By Lena Kauffman

Back when sleep laboratories were a novel new part of medicine, they were, well, laboratories. There was some type of narrow bed with hospital sheets and then lots of equipment and a technician in the next room looking through a window. It was all about getting good study results and not much else. Today, the focus is still on getting good test results, but the attention paid to patient comfort and efficient workflow for staff has increased tremendously.

Modern sleep laboratories are laid out specifically for sleep diagnostic testing. They allow patients privacy, in many cases with individual bathrooms adjoining the sleep testing rooms, and the technologist work areas are situated in such a way as to allow good monitoring and ease of access to patients during the night.

However, as sleep center design becomes ever more sophisticated, the questions about where to spend design dollars and how many amenities to offer increase as well. What will really help staff work efficiently and allow patients to feel comfortable, and what will just create unnecessary costs?

According to Steve Smith, president of the health care marketing firm Practice Builders, Santa Ana, Calif, sleep centers must master a unique balancing act that other medical offices do not have to worry about. On the one hand, they must inspire trust in patients that the sleep study they are about to undergo is a serious medical procedure. On the other hand, they must make patients feel at ease in order to get them to sleep in the testing room.

SPEND, BUT SPEND WISELY

Going over the top with amenities can actually leave a negative impression on many patients, says Dan Helmchen, president of the sleep center consulting group, Sleep Logistics, Las Vegas. Granite countertops and flat-screen televisions in the reception area may make patients think that a sleep center is in it more for profit than patient care. “There is sort of a boundary between making it comfortable for a patient and making it a spa,” Helmchen says. “There are some extravagances that go on.”

Patients are expecting a medical office when they come in for a sleep study, adds Smith, so the reception area needs to be pleasant but professional. “This is first and foremost a medical procedure,” he says.

The place to spend money on amenities is in the testing rooms. “That is when you should turn up the hotel or spa atmosphere because it will make patients comfortable,” Smith says.

According to Smith, amenities are extremely important. “When the patient goes home and their spouse says, ‘How did it go?,’ they are not going to say, ‘Did you know the doctor had a degree from Harvard?’ The patient is more likely to say, ‘Did you know they had heated towels in the bathroom?'” he says.

However, that does not mean that you need or even should spend a fortune on the patient environment. Keep the focus on what will make the patient comfortable, and that includes a sleep center layout that allows staff to do their jobs well. “It is more important for the sleep center to be set up logistically well,” Helmchen says.

CLEAN AND SIMPLE IS BEST

Paul Yañez, owner of Medical Space Planners & Interior Designers, Carpenteria, Calif, has been in the medical office design business for more than 30 years, and he agrees with Helmchen that function should come ahead of aesthetics.

One problem with an overemphasis on aesthetics is that often what is trendy can start to look dated long before it is time for a remodel, Yañez says. You may want to be a little more adventurous in color than just hospital white, but going for a color of the moment may mean that you have to repaint much sooner than you intended. The test of a good design is whether it works well not just on the day the sleep center opens but also in 5 years, Yañez says. When he designs an office, he keeps to a simple color palette and uses lighting and clean lines to create a slick but professional appearance for the office that will last for years. “To me, clean is better and it works,” he says.

When it comes to updating an older office, Yañez says that thanks to new materials that have come on the market in the past 10 years, this has become more economical than ever. For example, a large cost in a medical office remodel used to be buying all new cabinets. However, with the new primers and surface finishes that are now available, an office can simply refinish the existing cabinets and switch out the hardware (the latches and handles). “It is like buying new,” he says.

Also, when building or remodeling, keep future needs in mind, says Walter T. Curry, AIA, ACHA, director of the health care design team for the architectural firm Rees Associates in Dallas. You want to design a space with some flex in it. “We think we know what the future is and we don’t,” he warns.

To organize a space so it is not locked into only one thing, Curry places functions with similar space requirements near each other so that one can be changed over to the other if it needs to be altered in the future. For example, an office that could really go anywhere in the design might be placed near the sleeping rooms and the monitoring room so that, should the sleep laboratory need to add a bed or increase the monitoring space in the future, that office space could be converted to either of the other two functions fairly easily.

SPECIAL CONSIDERATIONS

While sleep laboratories share many of the same design concerns as other medical facilities, there are some unique aspects. One is patient access, Curry says. Because patients will arrive in the evening, they need an accessible entrance that feels safe and secure. This is particularly a concern in a hospital setting in an urban area where you want to locate the sleep center near the hospital lobby so that patients need not walk down many long empty hallways and past dozens of closed offices to get to the sleep center, which can feel unsafe. You also don’t want them to feel like they are being brought in through the back door.

Naturally, the sleeping rooms also should be as private as possible. “The number one priority is can we get the sleeping areas out of the main pathway,” Curry says.

In addition, it goes without saying that patients should never have any access to a monitoring room where they could accidentally observe or hear technologists discuss another patient, as this is a violation of the patient privacy protections in the Health Insurance Portability and Accountability Act (HIPAA).

Building a freestanding sleep center from the ground up is, of course, ideal, but most sleep centers are located in existing buildings and that means working within the existing space. If locating inside a larger building, make sure to work with the building management to ensure that services, such as air conditioning, are available 24 hours a day and are not turned off at 8 pm to save on energy.

Thinking creatively can make things easier. The Pediatric Sleep Medicine Offices of the University of Rochester Medical Center in Clinton Crossings, NY, used beds that fold down from the wall to convert daytime exam rooms in the hospital into sleep laboratory rooms at night.

Another trend is to outsource the amenities by locating inside a hotel. With a few considerations for patient privacy—such as a separate entrance and check-in procedure from those of general hotel guests—this is an attractive option for many sleep centers because the hotel handles all of the nonmedical comforts, like serving breakfast, cleaning, making up beds, and putting towels in the bathrooms, which leaves staff free to concentrate on obtaining good studies. Sleep HealthCenters, Brighton, Mass, and Southcoast Hospitals, New Bedford, Mass, jointly opened such a facility in June at the Residence Inn in North Dartmouth, Mass.

KEEP THE FOCUS ON THE PATIENT

When it comes to questions of patient comfort amenities, some decisions may be driven by competition in your market, but it is a mistake to think having the most attractive facilities, nicest beds, and best breakfast in town will be enough to win over patients and referral sources. Experience and results are what should matter most. So whether you are building a new facility or remodeling an existing one, make good design and special patient amenities a top consideration, but not the only one.

Lena Kauffman is a contributing writer for Sleep Review.