To build an orthopedic freestanding hospital, University of Iowa (UI) Health Care had to start from scratch. The land it would eventually occupy was once a bean field that had no utilities, roadways or supporting infrastructure.
“We really had to create it from ground zero. In fact, we had to build our own central utility plant to support this facility,” said Amy O’Deen, BSN, MHA, chief administrative officer of the new facility, known as University of Iowa Health Care’s North Liberty campus.
The project’s overarching goal? Creating intentional designs that would optimize patient care and elevate the patient experience.
“We engaged patients and families early in the planning process to understand their priorities and needs so that we could build the design around some of those factors,” said O’Deen.
In an interview with the AMA, she joined Larry Marsh, MD, chair of the UI Health Care’s Department of Orthopedics and Rehabilitation, and Bryan Garter, MHA, MPH, director of operations for the North Liberty campus, to discuss this unique “smart” hospital, which opened on April 28.
University of Iowa Health Care is the state’s only comprehensive academic medical system, consisting of three health campuses, four hospitals, a national ranked medical school and more than 70 facilities across Iowa. It is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
The new facility, UI Health Care North Liberty campus, offers a one-stop shop for patients. They can go to a clinic, imaging visit or a pre-anesthesia evaluation before they go to surgery.
“Their surgical care, their inpatient care, their physical therapy post-surgery is all here,” said O’Deen.
Building the new freestanding orthopaedic facility freed up capacity to expand other subspecialty services at the main campus, such as cancer or heart services.
“It is a win across the UI Health Care system as well,” said O’Deen.
An opportunity for needed growth
UI Health Care leaders said orthopaedics had outgrown its space at the health system’s university campus in Iowa City. Residential streets and a large football stadium constrain that hospital’s footprint, and the department of orthopaedics needed space to grow, said Dr. Marsh.
The North Liberty project represented a huge commitment by the institution. This is a large freestanding facility with a comprehensive scope of orthopaedic services, as well as research, education and administrative space, he said.
UI’s nationally recognized orthopaedics department has always maintained a large footprint at UI Health Care’s university campus, consuming more than 20% of the capacity in its operating rooms, said O’Deen.
The health system is poised to meet the demand from that growing population of orthopaedic patients who want to stay active but have significant mobility challenges. These aren’t the types of patients who want to be served in a large complex academic medical center, noted Dr. Marsh.
“They’re going to want ease of access and care rather than navigating around all the competing services that go with a major tertiary care center,” he added.
Overall, it’s a tremendous opportunity for the orthopaedics department to grow all its missions, he continued. This is about better serving patients, expanding educational programs to provide more opportunities to study, learn and grow in skills and knowledge of the musculoskeletal system. Plans are also in the works to expand the residency program.
“We will have a better, seamless opportunity to incorporate clinical and translational research into how we care for patients and how we learn better ways to do it in the future,” Dr. Marsh said.
Reflects “onstage offstage” features
The concept of a single service line that focuses on orthopaedic, musculoskeletal care, including surgery, inspired many of the design features on both the patient and the physician side. The North Liberty campus also houses an emergency room, a retail pharmacy, research labs, a state-of-the-art physical therapy space and a comprehensive imaging center.
Every design choice reflects the needs of patients, said O’Deen, noting “we utilize an ‘onstage offstage’ design in various elements of our facility.
“Patients all park in the front, and our staff all park in the back, so there's no crossing of patient and staff traffic,” she added. Additionally, patient waiting and travel areas don’t intersect with any of the staff work zones. For example, staff enter exam rooms through different doors to create a better experience for the patient.
From an aesthetic standpoint, the facility supports abundant interior natural light as well as ample green space around the building, including two stocked ponds.
“While this is a big orthopaedic hospital, it does not have the same magnitude as our university campus,” Dr. Marsh added.
At the university campus, patients often struggle with navigation, not knowing where to go or waiting in lines to get onto parking ramps. Intuitive way-finding and adjacent surface parking at the new hospital make it easy for mobility-challenged patients to navigate their way into the building.
“We also offer valet parking services for these patients,” said O’Deen.
Meanwhile, all rooms are single occupancy and have patient and family zones to allow for privacy and for families to stay in the rooms.
“Many of these features were built in intentionally to support a superior patient experience. And to date, the feedback has been very positive,” she added.
Imaging innovations streamline care
State-of-the-art technology features throughout the facility build on a principle that the new campus can function as an innovation center to trial new technologies.
“We have integrated several new technologies into the new hospital such as a suture robot in the OR, an electronic inventory management system and Oneview technology in the patient rooms, to foster efficiency for our physicians and care teams,” said O’Deen.
Physicians use advanced imaging throughout the facility, in orthopaedic clinics as well as the dedicated imaging center, said Garter. UI Health Care is one of a handful of places in the country to use a photon-counting CT, which uses less radiation and leads to better images and interpretation to help advance patient care.
Each orthopaedic clinic has embedded diagnostic imaging services. For most imaging modalities, patients don't need to schedule a separate appointment in the hospital imaging center. They can receive that exam as part of their regular patient care visit.
The building was also built to be adaptable too.
“We put extra IT wiring and stuff in place so we could add new technologies, as well as expanded floor to ceiling heights,” said Garter, noting this will allow for flexible use of the space as other infrastructure or technologies are developed.
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Convenience around the clock
A 24-7 drive-through pharmacy—a big success during the COVID-19 public health emergency—was one feature the new facility implemented to meet consumer needs.
“We’ve had a lot of great feedback from the community wanting to utilize that, especially as care goes virtual and people are doing virtual care appointments after hours and want their pharmaceuticals quickly,” said Garter.
The walk-in orthopaedic injury clinic is another successful component of the freestanding facility.
“That's something new for us. It's essentially like a quick care or urgent care clinic, but for orthopaedic-focused injuries,” said Garter. “Patients can check in ahead of time for an available time slot during the day, or they can literally walk right in the door and it's right off our main lobby.”
The walk-in clinic has already boosted patient volume, leading to improved access within its different clinics as well.
“We can see more patients even quicker and hopefully get them in with the appropriate specialist in a timelier manner than when they traditionally had to be referred,” he said.
A physical therapy space, which encompasses a huge glass cube on the side of the building, is another unique feature of the hospital. Inside, it’s almost two stories high to accommodate patients of all ages and all abilities as well as athletes. It makes it easy for people to kick or throw a ball indoors. There’s also a 40-yard field off the back of the building for outdoor physical therapy, as well as different walking trails.
“We even have a putting green for people who've had upper extremity injuries and want to get back to golf,” said Garter. “Those types of unique features make us stand out to a typical, physical therapy experience.”
Growing the local economy
The surrounding neighborhood has evolved substantially from an expansive bean field to a hub of economic growth, said Garter. Grocery stores, restaurants and other businesses have popped up, and there is talk of hotels and other things coming into the area.
“We’re on the border between two different cities and they've both been great partners in helping to encourage that development,” he said.
“With the expansion of our workforce and recruitment of an array of professional and support positions, that obviously spurs economic development in the community as well. They're spending resources, they're buying homes, they're supporting the interests of this area,” added O’Deen.
Looking at future community partners
In its short tenure, the new facility has received overwhelming positive feedback from residents and patients in the area, as well as local businesses and community leaders.
“We have a large education space on-site, and we've already talked about multiple ways that we can partner together to help bring the community onto our campus so that we can be a place for greater community benefit,” said Garter.
Patients have been amazed with how easy and convenient it is to find their way around the facility, and marvel at the technology throughout the space.
“We look to continue to build upon that success that we've had in these first few weeks,” he said.
O’Deen recently spoke to a family that drove 800 miles from North Dakota to the new facility to get surgical care for their daughter because “they were told by their provider that we are the best in the region for this young adult hip program that they came for.”
Expanding and building upon that reputation for excellence in patient care and becoming a model for other places nationally is the ongoing goal.
