Building a better hospital…with cardboard


It’s 1 a.m. on a Wednesday. A two-year-old boy involved in a rollover automobile accident is brought into the emergency department at Boston Children’s Hospital. A scan shows fluid in his abdomen. He is becoming progressively unstable, his blood pressure plummeting despite blood transfusions. A decision is made to bring him to the operating room (OR), where a surgical team performs an exploratory laparotomy for a liver laceration and massive bleeding.

This is a test. It is one of the many tests of Boston Children’s Simulator Program (SIMPeds).

On July 13, 14 and 15, the entire seventh floor of the nearby Longwood Center became a theater, rooms with walls of cardboard became the stage, and hospital staff members became the actors. It was just one of many simulations—complete with cardboard transfusion machines, heart-lung machines and more—intended to help architects design ORs, procedure rooms, recovery rooms and other clinical spaces. These spaces will eventually make up a new 11-story, 445,000-square-foot hospital building. During the week, similar exercises also took place for a planned facility in Waltham.

Reimagining room capacity


“We are trying to identify optimal room size for patient care and evaluate specific design elements,” says Catherine Allan, MD, SIMPeds clinical director, who observed the simulation with Peter Weinstock, MD, PhD, director of the Simulator Program. “These simulations are designed to create maximum stress on patient rooms. We picked scenarios that used the most equipment possible so staff can figure out how you get things in there, whether there is enough room for them, and how to maneuver them in and out of the room.”



Engineers, above, explain the behind-the-scenes aspects of the simulation: “We are in control of the mannequin, in control of the bleeding, in control of the monitor, we are in control of everything the patient would produce. We are like the medical Wizard of Oz. We make it happen.”



The exercise meets its goal: “We were able to simulate what we encountered in the operating room pretty well here,” says Boston Children’s Hospital surgeon Khashayar Vakili, MD, below. “It is important for everyone who is involved in the planning of the operating room and its design to see how we actually function there. The cardboard provides a somewhat realistic expectation of what the space would be.”



“In the old version, the more traditional version, you draw plans, you put a bunch of furniture in there, you model what people might look like in there from a two-dimensional view,” says Weinstock. “Now, we can actually create a three-dimensional representation of those drawings like a pop-up and have people live in them and say, ‘How does that feel?’”


Learn more about the Boston Children’s Simulator Program.