Making cancer personal

Ask to see the televisions in waiting rooms at the new Smilow Cancer Hospital at Yale-New Haven if you want to delight Abe Lopman, M.B.A., its executive director. He’ll smile triumphantly and proclaim that there aren’t any. “It always sends a message that you’re going to be waiting for a while,” he explained. Other cancer centers have found tropical fish to be much more popular with patients, so several patient waiting areas in the new hospital feature saltwater tanks the size of loveseats. Exotic fish create serpentine ribbons of color—a markedly different sensory experience from those of Judge Judy or Rachael Ray as people wait to be called for an appointment.

“You feel cared for and nurtured here,” said Thomas J. Lynch Jr., M.D. ’86, director of Yale Cancer Center (YCC) and Smilow’s physician in chief. That feeling is engendered by everything from the artwork in the lobby to the trees and a stream in a rooftop garden.

It’s a small thing, this preference for fish over televisions. But it’s indicative of a larger principle: cancer care should focus on what the patient needs and wants. It should be personal. At 14 stories and 500,000 square feet, Yale-New Haven’s new cancer hospital cost an estimated $467 million. Every floor boasts an arsenal of leading-edge technology. Yet that simple core principle of patient care is the new facility’s true cornerstone. The ideal of personal cancer care shows in amenities intended to bring comfort to patients as well as in the building’s very structure, designed to change the way medicine is practiced.

Bringing cancer teams together

Cancer care is by nature interdisciplinary; however, the physical distance between departments often made consultation a challenge. The traditional arrangement had physicians grouped by specialty, and patients traveled from the surgeon to the radiologist to the oncologist and hoped that their medical charts arrived ahead of them. Clinicians recognized that they needed to work collaboratively but often resorted to faxes and e-mails to do so. “It’s always more difficult when the team members are not in one place and living and breathing these cases together,” said Edward Chu, M.D., professor of medicine (medical oncology), and of pharmacology, and deputy director of YCC.

Now the patient will literally be at the center of care, with various disciplines housed together in suites that facilitate collaboration. The suites will be organized by the type of cancer treated there, and a multispecialty team is now mobilized to treat each patient. Before Smilow, cancer patients at Yale needed to visit as many as six different buildings to get their care, recalled Chu. It was inconvenient for patients—doubly so for the elderly or those exhausted from their treatments, he said.

The new building is designed to foster collaboration in New Haven and beyond, said Robert Udelsman, M.D., M.B.A., chair and the William H. Carmalt Professor of Surgery. Teams will have access to conference rooms where they can look at diagnostic-quality images on large screens and interact with specialists at distant sites. Prognoses are more favorable for patients whose treatment is overseen by physicians with specific expertise and access to the best scientific data, said Udelsman.

Smilow is also designed to accommodate patients who must travel to get their cancer care at the medical center. Nearby 2 Howe Street, also constructed as part of the project, will feature residential units for patients and their families. “We want to be a destination hospital,” said Udelsman.

Waterfalls, fish, music, and coffee

The building had its grand opening on October 21, when donor Joel Smilow, a Yale College alumnus and the building’s namesake, and his wife, Joan, were honored. The first therapeutic radiology patient was seen a few days later. Other operations will be moving into the building in carefully choreographed stages through the spring.

Patients typically enter for their first visit through the front door into a bright soaring space with a two-story waterfall, a café, a piano, and a large reception desk with staff who can look up a patient’s schedule for the day and offer directions. Patients can also enter through 55 Park Street, which is connected to the Air Rights Garage. The building has a walkway that leads directly to Smilow’s fourth floor. Yale-New Haven Hospital’s laboratories will be housed in 55 Park, constructed as part of the project.

Reserved parking is available by the front door for patients in therapeutic radiology who must visit daily during treatment. They’ll get treatment in the basement, but they will still enjoy the natural light that illuminates much of Smilow. A large skylight opening into the ground floor atrium brightens the reception area. Glass transoms above doors throughout the building add to the airy feel. Waiting areas have open spaces as well as private nooks to accommodate patient preferences. The cabinetry’s light wood tones create a less institutional look.

This décor is a change from the existing Hunter Radiation Therapy Center, said Peter M. Glazer, M.D. ’87, Ph.D. ’87, HS ’91, department chair and the Robert E. Hunter Professor of Therapeutic Radiology. The ambiance of Hunter is not bad, Glazer said, but Smilow is a definite upgrade aesthetically and practically. “We have very good equipment now and will have even better equipment at Smilow,” he said. For example, a Novalis BrainLAB system will be installed, allowing stereotactic treatment—minimally invasive techniques guided by a three-dimensional coordinate system—for tumors of the spine and other locations. The move also offers the therapeutic radiology staff housed there the benefits of being on a single floor. As the department doubles the number of exam rooms, Glazer expects better patient flow.

The ground floor is home to the Women’s Cancer Center for treatment of breast and gynecologic cancers. The center will also be the site of regular screening mammography. It is located across from a boutique selling wigs and other items for patients in treatment. The store will have a “Saks Fifth Avenue” feel to it, said Lopman.

New space for patients, more space for physicians

Smilow will increase imaging capacity for the Department of Diagnostic Radiology from five magnetic scanners to eight, including dedicated MRI machines in the Breast Center and in the operating room for MRI-guided surgery. Diagnostic radiology, like many departments involved in Smilow, however, will not move all its faculty and staff to the new building. “The logistics are challenging, but Smilow Cancer Hospital represents a wonderful growth opportunity for our department,” said department Chair James A. Brink, M.D. But he noted that the radiologists had been practicing at varied locations already. The improvements offered at Smilow and the additional capacity in a department that sees more patients every year make the move “something we’re very excited about,” he said.

Smilow’s operating rooms are unusually large. All equipment is ceiling-mounted and slides into place wherever the surgical team wants it. This mobility includes drop-down high-definition screens that allow a surgeon to refer to an imaging study. The ceiling-based system makes it easier for the team to move and allows the room to be rapidly cleaned, explained Lopman. According to Udelsman, when physicians being recruited to the Department of Surgery tour the new facility, they ask: “What do I have to do to practice here?”

Children will continue to receive inpatient care at Yale-New Haven Children’s Hospital. A connecting walkway will give them access to a pediatric floor in Smilow for treatment.

For adults, the hospital offers inpatient rooms, all private. And yes, these rooms have televisions. Private rooms are better for infection control and make it easier for nurses to practice, said Lopman. Clinicians will be able to enter information on a bedside computer. The information will be available to every member of the team immediately. Each room has a sleeper sofa so that family members can stay overnight, and visiting hours never end at Smilow. “I’ve always been shocked by how we divorce the family from the patient at a time when they need their families more than anyone,” said Lynch.

On the rooftop garden, water features filter out the noise of the city and make the spot a destination for quiet walks. The building is equipped with high-speed elevators, but many stairwells have glass exterior walls to make them an inviting alternative. “We’re trying to encourage walking,” said Lopman. It’s an untraditional goal for a cancer center. But then Smilow doesn’t intend to be a traditional cancer center. “It’s built,” he said, “to change the patient’s experience.” YM