In the cramped yet bustling waiting room of Stanford Hospital's emergency department, dozens of people sit in blue vinyl chairs waiting to see a doctor. Some are engrossed in their smartphones; others don masks to protect the roomful of visitors from their respiratory illnesses. A few arrive in wheelchairs, too injured, nauseous or dizzy to stand.
When this 1,142-square-foot room overflows, people wait on benches in the hall.
There's little privacy when the patient finally gets to see a physician in one of the emergency department's 54 treatment bays. A thin curtain separating each bed doesn't mask conversations or the sound of someone's rattling cough or the moans of an accident victim.
Nurses squeeze past each other in the examination bays. Medical staff navigate through labyrinthine spaces in which EKG machines and saline-drip stands co-mingle.
The emergency room, or ER, is a hectic place. Every square inch of the 18,069-square-foot space has been claimed by patients, equipment or staff.
"In the current ER, we're like a tight-knit family," Samuel Snell, emergency department assistant patient care manager, quipped during a recent August morning.
For Snell and other hospital personnel, the Stanford emergency room capacity has been outpaced by the region's rapidly growing population. It outgrew its space long ago.
But in less than two months, the new Stanford Hospital will be opening and with it a 42,692-square-foot ER and regional trauma center with a shiny, cavernous hallway and 66 private treatment rooms. (See more in "Readying for any disaster.")
"The new emergency department is the full length of a football field from goal post to goal post," Snell said.
Snell toured the command center/nurses station, from which staff can see through the glass walls of the ER's individual patient rooms to monitor the ill. In one ER room, doctors and staff can consult and strategize in complex cases using mannequins and computer models to simulate medical conditions. They can also video-conference with specialists on the other side of the world.
The new ER and trauma center is part of a $2 billion expansion a decade in the making. After receiving approvals in 2011, the project broke ground at 500 Pasteur Drive in May 2013. Stanford built the new hospital in part to fulfill a state seismic mandate for all hospitals by 2030 — a major impetus for the new hospital and retrofitting the old one. (The renovations inside the existing hospital at 300 Pasteur Drive are scheduled to be complete in 2025.)
The 824,000-square-foot new hospital adds 368 private rooms, for a total of 600 beds on the whole hospital campus, three acres of surgical floor space, 20 operating rooms, specialized diagnostic equipment to scan patients adjacent to the operating room and more than four acres of gardens.
The public will have a chance to tour the hospital during two community days this weekend, Sept. 14-15. Though pre-registration for tours on both days is full, there will be a limited number of tour openings each day for walk-ins; those interested can go to the on-site registration booth.
Aside from taking the tour, the public can attend the community fair on the hospital's grounds on both days, but pre-registration is required. (Scroll down to the bottom of the story for more information on the community fair.) Events will include a photo booth, opportunities to ask an expert questions, a teddy-bear triage center where kids can make a take-home bear, a larger-than-life game of Operation, face painting, a treasure hunt, music, food trucks and more.
The prospect of the hospital's opening stirred palpable excitement among nurses walking through the new ER on the morning of Snell's tour.
"When I came to Stanford 30 years ago, they said they were going to build a new hospital. Now, it's finally happened," Patrice Callagy, executive director of emergency services, said as she accompanied staff through the new ER.
The expansion is long overdue, Callagy said. The Stanford ER receives 210 patients per day on average in a facility built in 1959 to handle only 70. During influenza season, that number rises to 250. Annually, the ER handles more than 78,000 patients; by the end of next year, staff estimate they'll be handling up to 90,000 patients, said Courtney Lodato, director of communications for the renewal project. The lack of space causes the current ER staff to triage flu patients in a tent in the parking lot.
The overcrowding isn't confined to the ER. As recently as two weeks ago, all of the old hospital's beds were full, Callagy said. Annually, the existing hospital has nearly 27,000 inpatients, who stay overnight or longer.
Staff refer to the old and new hospital buildings by their addresses: 300 Pasteur and 500 Pasteur drives, respectively. Located a stone's throw from the old hospital's iconic fountains and pool, 500 Pasteur is envisioned as a healing community, the "new model" of patient care, according to staff: inclusive of family; using technology to give patients a greater ability to communicate with their medical team and more control over their care; designed with flexible spaces so the hospital can be adjusted to meet changing needs; and incorporating nature and art to aid healing.
Creating calm and beautiful spaces
Visitors to 500 Pasteur walk into a soaring, three-story atrium. The glass-domed, light-infused entry in travertine, terrazzo and sand-colored tones and wood looks more like a posh hotel or museum than a hospital.
Comfortable seating, internet stations, coffee and magazines have replaced the old hospital's long, polished entry hallways with patients in wheelchairs and on gurneys.
Two wings on the new hospital's ground floor contain a main cafeteria with floor-to-ceiling windows and outdoor seating, a gift shop and patient-discharge lounge.
Visitors who enter the atrium won't see sick patients being wheeled around. Imaging rooms lie behind walls off of the atrium; the second floor is dedicated to operating rooms.
Four floors of patient rooms surround the atrium in four buildings laid out in a cross pattern. Through a patient room window on the fourth floor, the Santa Cruz Mountains stretch out in an expanse of greenery. On summer afternoons, fog drapes over the conifer forest in cottony folds.
Patients in all rooms have views of the mountains, the Stanford campus and foothills or the San Francisco Bay through picture windows, and each room is private.
Jennifer Winder, public relations manager for planning design and construction, admired the views on a recent Thursday.
"There's not a bad room in the house," she said.
Scientific evidence has shown that nature positively affects healing, she noted.
According to groundbreaking scientific studies by environmental psychologist Roger Ulrich, patients who had window views of greenery or who viewed murals of natural scenes experienced more positive emotional feelings, had less stress, fear, anger and sadness and had lower blood pressure, better heart activity, less muscle tension and more positive brain electrical activity. Some research has found these positive outcomes occurred in as little as three to five minutes, Ulrich, of the Center for Health Systems and Design at Texas A & M University, noted in a 2002 paper.
Art has been used as a healing influence at Stanford for decades, and the new building will feature 400 works of art.
In the early 1980s, a volunteer group began acquiring and hanging art on Stanford Hospital's walls with the idea that art could enhance recovery — something that Ulrich later proved.
Ulrich's studies also showed patients healed faster when they viewed photographs of nature rather than artwork of other kinds. The new hospital has mural-sized photographs of forests and trees to reinforce the presence of a soothing outer world, Winder said.
Stanford has gone even further to incorporate the healing power of nature into its hospital setting. The hospital's third-level garden floor contains four acres of gardens, walking trails, a meditation room, family resource center, a dining room and an assembly hall for lectures and all-staff meetings. It is designed to be a respite from the clinical setting for patients, families and employees. The five gardens are filled with native California and other flowering plants.
On the ground level outside the emergency room, there are more verdant spaces to soothe the visitor. Crews have planted an 85-tree orchard that includes fruit, nuts and flowering trees. Gingko, loquat, apricot, olive buckeye and live oaks were selected for fruit-bearing or medicinal properties in eastern, western and native cultures.
The orchard has a shady retreat for patients, families and staff and a dog park with a water fountain and a fire hydrant for visiting pets.
The power of simple places of respite isn't lost on Chad Reeder, controls manager at the new hospital.
"I asked a mom what she likes best about Stanford Hospital, and she said, 'Starbucks — that's the one time of day I can grab coffee'" and have time to herself, he said.
The new hospital's patient-care model also focuses on integrating the family into the patient's care and supports families' needs, Winder added.
"There's no more visiting hours. Family can stay overnight," she said.
Each room has a comfortable nook with a table and sofa that converts into a bed for a family member.
Patients will also experience a bit more quiet on the hospital floor. Sound buffering at the nurses stations helps reduce noise, she said.
David Entwistle, president and CEO of Stanford Health Care, said the features he finds most compelling for patients include the private room and bedside technology. The latter empowers patients to have more control over their care.
Each room has a 55-inch television screen and an iPad at the bedside. The patient can see his or her care team's information, and there are apps on the iPad to order food from the cafe. Patients can operate the lighting and stream video conferences with their doctors and families.
Patients often have a sense of losing control over their care and lack the ability to connect with the outer world in the hospital setting, Entwistle said.
"If you can take the technology we use on a daily basis and use it for patient care, that's exciting," he said.
A grand opening with ribbon cutting is scheduled for late October. More information is available at stanfordhealthcares.com.
A Q&A video with CEO David Entwistle is available here.
Dr. George Tingwald of Stanford Health Care, joins Weekly staff to discuss the planning that went into building the new Stanford Hospital on an episode of "Behind the Headlines," now available on our YouTube channel and podcast page.
New Stanford Hospital tour and Community Days
When: Sept. 14, 9 a.m.-5 p.m. and Sept. 15, 9 a.m.-3 p.m.
Where: 500 Pasteur Drive, Stanford.
Pre-registration: Required, at stanfordhealthcares.com.
Activities: Events will include a photo booth, ask-an-expert opportunities, a teddy-bear triage center where children can make and take home a bear, a larger-than-life game of Operation, face painting, a treasure hunt, music, food trucks and more. Online registration for the walking tour of the hospital is closed, but a limited number of spaces are expected to be available each day through on-site registration. The event will also include a digital virtual walking tour of the hospital with limited seating.
Parking: Parking is available at a lot and a garage at Stock Farm and Oak roads, a short walk or shuttle ride to the hospital. A map is available here.
Other info: Stanford will post the virtual tour after the event on the website stanfordhealthcares.com.