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The changing face of hospitals and health care: planned Sherwood facility will reflect the newest trends.

AS AMERICANS MOVED out of the city into the suburbs in the 1970s and early '80s, they moved from the health care facilities and the treatments that couldn't follow.

In the past decade, though, both the facilities and the treatments have adapted. Ambulatory or outpatient facilities are opening in neighborhoods and communities in need.

Sherwood is such a place.

The 19,000 or so people in this expanding suburb of Little Rock-North Little Rock in northeast Pulaski County have a problem: Health care is a few miles away. Jacksonville and the west side of North Little Rock have the closest hospitals.

For more than a decade, Sherwood has tried to alleviate the problem.

Now, help is on the way. Sherwood will have an ambulatory care campus in 18 months, says Tom Feurig, chief executive officer of St. Vincent Infirmary Medical Center in Little Rock.

St. Vincent and developer Continental Medical Systems Inc. of Pennsylvania have joined forces to bring the facility to Sherwood. The architectural firm of Burt Taggart & Associates Inc. of North Little Rock will design the facility.

"We are in the process of defining what services will be offered at the Sherwood ambulatory campus," Feurig says.

Feurig says he expects the facility to have some physician office space, provide clinical and diagnostic services, and have 24-hour urgent care for clients in the area. "We would also expect the potential for ambulatory surgery or a special procedures room," he says.

As for design, the facility would have the input from the people and health care providers of the community, Feurig says.

"Based on those interviews, we will finalize a description of the building, proceed to the architectural design and build the facility," he says.

Because the plans are not definite, Feurig says he can only give a "ballpark" figure of $8 million-$10 million on the cost of the campus, which should total 45,000-50,000 SF with a prominent five-story building.

The ambulatory care facility would be built adjoining the 3-year-old Central Arkansas Rehabilitation Hospital, developed and controlled by CMS and designed by BT&A.

Just as medical advances are bringing on trends, architectural firms such as Burt Taggart & Associates are helping change the look of health care.

No longer erected are the giant edifices with 500 rooms. The trend is to outpatient or ambulatory buildings -- 75 percent of health care is now in outpatient form. Insurance costs have led to less extended stays in hospitals, and surgery advances also have shortened the patient's recovery time.

When the larger inner-city hospitals are renovated, it usually results in more outpatient or ambulatory care wings to adapt to the trend. Patient comfort is a focus.

Free-standing surgery clinics and medical parks have arisen in cities for some time now. None, however, offer the comprehensive care in facilities like the one planned for Sherwood.

Most cities of Little Rock's size or larger have an ambulatory care facility in the outskirts. For example, 14 ambulatory care facilities have sprung up in the suburbs of Detroit.

"They are taking facilities to the community. The facilities are a satellite," says Jerry Currence, vice president and chief designer with BT&A.

Outpatient medicine in suburban America has become possible because technology has developed both in equipment and physician skill, says Larry Taylor, a health planning and regulatory consultant in North Little Rock.

"For awhile, there was resistance to the outpatient move by physicians," he says. "But in the last three to five years, that has changed. Physicians have seen less infection, less problems. All resistance has gone away."

Driving Force

Taylor was the driving force behind bringing an acute care facility to Sherwood.

Humana Inc., a national hospital firm, tried to build a facility in Sherwood starting in 1981. After several court appearances, Humana was without a certificate of need and not allowed to build the hospital. It left a half-finished building.

The law on certificate of need was changed, but Sherwood couldn't find companies building facilities. Then, the trend to outpatient modality changed the thinking.

"St. Vincent has recognized that," Taylor says.

BT&A, one of the largest firms in the state, devotes about 55 percent of its total work to designing medical facilities. Much of its work, such as the comprehensive outpatient rehab facility at the Loma Linda Medical Center in southern California, is out of state in concert with CMS.

"We've always tried to keep ourselves abreast of health care, the research in the field, traveling to various ambulatory care facilities," Currence says.

Research indicates that 39 firms in Arkansas devote at least some of their work to medical design. All are trying to adapt to health care's changing look.

The various projects in the University of Arkansas for Medical Sciences' $90 million building bonanza all have the 21st century in mind. The expanding Arkansas Cancer Research Center was one of the first facilities in the world to do bone marrow transplants on an outpatient basis, drastically reducing the cost of this procedure.

Conway has built an ambulatory care facility on its hospital campus. Fayetteville has a facility in the works away from Washington Regional Medical Center, in a medical park north of town.

Russellville's old St. Mary's Hospital now has a new look as a complete regional medical center with $7 million in new construction. The facility has a cancer center and a Magnetic Resonance Imaging center, both with separate entries.

Cromwell Architects Inc. of Little Rock, the largest firm in the state, handled the Russellville design work. About 27 percent of Cromwell's work is in medical-related areas, according to ProFile, the official directory of the American Institute of Architects.

"A lot of other people might not agree, but I think it takes a lot of experience and research and depth of expertise to do hospitals, because they are complex buildings," says Brent Thompson of Cromwell. "A person's life literally depends on many of the systems you're putting in the building."

Cromwell has several out-of-state projects. Thompson finds most interesting a job in Monroe, La., where a shopping mall has been taken over by a hospital to create a center for outpatient surgery and diagnostic services -- a Medical Mall.

If architectural trends have changed in hospitals, Thompson says, it's in the flexibility of the rooms. His firm puts an emphasis in making all rooms private for patient care. That enhances occupancy rate and utilizes space. Diagnostic and surgery rooms, he says, keep getting bigger.

The Fletcher Firm in Little Rock devotes 100 percent of its work to health-related design. Dwayne Wilson of the firm says design trends have followed hospitals' marketing efforts to target the maternity and female aspects of services.

"You see more of a residential hometype atmosphere," Wilson says. "The trends are more residential, the maternity and even the outpatient, to draw the whole family."

The architects admit there is uncertainty in the field, too, as the Clinton administration looks at health care reform. Rural areas in particular need answers in providing health care.

Sherwood, certainly not rural, needed those answers not long ago. Soon, the doctor will be right in town.
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Author:Harris, Jim
Publication:Arkansas Business
Date:Mar 29, 1993
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