Creating A Flow Berkshire Medical Center Gets A $40M Facelift

When the surgical and laboratory professionals at Berkshire Medical Center discuss the changes involved in the hospital’s $40 million expansion and renovation, they keep coming back to a key concept: communication.
To be sure, the new surgical wing and laboratory, which opened in mid-January, are both stocked with cutting-edge technologies that promise both better patient outcomes and more efficient response time.

But it’s how these outcomes and information are shared that place BMC squarely in the 21st century of hospital design. Take, for example, the system of video cameras and monitors that extend throughout every room of the new surgical center.

“The advantage is in how it allows us to telecommunicate with other physicians,” said Robert Fanelli, director of Surgical Endoscopy at BMC and assistant professor of Surgery at UMass. “Say one of us is doing surgery in Room 7 and needs to see what a surgeon operating in Room 3 thinks about something. With the video cameras in the overhead lights, on the wall, and laparoscopically inside the abdomen, we can communicate from one room to another and say, ‘this is what I’m looking at. What do you think?’

“Right now,” he continued, “you have to scrub out of the operation and go knock on someone’s door and ask them to lend an eye or opinion. That’s OK, but this is a much more efficient way to do it, that doesn’t inconvenience a surgeon or require him to leave a patient. It lends itself to more collegiality and communication.”
Such efficiency leads directly to less wasted time, better organization, and fewer mistakes — in other words, better patient care. And that’s the ultimate benefit of any new technology or hospital design.

Face to Face

Fanelli said the extent of the new video system is rare for any hospital, linking all eight operating rooms, a minor-procedure room, and a urology room. In contrast, he said, the prestigious Dartmouth-Hitchcock Medical Center in New Hampshire has two such rooms, and the University of Cincinnati Medical Center recently installed it in just four of 30 surgical rooms.

“This is quite a commitment from the administration to get this,” he said. “It’s state-of-the-art, and I think it’s great.”
In addition to linking surgeons in different operating rooms, the system also makes it easier for a surgeon to communicate with pathologists in a different area of the building and get feedback on, say an excised tumor or the tissue left behind. “That’s going to improve their ability to render an appropriate diagnosis and improve patient outcomes,” Fanelli said.

The technology has an added benefit in its educational possibilities, he added. Fanelli currently conducts courses whereby surgeons from across the Northeast may visit Berkshire Medical Center to observe procedures being performed. “That’s inconvenient and possibly cost-ineffective,” he said.

However, the audiovisual capabilities of the new surgical wing have opened up possibilities in telementoring. Now surgeons from other states have only to locate a teleconferencing center near them — perhaps even in their own hospital — and watch surgery being performed live in Pittsfield.

“They’ll have the opportunity to communicate back and forth and to ask questions,” Fanelli said. “This will benefit a larger number of surgeons — and we’ll also use it to bring in outside expertise for procedures we’re doing here.”

Surgical technology itself has been improved at Berkshire, including the incorporation of more advanced minimally invasive techniques, which will allow surgeons to perform more such surgeries.

And patient privacy before and after surgery has also been improved with the creation of hallways that enable them to be transported away from the general hospital population.

“I think that’s a huge advantage,” Fanelli said. “I had an operation here six months ago myself, and I’m not a particularly shy fellow, but when I was out in the halls in the wheelchair in my johnny, I thought, ‘this could be compromising for someone who doesn’t have the lasseiz-faire attitude that I do.’”

The surgical rooms have also been designed with equipment closer to patients in order to lessen the time between when a patient is rolled into the room and when the operation can begin. “We’ve streamlined the process in many ways, which leads to good patient outcomes,” Fanelli said. “We have a good track record in that regard, but we can improve on it.”

Put to the Test

Facilitating communication is a key element of the hospital’s new laboratory, which is actually a merging of four lab areas — one of them formerly off-site.

“We’ve always been a state-of-the-art laboratory in terms of the services we offer and the technology we have, but this lab consolidates four little sites into one big site,” said Dr. Rebecca Johnson, medical director and chair of Pathology and Clinical Laboratories for Berkshire Health Systems. “That should improve our efficiency and communication, which translates into better service for doctors and their patients.”

The new lab facility also reflects a decidedly 21st-century approach in health care — specifically, an open design. “Instead of a lot of little rooms and a lot of walls, this is bright and open,” Johnson said. “It’s a beautiful place to work, and people get a better idea of what other people are doing.”

The improvements in the laboratory go beyond the physical space itself, however. For example, a new robotics system takes specimen tubes — marked with bar codes to accurately identify patients — interfaces with a computer, and sends a message back regarding which tests need to be done, Johnson explained.

“It’s like a conveyer belt,” she continued. “It takes the tube to the right instrument, which then performs the test. Those results go to the laboratory computer, where they’re reviewed by a technologist — or, if they’re normal, they’re automatically reported. It’s a very rapid testing and reporting system.”

That was easy to see during the first week with the new robotics system in use. The equipment allowed for 400 tests to be performed in one hour, as opposed to 100 or 150 per hour before.

“So it has improved,” Johnson said. “With the rapid reporting, the doctors aren’t waiting hours for results — and the patient doesn’t have to wait as long.”
That speaks to patient satisfaction, she explained — and a hospital’s laboratory can be a significant factor in quality of care, as well as a patient’s overall experience.
“People often forget about the importance of the lab because we’re one of those behind-the-scenes departments,” she said. “We’re not high-profile, but we’re extremely important to patient care. More than 70{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of the information in a patient’s medical record is from the laboratory or pathology. We’re key to the diagnosis, treatment, and monitoring of patients.”

Total Shift

The former main lab area occupied the space that is now home to the expanded emergency room, while the radiology area will also see some additions. Meanwhile, even the patient waiting area in surgery received not only a redesign, but a new strategy.

Specifically, recovery beds for same-day surgery weren’t being used in the morning, while patient intake beds were going unoccupied later in the day, so the entire area has been reconfigured — complete with movable walls — to shift its uses as the day progresses, and make the best use of all available space, Fanelli said.
“It provides privacy for patients who are pre-op and immediately post-op, and after most of the day’s surgery is done and patients have recovered, it shifts back to what it was in the morning,” he said.

Fanelli said he was excited to watch the progress unfold on all areas of the revamped wing.

“I’ve been going over and seeing what the hardhat guys were up to for months,” he said. “After two or three years of planning and talking about it, it’s good to see how nicely it’s come together.”

And that, he said, is news worth sharing.