The Art of Visualization

 

From pencil sketches and watercolors to modern computer based renderings, architectural visualization has proven to be the keystone to client project comprehension. The ability to take two dimensional line work drawings and bring them into our three dimensional world creates a link between what is in the architects mind's eye and what the built project will look and feel like.

Architectural visualization seeks to strike a balance between the often criticized utopian ideal of a project and the realities of its surroundings by creating a series of image which tell the story of the space to clients and future users. This can be especially important in healthcare design where much of the functionality of the space takes place in the three dimensional plane. Where plans and elevations show the layout of a room in relation to the whole through a series of drawings, a rendering can show how the space feels in a single, easily comprehensible image. 

The following are renderings and photographs of some of our recent projects:

Emergency Department at Lake Charles Memorial Hospital


Emergency Department at HackensackUMC Pascack Valley Hospital


Cath Lab at Chilton Hospital


Nursing Station at Lake Charles Memorial Hospital


Infusion Center at Memorial Sloan Kettering - Basking Ridge Hospital


Entry Lobby at Memorial Sloan Kettering - Basking Ridge Hospital

Emergency Department Care Initiation

PDS has been performing research and development to understand, assess and improve the Emergency Department patient experience through improving the care initiation process. 

This work is focused on a fundamental change in the patient arrival, triage and registration process, including management of ESI 4/5 patients to minimize their impact on ED bed positions.


In the traditional model the patient arrives and is greeted at a reception desk.  A registration clerk, and/or clinician along with a security representative or any combination of this group may staff this desk position.  At this point a variety of processes may occur, registration, verification and possibly a quick triage.  Then the patient would be directed to bed, triage or waiting contingent on current occupancy within the ED.  They may be indicated for either the core ED or Fast Track if available. 

Within the constraints of this model, a number of issues may develop that impacts the patient experience:

  • Multiple simultaneous arrivals may overrun the reception desk staff causing lag and an extended queue time to reach the registrar or clinician.
  • Extended queue line may impact access to the ED lobby or waiting area, may cause automatic doors to cycle excessively and impact environmental control.
  • Extended queue line causes patients to comingle in close quarters, a potential infection control issue.
  • Acquiring of personal information at the registration desk may compromise confidentiality, patients may not have audible privacy and may refrain from wanting to reveal their health issues or feel uncomfortable in doing so.
  • Triage may become overwhelmed also, which may cause backlog in the waiting room and waiting room saturation, again causing patients to comingle and potentially causing patient dissatisfaction.
  • Bed saturation within the ED may also cause waiting room saturation, again triggering co-mingle and dissatisfaction issues.

In the PDS R&D model the patient arrives and is greeted by a clinical concierge person at a podium, rather than a desk.  The clinical concierge performs a quick assessment of the patient and then directs them into a series of Care Initiation Pods.  Once in the Care Initiation Pod, both the registration and triage team supports the patient, working together to support multiple patients, each in a discrete confidential and environmentally friendly space.  From this point patients are either taken direct to bed (ESI 3) or if ESI 4/5, are directed to what we are calling a Rapid Treatment Unit.  The RTU is comprised only of chairs/recliners and intended only for the ESI 4/5 patient, which may comprise of 20% of the ED volume.  The intent is to siphon these patients out of the flow of the core ED and minimize impact to operations.  In addition to supporting the ESI 4/5 patient, the RTU can act as a buffer between the Care Initiation Pods and the core ED, allowing patients to be seated, waiting for transfer to a stretcher in the ED but with oversight of the clinical staff and not being warehoused in the Waiting Room.


Anticipated impacts to the patient experience:

  • Immediate greeter station that quickly moves patient into the care initiation process, which will eliminate queue times and congestion in the lobby.
  • The registration and quick triage process occurs in a private space, not in the waiting room, which improves confidentiality, and makes the patient feel that they are seeing a provider immediately upon entering the ED.
  • Minimized impact to waiting room overcrowding and co-mingling of patients.
  • ESI 4/5 patients go direct to chair, are treated and released without ever entering the core ED.
  • Creation of a buffer to bridge between the waiting room and the core ED when occupancy rates are high, providing space to hotel patients within a clinical environment under supervision, not in corridors or waiting rooms.

We are currently testing this alternative delivery concept with a number of clients with whom we are working on Emergency Department planning.  In addition we are using computer simulations to further this research and optimize the ratios of initiation pods to rapid treatment unit chairs to maximize efficiency.

Brooklyn Hospital Think Tank

Earlier this year, our Principle, Michael had the opportunity to work alongside noted healthcare design industry leaders around the New York City area to spend three days in Brooklyn thinking about what an idealized future of healthcare could be.

Read the full article

Participants included:

Rosalyn Cama, president and principal interior designer

CAMA Matthew A. Finn, president and director of applied research, Cognitive Design

Carolyn Glaser, vice president for strategy and operations, The Center for Health Design

Robin Guenther, principal, Perkins+Will and senior advisor, Health Care Without Harm

Debra Levin, president and CEO, The Center for Health Design

Don Orndoff, senior vice president, National Facilities Services at Kaiser Permanente

Tanya Paz, senior designer, CAMA

Michael Pomarico, principal-in-charge, Pomarico Design Studio Architecture

Barry S. Rabner, president and CEO, Princeton HealthCare System

David Ruthven, creative lead, Philips Design 

 

Studying Context

In developing intelligent design, we always consider context first. Regardless of scale or project type, the goal is always the same: seamless integration. In this schematic study for a new hospital, we are understanding the existing systems of movement within the local community in order to shape our site and building flow in ways that are compelling, convenient and welcoming to the neighborhood. In this scheme our goal aims to create not only a functional hospital but a cultural hub for a wide range of activities and public functions.

Nyack Hospital Breaks Ground

We are ecstatic to break ground for Nyack Hospital's Emergency Department!  PDS was tasked to modernize and reconfigure the existing Emergency Department.  This 18,000 SF project will be a mixed occupancy expansion, including a newly designed Emergency Department, Lobby, and supporting spaces.

Click the following image to read more at Lohud

PDS' ED rendering for Nyack Hospital

PDS' ED rendering for Nyack Hospital

Three bricks, different aesthetics

Gauthier Behavioral Health Hospital

Location: Lake Charles, Louisiana

In this material study, PDS was challenged to find a simple and cost effective way to make an ordinary brick wall appear extraordinary and dynamic. In an attempt to make the massive 65,000 SF building feel light weight, we are working with a gradient of 3 brick types. Moving from darkest at the bottom and fading slightly to a light colored brick, we ended by capping the building with a Bone colored roof in a final gesture of lightness and visual balance.

HackensackUMC at Pascack Valley Emergency Department Ribbon Cutting Ceremony

We are thrilled to see the opening of the newly renovated Emergency Department at Hackensack University Medical Center at Pasack Valley, New Jersey!   Pomarico Design Studio Architecture worked alongside HUMC medical staff and contractors at Wm. Blanchard Co. to modernizing the Emergency Department in order keep up with advancing medical technologies.

Click the following images to read the full article on The Record and NorthJersey.com!

Organizing Interactions

Oftentimes our healthcare designs focus intensely on efficiency. We are constantly optimizing layouts to meet the desired program, while ensuring that each piece of required equipment finds an intelligent home too. To balance this practical behavior, the PDS team also enjoys integrating a less obvious element when appropriate: organizing social interactions.

In this study, we needed to introduce acoustic paneling to dampen the loud sounds created in a large/open shared space. The challenge was one of cost efficiency and pattern making: how to intelligently introduce a simple acoustic tile. The opportunity that was identified dealt with understanding the nature of each unique activity associated with the nurse's station, the cafeteria and the quiet meeting spaces.

Here we have diagrammed the organization of the (3) types of activity: medical staff (red), patient-active (green) and patient-quiet (blue) in an attempt to better understand where acoustic adjustments might be necessary. To accommodate the auditory volume of conversations, we were able to assume that the panels should be "clumped"  in obvious areas where interaction was more likely. This assumption, combined with a simple grid, allowed us to generate an intelligent pattern that was both expressive of the user, practical and cost efficient. 

PDS is moving into a new studio!

Pomarico Design Studio is excited to announce that we are relocating our headquarters to the charming waterfront, within the City of Newburgh. We have proudly outgrown our space on Main Street, in Beacon. Although our 8-year stay was delightful, we are looking forward to enjoying our new view from the other side of the river. 

At the beginning of February, 2016, the home base of PDS can be found at 19 Front Street in Newburgh, NY with a new phone number too: (845) 561-0448. Our New York City Office will remain the same and you can still reach the team with all of your existing contact info. 

We always welcome visitors. Feel free to stop by to see what we we are working on or just to say hello.

Rethinking Psychiatric Care

We were recently asked to imagine a new platform for administering treatment to a growing population of psychiatric patients, with a wide range of ages, personal stories and levels of care needed. 

In this study we have focussed our attention on what we call COMMUNITY CARE. We recognized a serious void in the amount of common space allocated to patients within psychiatric treatment centers. 

Our aim here is simple: provide each client with a safe level of freedom to move and converse with the rest of their treatment neighbors.

This project is now moving in its Construction Documenting phase so check back for updated media in a few months!

Following up on the Human Gait

In our last post, we were testing some new techniques and looking closely at ways to make the typical Nursing Unit more efficient. Our first step involved something we are exploring across the board, in many of our current projects: DECONSTRUCTING THE  NURSE STATION.

In other words, we have asked ourselves (and our clients) "Why do nurses sit at desks? Is this still a relevant concept or are we simply replicating past necessity with outdated approaches?".

We have concluded that Nurse Stations are not a necessary element in all Nursing Units, anymore. There are plenty of new/mobile tools that make charting and patient documentation much more efficient, freeing up space and saving cost on traditional millwork expenses.

Now that we identified the opportunity to save space and money, the next challenge is how to intelligently use all this extra space.

In this project our focus has been on the patient first and the visitor second...don't worry the staff are also seeing great improvements in how they utilize space and work within the unit. But in this project we have focused heavily on the amenities that make the visitor's wait and stay more comfortable while they provide the companionship necessary to all patients during recovery. 

Shaping Space, The Human Gait, Technology and Planning for the Future Deconstructing the Nurse Station

PDS was recently faced with an exciting challenge: Convert a 30-year-old nursing unit into an efficient / felxible space, prepared to adapt to the next 30 years of healthcare advancement.  Looking back and looking forward, we find ourselves in a unique place in time.  Behind we see nursing units structured around large bulky stations, crafted to address the needs of the paper chart world.  The present, we find ourselves surrounded by constant advances in the delivery of data.  Data is everywhere.  We access it on our watches, phones, tablets, laptops and occasionally a desk top computer.  The future, we anticipate will further the human mobility of navigating in a world of data; It will be everywhere.  The Cloud will be an ether in which we live, we will be surrounded by data and we believe devices will eventually become integrated into everything we do, who we are, what we are, our spaces, our environments, our clothing, our accessories.  All to facilitate access to our data.

So how do we create a nursing unit that will address the current needs of large mobile computing carts and residual paper as our society transitions to the ether?  How do we create a flexible environment that will embrace the movement to a mobile society that is fluid in its access to data?  How do we understand mobility, stations, visual fields, and layering of space to create flexible environments?

We have begun our study by breaking down the unit through a cohesive study of the human gate and how the users of the space might actually occupy it.  How do we move through space, how do we embrace the fluid needs of mobile access to data? How do we create space where there is none?  We see deconstruction of the past as a solution to creating space for the future.  Removing barriers that are impediments to our being able to embrace mobility and access to data, each other and the patient.  Removing barriers to find space where there was none, to accommodate family members in calming, collective space that supports their needs.

Below you will find our early studies that focus on natural circulation and usage of the residual "negative space" that occurs through deconstruction.  Woven through this space are the path of patients, visitors, nurses and physicians.  Within the deconstruction, we aim to find the solution to the future, mobility and access to data.  Ultimately, we believe this will free us to finally realize the true benefits of technology which will allow nursing to function in a fluid space facilitating patient care and interaction with all involved in the healing process.