Day Surgeries Aren't the Real Disruptor—Bedless Hospitals Are

Editor’s Note: Recently, day surgery, renowned for its low cost and high efficiency, has taken the medical community by storm. What makes it so impressive? The entire process of patient admission, surgery, and discharge is completed within a single day. In fact, there is an even more groundbreaking model: the “hospital without inpatient beds,” where hospitals do not provide inpatient beds yet patients can still receive high-quality medical care. How is this achieved?If a child were to build a hospital using LEGO bricks, it might resemble the colorful and whimsically designed Children's Hospital of Michigan Specialty Center, scheduled to open in February next year in Troy, a Detroit suburb in Michigan.

Children's Hospital of Michigan Specialty Center

“Everyone who passes by here says, ‘I know it’s for children, but I really don’t know what it’s actually for,’” said Ron Henry, Chief Equipment Engineer and Construction Director at Detroit Medical Center.The building is indeed designed for children, but its LEGO brick-like appearance serves another purpose.Detroit Medical Center (DMC) is one of a growing number of hospitals that focus on providing a wide range of medical services without offering inpatient beds. Spanning 63,000 square feet and built at a cost of $44 million, the pediatric outpatient center features a 24-hour pediatric emergency room and operating rooms, while its outpatient services cover multiple disciplines including cardiology, neurology, and oncology for various pediatric surgical conditions.“This hospital has everything you would expect from a hospital, except inpatient beds,” said Henry.

Similarly, last year, Montefiore Medical Center in New York opened a “hospital without beds” in the Bronx. The $152 million, 12-story facility spans 280,000 square feet and features 12 operating rooms, multiple laboratories, a headache clinic, comprehensive medical imaging equipment, and a full-service pharmacy, but it does not offer inpatient beds.These healthcare institutions provide services including telemedicine, medical imaging, short-term observation care, and surgery.

Technological advancements have eliminated the need for patients to stay overnight in hospitals for monitoring, as many routine examinations can now be conducted entirely through remote digital technologies. “Patients can log in via iPad from home, where they can access discharge instructions and medication information, as well as engage in video consultations with nurses,” said Paul Strom, Global Director of Healthcare at the architectural design firm HOK. “Large medical institutions are becoming less common, replaced by smaller, highly focused facilities. The hospitals we design today are trending toward being smaller, more efficient, and more flexible.”John Kouletsis, Vice President of Planning and Design at Kaiser Permanente, noted, “In 1952, people rushed to the hospital for any health issue. We always asked ourselves, ‘Can we reduce these frequent hospital visits?’ With the gradual advancement of technology, we have finally achieved this.”Technology has enabled Kaiser Permanente to provide patients with what they truly need: access to the majority of their healthcare services at small clinics located near their workplaces or residences. According to Kouletsis, “A significant portion of care is now delivered virtually.”

“If patients can access a wide range of healthcare services via mobile devices, they will certainly be very pleased.”Some healthcare providers have even separated post-treatment observation and rehabilitation functions from their emergency departments. Likewise, these medical institutions no longer require physicians to be physically present to review diagnostic results such as medical images and laboratory tests, as these tasks can be fully performed remotely. Curtis Skolnick, Managing Director of Healthcare at CBRE (a globally renowned comprehensive real estate services and consulting firm), stated, “In remote areas, it is certainly much easier to lay fiber-optic cables than to hire a neurologist.”One of the drivers behind the trend of hospitals becoming “bed-less” is cost.

Under dual pressure from insurance companies and consumers, hospital systems are gradually shifting toward low-cost outpatient care, which typically yields higher profit margins than inpatient care. However, other drivers are also at play, such as consumer demand and advances in science and technology.Many healthcare groups are abandoning the traditional model of hospital expansion by building standalone emergency centers outside major hospitals. For example, last year Mercy Health (Related topic: How does it bridge the information gap between hospitals by exchanging more than 600,000 medical records per month?) opened the first emergency room in Bella Vista, Arkansas. Another health system also named Mercy, whose service area is primarily concentrated in northwest Ohio and southeast Michigan, opened a standalone emergency department in Perrysburg, Ohio. This emergency department has short-stay observation beds but transfers patients requiring hospitalization to full-service hospitals.

Hospital systems are still building suburban clinics and studios to provide surgical and medical imaging services, rather than expanding these capabilities within large, functionally centralized hospitals. Moreover, these healthcare facilities are designed from the outset to fully embody the concept of maximizing telemedicine utilization. Skolnick cited an East Coast client as an example, who sought to specially design an outpatient center that would connect its physicians with those at major hospitals in nearby large cities. “They set up a room capable of connecting to the urban center, with all communications conducted in real time.”As for the new bedless pediatric hospital established by Detroit Medical Center in Troy, its functions can be reconfigured or its scale expanded if local healthcare demands and the company’s business objectives change.

Henry stated, “The building was designed with future expansion in mind. The children’s hospital is composed of modules serving different medical and nursing functions, making it easy to adapt its functionality.”Despite the establishment of this suburban healthcare facility, Detroit Medical Center will continue to provide pediatric inpatient care services. Moreover, these services are still being expanded within the city. Construction broke ground in August on a $140 million medical center featuring upgraded pediatric and neonatal intensive care units, surgical equipment, examination spaces, and 87 private patient rooms. Joe Marani, President and CEO of the medical center, remarked, “These needs are not going away.”Henry from Detroit Medical Center said, “The less distance patients have to travel to reach the hospital, the better their treatment outcomes, especially for children.” The need for numerous additional arrangements prior to treatment often exacerbates patients’ anxiety.

The design of this hospital building, and indeed other facilities, clearly reflects a patient-centered workflow. The Detroit Medical Center invited pediatric patients, their families, physicians, nurses, and other healthcare staff to participate in the design of its downtown Detroit Medical Tower.A significant aspect of improving the patient experience lies in reducing wait times. Many patients scheduling appointments for minor ailments, as well as those with serious conditions, often wait longer than expected. As wait times increase, patient satisfaction declines.New York’s Montefiore Medical Center has moved many routine surgical procedures out of the acute care setting, thereby significantly reducing delays. Susan Solometo, who oversees clinical services at Montefiore’s Surgical Care Center, stated, “You would not want a healthy individual undergoing a minor procedure to be treated in the same environment as someone next door requiring neurosurgery. If that were the case, the entire care process would likely be rushed.”

Montefiore Medical Center

The improvement in hospital efficiency, which eliminates the need for patients to stay for observation, has been widely embraced by many patients. Solometo stated, “Patients come to the hospital, receive hotel-like services and attentive care, and then are discharged to return home. Both our patients and physicians highly appreciate this experience.”Solometo pointed out that the healthcare system must attract consumers by incorporating more retail-oriented, patient-centered design features. Ease of use was a key focus during the design phase. Simply downsizing hospitals is not the optimal solution, as patients do not wish to travel between multiple locations to receive treatment.

At Montefiore Medical Center, they bring physicians together to address this issue. Therefore, rather than simply consolidating all operating rooms in one area, cardiac and vascular surgeries are located on the first floor, while plastic surgery and dermatological procedures are situated on another floor, with all services housed within a single building.

The trend toward “hospital-lite” models is expected to continue as greater emphasis is placed on population health management and reducing healthcare costs. “These acute care facilities will never disappear, but ultimately we will see a future where people rely less on hospitals,” said Richard Taylor, Managing Director of the Healthcare Solutions Group at JLL (a real estate firm).Skolnick suggested that if patients could receive treatment at nearby outpatient centers and return home afterward, they would prefer this model—provided they are confident that the facilities can deliver all the care they need. “A single point of entry, ease of navigation, and convenient access in and out—that’s exactly what they’re looking for,” Skolnick stated.

Compiled by Zhou Yanxun

Editor: Mo Renying