Inside Duke Medicine

Duke Medicine Pavilion to set new course for all of Duke University Hospital

Work progresses on the seventh floor of the Duke Medicine Pavilion, where the Heart Center will be located.

More than the birth of a new building, it’s a chance to make changes that will chart the hospital’s course well into the mid-21^st century.

“This is really exciting,” said Thomas Owens, M.D., chief medical officer of Duke University Hospital (DUH). “This is the first chance in 30 years we have had to think about how we organize and deliver care for patients, not just in Duke North but across our new Duke University Hospital platform.”

The bricks-and-mortar component embodied in DMP is only the start.

“We are taking the next step with this state-of-the art new facility and bringing our current infrastructure up to par, so that we equalize at the highest possible level the patient experience throughout DUH,” said Jeff Langdon, MHA, administrative director of strategic operations.

As DMP construction ends work begins to realign and reallocate units, beds and clinical services across DUH using a comprehensive, data-driven process centered around strategically significant goals focused on high-quality patient care and organizational efficiency. At the same time, the changes focus on maximizing operational efficiency by creating contiguous clinical space and on positioning DUHS for expected future growth of services.

“The unit and bed allocation recommendations are the product of many months of careful, collaborative consideration from across the DUHS organization,” Langdon said. “We are making decisions based on what is best for our patients and their families, and on what positions our entire organization for clinical and financial success now and moving forward.”

At the heart of the decision-making process lies a commitment to providing high-quality, patient-centered care. Also central to that process is enhancing the work lives of our staff and caregivers by more efficiently grouping and aligning clinical services and the support services.

The DMP was planned and is being built with those goals in mind. DUH’s infrastructure presents a challenge but also offers great opportunities to further optimize the impact of the DMP.

The planning process included one-on-one meetings with medical leaders to gain input on key factors to consider, such as clinical care, capacity management, and opportunities to group related clinical services to facilitate patient flow. Additional meetings followed involving front line staff, department chairs and others to discuss how DUH’s overall geographical configuration and limited space affect patient care. Several scenarios then emerged for allocating beds and realigning services in DMP, Duke North and across DUH to carry the organization into the next 30-50 years.

“I am thrilled we have the chance to rethink this,” Owens said. “It doesn’t mean the transition won’t be challenging, as we rethink our organization of care units and teams.  As we move forward, we will work with staff, faculty, and our consultants, engineers, and architects to make the best decisions to enhance the care of our patients. It will be a dynamic process to make sure we are doing all the right things as we go forward. This won’t be flipping a switch in 2013 and having our end-state hospital.”

“This is organic,” Owens said. “Our plans have developed from the ground up with front line caregivers and their teams -- physicians, nurses, and others – who have come together to decide what makes the most sense for patients. There has been broad agreement about a number of very important decisions.”

For example, the DMP originally was conceived as a DUH expansion devoted to intensive care, surgical and step-down space. As transition planning progressed, however, it became clear that some Duke North units should move into the DMP in order to offer patients and caregivers the benefit of the additional space and optimal equipment. 

Meanwhile, Duke North spaces will be renovated to one degree or another.  Many need upgrades related to information-technology and other infrastructure as well as wiring and building code compliance. Some will be renovated to meet patient needs and efforts will be made to reclaim space for families.

Efforts also will be made to co-locate services whose patients require similar skill sets from nurses and other caregivers, including creation of an abdominal transplant inpatient unit on the third floor and a Heart Center on the seventh, along with all cardiac and cardiothoracic units.

Final decisions regarding all proposed changes hinges on an architectural review that will take place in the coming months.

With the opening of the new Cancer Center and associated space being vacated from the providers currently working in the Duke Clinic, the ambulatory leadership team is similarly taking the chance to evaluate future growth needs and realignment opportunities.

As with the DUH-wide plan, the goal in the clinics is to offer multidisciplinary, disease-based models of care; bring clinically related services together and put them closer to the ancillary services they most often use; reduce the amount of patient travel between commonly grouped care episodes; to enhance the current level of clinical space while supporting the desire to improve the patient and family experience; and to take advantage of the chance for growth beyond what the current makeup of clinics affords DUH in its current structure.