Sitting on a tight campus site, Carilion Roanoke Memorial Hospital in Roanoke, Va., is partially landlocked by Mill Mountain on the back side, leaving little room for the facility to grow over the years. In fact, the hospital had not expanded significantly since 1994 with the addition of the South Pavilion, which houses a 55-bed emergency department on the second floor.
In 2017, facing significant increases in patient volumes, especially in its emergency department which was straining to treat nearly 90,000 patients each year, the healthcare organization purchased 2 acres of land adjacent to the South Pavilion from the Western Virginia Water Authority.
As “the last adjacent land to expand the hospital campus horizontally,” the hospital sought to deliver the best-use case for the site, slated to include more than 40,000 square feet for increased emergency services, including 44 new beds, and a new 500,000-square-foot patient tower, says Sam Burnette, principal at Earl Swensson Associates (ESa; Nashville), which was hired to conduct a feasibility study and to design the expansion.
Outlining service lines for hospital addition
The architecture and design firm, together with Pinnacle Consulting (Philadelphia), studied long-range planning for the hospital’s service lines, determining that consolidating existing cardiovascular services into one location would support improved coordination among staff and provide more efficient and safer care for patients.
The new Crystal Springs Tower would house the Carilion Clinic Cardiovascular Institute as well as space for research and education. “Cardiovascular care is one of Carilion’s core strengths and a growing need in our community,” says Marguerite Underwood, vice president of the Carilion Clinic Cardiovascular Institute.
Overcoming site constraints on hospital campus
Turning to the site, the project team faced challenges with an approximately 40-foot grade from the highest to lowest points. ESa saw an opportunity to support the expanded service lines while bringing more parking on the campus. Specifically, to line up the ED expansion with the existing department on the second floor, two parking decks were built underneath, providing 150 additional spaces.
To address the clinical stacking strategy in the new 12-story tower, the project team sought to organize services and departments to enhance patient outcomes and improve provider communication. Direct vertical connections via dedicated trauma and patient elevators are located between the ED and critical heart and vascular care.
Additionally, the highest-acuity services are located on the lower floors to allow shorter transport times from the ED and trauma units, such as cardiac diagnostics and a heart failure clinic on the third floor and catheterization, electrophysiology labs, and cardiovascular surgery on the fourth floor.
“The vertical stacking is very important to minimize the distances for patients who need to be taken up to the Cath lab or surgery quickly,” Burnette says.
The third floor of the tower also connects to dietary and public dining services in the South Pavilion and a 550-space parking garage via an outdoor pedestrian bridge—the only public and visitor connection above the second floor. The new tower also features a second rooftop helipad for direct vertical connection to trauma bays in the expanded ED and critical cardiovascular services, as well as three floors of shell space that each can house a 32-bed inpatient unit.
Streamlined patient journey at Carilion Roanoke Memorial Hospital
Underwood says the feedback from patients and staff has been overwhelmingly positive.
“Patients now experience a streamlined cardiovascular journey. Every step of the care process is closely connected for maximum efficiency and ease,” she says. “Staff tell us the workflow improvements are making a real difference. We’re already seeing shorter treatment times and better coordination.”
