized the word “plan” — the master plan will be a blueprint, not a work order that brings excavators and jackhammers into action Jan. 1. However, they said, it is also not a wish list — it addresses needs that are real and/or pressing.

The main parking garage on Nott Street is nearing the end of its useful service life, and needs expensive annual repairs and maintenance. The hospital needs to replace it and wants to replace it with something bigger. And Ellis Hospital has fallen behind the industry trend toward single-bed private rooms for patients — a large percentage of its 438 patient beds are in semiprivate rooms, which hold two or more patients.

The architecture firm has already begun its work, with goal-setting meetings with hospital officials.

On Wednesday E4H will kick off its meetings with hospital staff to get a sense of what they want and need changed at Ellis Hospital.

Next, it will determine what the space requirements are for the goals it has been handed.

The four-week survey of the Ellis Hospital facility and assessment of its needs by the E4H team will include the physical condition of the buildings, some of which are decades old.

In the following six weeks, its architects will assess programs to explore existing services and identify initiatives.

In the following 12 weeks, its designers will use a two-team process to create multiple design options that will be presented to the hospital team, reviewed and modified as necessary. 

A final report in December will outline the assessment and the proposed solutions for the reorganization of the campus.

“We’re very much in the early stages of the process,” said Wendy Rosher, executive vice president of operations and strategic planning for Ellis Medicine.

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The master plan is expected to focus heavily on Ellis Hospital, the headquarters and largest single component of Ellis Medicine, but it could also include changes in the rest of the system, the main components of which are Bellevue Woman’s Center, a Niskayuna maternity hospital; the former St. Clare’s Hospital, now called the McClellan Street Health Center and used as an outpatient care, short-term rehab and nursing facility; and the Medical Center of Clifton Park, a large urgent care and clinical facility. 

Besides its garage, parts of Ellis Hospital itself are old and aging poorly, Rosher said. Some will need to be repaired, improved or even demolished.

The clinical facilities, she said, are mostly updated or even brand new. It’s mainly the patient accommodations that need to be revamped.

Bill Repichowskyj, a partner at E4H, explained that the industry is moving toward single-patient rooms for several reasons, the least important of which is that most people would prefer not to lie in bed in a loose-fitting gown contemplating their own problems with an ailing stranger in another bed 5 feet away. 

Most important is that private rooms produce healthier outcomes for patients: They contract infections less often and their families more easily can be part of the care and healing process. Private rooms also eliminate the planning shuffle needed to keep apart patients who because of their ailments should not be in close contact with each other.

Eliminating semiprivate rooms is one of three main goals for E4H as it draws up the master plan, Repichowskyj said, though that may need to happen in phases. The second goal is the garage. The third is the entrance to Ellis Hospital: Most people are entering through the Nott Street garage, so Ellis wants to give them a better entrance.

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Replacing the 700-car Nott Street garage with an 1,150-car garage brings to mind the long and acrimonious battle over the new 386-space garage Ellis built on Rosa Road, subject of bitter complaints by neighbors unhappy with its imposing size and proximity.

Repichowskyj said E4H is very aware how unpopular the Rosa Road garage was during its planning stages, and neighborhood opinion will be factored into planning of the new Nott Street garage.

But Rosa and Nott are different in a couple of ways, he said: Nott Street already has a large garage on it, Rosa Road did not.

Also, the Nott Street garage is removed from nearby houses, facing onto a school, its field and a power plant with a large smokestack, while the Rosa Road garage faces onto homes.

Repichowskyj said a significant limitation faces Ellis in all this: It is landlocked, with no real room to expand horizontally. If nothing else, more space would be needed for all of those private rooms it wants to create.

“There are certainly constraints imposed by the boundaries of that campus,” he said.

For that reason, Ellis may have to grow vertically if it wants to add space.

There is the capacity to do this. When it was constructed in 2015, the new Emergency Department was reinforced sufficiently to hold four more floors above it — and one of those floors was actually constructed, but left vacant and unfinished for future needs.

Configuration is as important as square footage when laying out a cluster of private rooms, Repichowskyj said. With the right layout, a unit totaling 28 to 36 beds is ideally sized to avoid excessive walking by nurses and maximize care and monitoring of patients.

Details like this are a specialty for E4H, which designs health care facilities and only health care facilities.

“There’s a scientific bent and a rationality to the work that we do,” Repichowskyj said. “Our work, when it’s done right and done well, can actually help patients get well.”

This ties together a lot of details, from the practical (less walking by nurses) to high-technology (405-nanometer violet LED room lighting shown to be as effective as bleach in killing bacteria) to common sense (nice views and natural light through windows in patient rooms).

All of this is likely to cost a lot of money.

“We always do look for philanthropic assistance when we take on big projects like this,” Rosher said.

It also comes at a time of consolidation within the hospital industry. Ellis Medicine itself was formed by the state-ordered merger of Ellis, St. Clare’s and Bellevue hospitals a decade ago. Now, as a single entity, it is the last independent in the immediate Capital Region — the other remaining independent, Saratoga Hospital, affiliated with Albany Medical Center in 2016. 

Albany Medical Center and St. Peter’s Hospital are now the heart of two networks that sprawl across thousands of square miles with eight hospitals, hundreds of smaller facilities and a combined 21,000-plus employees.

Against this backdrop, the 3,500-employee Ellis Medicine is considering if it should and how it would affiliate with another health care entity in the future. No specific merger or affiliation is proposed or contemplated at this point, but the groundwork is being built for such a move if it becomes necessary or desirable in the future.

The substantial Ellis Hospital overhaul that will be outlined in the master plan E4H presents will be work that needs to be done whether or not Ellis Medicine remains independent, Rosher said.

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