GI’s Move to Redwood City:

Not long ago, new patients at the gastroenterology and hepatology (GI) division would sometimes wait for months for a non-urgent appointment. They were well cared for once they got in, but the clinic space in Palo Alto was small, the huge enterprise was overwhelming and intimidating, and parking was nightmarish. Then someone suggested the possibility of moving five miles away to Redwood City, where an existing building could be redesigned to meet their needs. The division’s leadership decided to do it.

Preparations for the move were exhaustively detailed. Consultants were brought in and, says W. Ray Kim, MD, chief of the division, “They literally counted the steps that patients take, that staff take, that physicians take. Then they came in with Lego-like building blocks, and they had us arrange them. Then they mocked it up with cardboard boxes and we went through a day in the clinic with that mockup, then fixed things the best we could. They analyzed our workflow and talked with us about optimizing it. And then they built a physical space that would support the clinic space we wanted.”

The building’s redesign incorporated all the changes faculty sought to accommodate patients on the long appointment waiting list. It also gave them the opportunity to build to meet their future needs.

“As we were planning for the move,” says Uri Ladabaum, MD, senior vice chief of the division and medical director of the Digestive Health Center, “we stepped back to see how we wanted to practice in the future. The changes we wanted revolved around having patients taken care of by teams of people — physicians, nurses, patient care coordinators, medical assistants — who are now grouped into team cells. Every patient has one individual key contact person or navigator on their team cell. The physical space, the hardware, was designed around our new practice model, the software.”

Clinical spaces — including imaging and pharmacy on the first floor, the clinic on the second floor, and endoscopy on the third floor — occupy Pavilion D while administrative and clinical research areas are across a 30-foot-long bridge in Pavilion C. “The co-location of the clinic activity with clinical research and administrative space is really a huge thing for us,” says Ladabaum. Kim agrees: “It’s fantastic.”

The Clinic

Patients access the examination rooms in the clinic through one door, and members of the team cell through another. Behind the second door is a large area where all members of team cells work together. Ladabaum describes the clinic as “a very efficient space, very pleasant, calming. People have a good feeling being here, first and foremost the patients and their families, who are always the focus of the design, but then also the staff and faculty who work here.”

The clinic space lends itself to housing several multidisciplinary clinics, which especially pleases Linda Nguyen, MD, head of the clinic. “We have a pelvic health program where colorectal surgery, GI, urology, and urogynecology all see patients in the same area. We also have a multidisciplinary esophageal program, where both a gastroenterologist who specializes in esophageal disorders and a foregut surgeon can take care of patients with GI motility disorders like gastroparesis.”

“Because we’re working together, we’re easily able to talk to each other about mutual patients, and we meet to discuss those patients both informally and formally and come up with a comprehensive plan. In this way, patients with complex problems, irrespective of which one of us they see, have a group of physicians who are on top of their case,” Nguyen adds.

One administrative change that directly benefits patients is moving procedure scheduling under the supervision of the clinic. Now when patients are seen in the clinic and are found to need procedures, those procedures are scheduled before they leave the clinic.

The Endoscopy Suite

One floor up from the GI clinic is the endoscopy suite. Its design also reflects thoughtful attention to detail: All medical equipment is suspended from the ceiling or walls, freeing the floor for ready reconfiguration of rooms for different procedures. There are nine rooms for endoscopy procedures, and each has a pre-procedure area immediately outside. Rather than wait in a common waiting room, patients occupy the pre-procedure area outside their endoscopy suite and then are taken just a few feet for their procedure. Afterward they are taken to a central recovery room.

Back in Palo Alto, a second endoscopy suite is maintained at Stanford Hospital. Ladabaum explains the reasoning behind this decision: “That suite is focused on more advanced, complicated cases: inpatients who are sicker, and certain types of procedures that need fluoroscopy or complicated equipment. By focusing on just those types of patients, that unit is developing efficiencies in more challenging scenarios.”

Two other clinics remain in Palo Alto, explains Kim: “a liver transplant clinic where we need surgeons, nurse coordinators, and others located at the hospital helping us; and a collaborative clinic at the cancer center.”

Accomplishing Their Mission

Academic medical centers pride themselves on attention to their tripartite mission: to care for patients, to conduct research, and to train the next generation of care providers. Ladabaum believes the new facility that gastroenterology and hepatology occupies in Redwood City helps the division accomplish those goals. He says, “The idea is to fulfill our mission as an academic division. First, we want to provide outstanding patient care in a very friendly environment, and now we have what’s necessary to do that. Second, we need to integrate clinical research, and the personnel to do that are right here with us. Third, we need to train fellows, residents and medical students, and the space really is conducive to that, too.”