advanced interventional

pain management

A I P M
a healing space for patients with chronic pain susan webster, asid

Interventional Pain Management is a group of health care professionals in WinstonSalem who specialize in the treatment of chronic pain. The practice consists of physicians, a psychologist, physician assistants, nurses and administrative staff. Treatment options include interventional procedures, psychiatric evaluation and/or counseling, medication management and surgical procedures.

Advanced

The practice is currently located in Winston-Salem on Kimel Forest Drive. This project will provide the practice a satellite clinic in Greensboro by renovating the existing structure at 314/316 West Elm in downtown Greensboro.

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advanced interventional
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original clinic

Miller Furniture Company, until 2007 the

oldest furniture store in Greensboro, opened in 1893 and moved into its final location on Elm Street in the early 1930s. The business survived the depression but not the changes in the furniture industry that followed. The building has been vacant since the current owner, Quinn Miller, closed the doors on his retail furniture operation.

south greene stre

314 316 west elm

et

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location

The building is actually

the existing building poses some problems

the support system is comprised of closely spaced columns and a wide wall.

two adjoined buildings. The downstairs of the building has solid tonguein groove maple floors. Columns are steel which rest on granite and support double I-beams. T

staff interaction could be inhibited by the vertical nature of the building stairways are narrow, steep and do not meet code

natural light is available only from the short ends of the rectangular building.

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challenges

by replacing existing small windows with much larger ones and adding a large oval skylight in the center of the building. An opening is created under the skylight which extends through all four floors so that most of the building will receive natural light from the skylight.

The problem of limited natural light is solved

The closely spaced columns are replaced with steel beams in order to install the skylight and allow for the large opening under it. The other benefit from this upgrade are fewer restrictions on where walls are placed which allows for a more efficient floor plan.

The building created a feeling of isolation between the four floors due to the small and poorly placed stairways and elevator. The opening under the skylight provides a visual connection between the floors, while the larger stairways and a more conveniently placed elevator provide a much better physical connection. The large stairway in the center of the building connects the two floors used by patients. The top two floors are only used by employees and are accessed either by fire escape stairs on the ends of the building or with a pass code on the elevator.

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the big picture

evidence-based design
The design process used in the AIPM facility incorporated evidence-based design, the practice of making design decisions based on the best available information and practice evaluations (Hill, p. 3). Roger Ulrichs report The Role of the Physical Environment in the Hospital for the 21st Century: A Once-in-a-Lifetime Opportunity was particularly useful. In the report Ulrich Indicates five key factors that are essential for the psychological well-being of patients and their families: provide access to nature reduce or eliminate environmental stressors give a sense of control provide positive distractions provide social support spaces Design elements incorporated in the plans that embody these principles include: access to nature or views of the outdoors harvested daylight use of materials that evoke nature
Hill, Tara R. Using Color to Create Healing Environments. http://www.hand-hygienesink.com/downloads/white-paper---using-color-to-create-healing-en.pdf. 9 May. 2011.

gold 3-form walls create the suggestion of warm sunlight

water fountain provides a natural element

large landscape paintings provide a positive visual distraction and views of nature

a large skylight adds natural light

natural materials evoke nature

windows were either added or enlarged to provide outdoor views and light

(Hill, p. 4)

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philosophy

hospital green is a thing of the past

Tara Rae Hill, ASID, from the LittleFISH Think Tank, in her paper Using Color to Create Healing Environments, provided information which influenced color selections in the space. She says, Evidence based design shows a strong correlation between healing and interiors that are stimulatingspaces that are not overly neutral, have interesting uses of color, and use positive distractions that focus on nature and color (p. 6). ...patients surrounded by vibrant surroundings recover three-quarters of a day faster, and needed fewer pain medications than those who did not (p. 7). ..colors previously considered too bright for health care settings, such as vibrant golds, citrus greens, crimsons and Carribean blues are considered therapeutic tools that directly promote healing (p. 7). Walls in the transitional spaces are white in order to reflect the natural light pouring into the center of the building from the large skylight, but use of intense color with art, translucent gold on walls, the stairway and water fountain. Copper is used generously on hardware and counter surfaces to inhibit the transmission of diseases and to add more warmth with its color.

Hill, Tara R. Using Color to Create Healing Environments. LittleFISHTHINKTANK. Mar. 2008. 11 May. 2011. <http://www. golittlefish.net/Corian_Using_Color_to_Create_Healing_Environments.pdf>

Color in exam, treatment and recovery rooms are not as vibrant as those used in short-term use spaces, but still avoid monotone or drab hues. Red is avoided because of the potential for wounds or piercing the patients skin (Hill, p. 8). Deep olive floors, copper counters and accents, and multi-color landscape paintings provide a restful area and eliminate the typical clinical atmosphere.

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color selections

the value of art for healing is a simple equation:

Healing has nothing to do with what appeals to the 21st century design mind says Barbara Lyons Stewart in her article Are we being too innovative when we select healthcare art? She references studies, including Roger Ulrichs, which establish the benefits of nature views, whether real or simulated, on healing. Nature views can lower heart rate, blood pressure and pain while improving mood. Design professionals need to avoid using art simply because it fits a specific aesthetic. Even abstractions of nature should not be used. Geometric compositions of leaves or abstractions of water or sky do not produce the positive results that representational landscapes do. In the AIPM facility art choices which are not representational landscapes are limited to non-patient areas.
Stewart, Barbara L. Are we being too innovative when we select healthcare art?. Healthcare Design Feb. 2011: 54a-b56.

art affects emotions emotions affect outcomes

Haggith, David the art of healing. healthcare design Mar. 2011: 62a-b63.

&

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art selections

ancient wisdom assists new technology

Michael Schmidt, Ph.D., a microbiologist at the Medical University of South Carolina (MUSC) in Charleston, has proven with recent studies what ancient civilizations knew and used to their advantage. Copper is microbiocidal, meaning that it kills bacteria that come into contact with it. Dr. Schmidt says We are just now rediscovering this activity that copper is antimicrobial and by placing it in close proximity to our patients, we may then be able to short circuit the transfer of the microorganism from the environment to the patient......by putting metallic copper onto these surfaces, we are going to reduce the concentration of indigenous microbes in the room to a level that will drop the incidence of hospital-acquired infections.
Healthy Life: Copper to Fight Infection. kcrg-tv news. 23 Sep. 2008. 15 May. 2011. <http://www.kcrg.com/news/health/29579524.html>.

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fighting infection

Bold color, sinuous lines, liberal quantities of glass and the juxtaposition of strong vertical and horizontal planes are the elements which directed the design of the building. The large windows combined with multiple patio spaces blur the boundaries between indoors and outdoors. Materials - concrete, steel and copper - provide contrast in both color and texture. The patient entrance establishes the tone of the rest of the building with its garden, outdoor seating and circular components.

The rear of the building continues the elements established on the front, but in a more subdued manner. The geometric planes are more delicate and the presentation is more informal, appropriate for the section of the building used primarily for staff: offices, patios, exercise room and rear entrance.

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exterior

1st floor reception, psychology, exam

2nd floor surgery, recovery, exercise

3rd floor administrative, clerical

4th floor physicians , pas, dining

floor plans
Spaces are organized based on public and staff use, with the first floor being the most public and the fourth the most private. There are two entrances to the building: the patient entrance is on Elm Street and the staff entrance is on the alley parallel to it. The center of the building is open through all four floors with a large skylight above the opening. Due to the fact that most of the small rooms in the interior of the building do not have access to natural light, clearstory windows on interior walls are planned in order for them to benefit from it. Curved lines are used throughout the plan to create movement and to avoid long, narrow hallways in spite of the multiple small rooms required in the space.

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space planning

waiting and reception nurse station examination rooms psychology

Even before entering the building it is apparent that the design includes necessary accommodations for the large percentage of the patient population with ambulatory issues. A covered outdoor area with seating is provided for patients who need to wait for a driver to pick them up. Spacious pathways are allowed for wheelchairs and other mobility aids. Receptionists are able to supervise any problems patients may encounter with clear views to the outdoor waiting, indoor waiting and examination area from their work space.

psych testing psychology clean linen soiled linen

up exam exam exam exam exam elevator exam storage reception outdoor waiting

down down mechanial

consult storage nurses station

up waiting

exam exam exam up women men exam exam

staff
patient

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first floor

procedure and surgery patient recovery staff exercise

exercise

women surgery down elevator

men

up hand washing

storage

surgery

Employee health issues are taken into account with both the provision of an exercise room and the option of having treadmill desks. Issues to be considered on this floor are hallways wide enough to maneuver stretchers, lead installed in procedure/surgery room walls to contain radiation from fluoroscopy machines and the potential for adding physical therapy services in the future.

surgery

women up men

recovery

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advanced interventional
pain management

second floor

administrative file storage conference

office

women office
coffee

men elevator

up fax/copy office practice administrator

office

office

office

office

office office office file storage office conference office office

Staff can exit the building or go to the exercise room without going through patient spaces via the rear fire escape stairs. There is easy access to the dining room, which is one floor up. Both covered patios are available during meals and breaks.

office up

mech./ storage

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third floor

physicians physician assistants dining conference

The dining room is large enough to be used for meetings or presentations for the entire staff and the kitchen area is well equipped to accommodate catered meals. All three of the physician offices are generously sized with ample windows.
physician

women physician assistant physician physician assistant elevator

men

dn

fax/copy

storage physician

physician assistant

down

mech./ storage

physician assistant conference

dining/meeting

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advanced interventional
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fourth floor

north

west

N W

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sections

entrance and waiting room

1st floor patient entrance waiting_view 1 waiting_view 2

patient entrance

waiting_view 1

waiting_view 2

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advanced interventional
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first impressions

central stairs & examination area

3rd floor_central stairs

1st floor_examination area

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core of the clinic

water fountain

The fountain is constructed of 3form panels supported by a frame of 1 aluminum tubing.

Water is pumped through the tubing and flows out of multiple 1/4 openings at the top of the structure.

A sheet of water pours into the pool.

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advanced interventional
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focal point

recovery & examination

2nd floor

Hardware on cabinets in the recovery room is

plated with copper for the anti-bacterial benefits it provides. Drawer pulls are the entire height of the drawers and designed so that contact will be made with only copper. Openings covered with copper are used in lieu of handles for the cabinet doors.

1st floor

drawer pull

cabinet doors

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advanced interventional
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patient care

physician office & dining room

4th floor physician office dining room

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staff spaces

waiting room furnishings

item fabricator description

price quantity

custom cocktail table Charleston Forge Boone, NC 48 d. x 16 ht. base: iron with antique pewter finish top: 48 x 3/4 flat edge glass $1000 3

item fabricator description

fabric price -

custom upholstery Michael Thomas Liberty, NC depth 39, height 39, seat height 19, seat depth 20 94 linear feet in 4) sections Sunbrella 5403 Canvas Jockey Red $12,000

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product specifications

waiting room finishes

gypsun board walls to be painted Benjamin Moore Paint Guilford Building Supply 1621 Battleground Avenue Greensboro, NC 27429 paint product: Natural paint color: Oxford White high gloss Eco Safety Products 2921 W. Culver St #4B Phoenix, AZ 85009 TimberSoy Natural Wood Stain Color: Natural

waiting room fixtures

item manufacturer

existing maple floors to be repaired and stained (the actual appearance ot the wood floors will be darker than the sample )

material quantity price estimate

translucent walls 3form 2300 South 2300 West Suite B Salt Lake City Utah 84119 chroma/lemon installed with align hardware 32 linear feet @ 14 ht. 37 linear feet @ 8 ht. $18,000

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product specifications

waiting room fixtures

item manufacturer exterior door Steiner Doors 694 Myrtle Ave. PM Box 504 Brooklyn, N.Y. 11205 custom design 2)36 x 96 glass doors base and top plate steel with antique pewter finish $4000 for set interior door Lynden Door 2077 Main Street Lynden, WA 98264 IC6000FD60 Mineral Core/wood veneer ebony finish 36 x 96 $200 2) doors

item manufacturer

product

price

door knobs A.S.Hardware Limited, 3 Central Court, Finch Close, Lenton Lane Ind Est, Nottingham, NG7 2NN UK ASH900 copper solid round bar lever handle with 50mm dia. round rose custom backplates of copper and steel to be fabricated $150 interior doors 2) sets $600 exterior door,1)set

product

price item manufacturer product

price

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advanced interventional
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product specifications

physician office furnishings

item item fabricator description plywood s-chair sketchup design Adrian Boggs depth 39, width 36 height 39, seat height 19, seat depth 20 plywood $1000 2 fabricator description

fabric price quantity

material price quantity

custom upholstery sketchup design Michael Thomas Liberty, NC depth 39, width 95 height 39, seat height 19, seat depth 20 Schumacher Babes Tweed 54230 Granny Smith $2,300 1

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advanced interventional
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product specifications

physician office furnishings

item fabricator description material price quantity

desk Charleston Forge width 72depth 39, height 29, base-steel top-3/4 flat edge glass $1000 1

item fabricator measurements materials price quantity

cabinetry Charleston Forge Boone, NC shelf - 72 x 14 x 14 base - 72 x 25 x 35 maple with steel top and trim $2,500 1

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advanced interventional
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product specifications

physician office furnishings

item fabricator description

fabric price

custom upholstery sketchup design Michael Thomas Liberty, NC side chair depth 39, width 36 height 39, seat height 19, seat depth 20 Sunbrella 5403 Canvas Jockey Red $1,000

item manufacturer description

price

desk lamp Lighting Universe Liberty, NC Ott-Lite F48LU8 Natural Day Desk Light 6.75 W x 14 H copper finish $53

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advanced interventional
pain management

product specifications

physician office finishes

gypsun board walls to be painted Benjamin Moore Paint Guilford Building Supply 1621 Battleground Avenue Greensboro, NC 27429 paint product: Natural paint color: Oxford White high gloss Eco Safety Products 2921 W. Culver St #4B Phoenix, AZ 85009 TimberSoy Natural Wood Stain Color: Natural material quantity price estimate

physician office fixtures

item manufacturer

existing maple floors to be repaired and stained (the actual appearance ot the wood floors will be darker than the sample )

translucent ceiling 3form 2300 South 2300 West Suite B Salt Lake City Utah 84119 Mango Varia Ecoresin installed with shapes and versa hardware 12) 12 x 20 0 sections $12,000

MATERIAL USED

37

HARDWARE USED

Mango Varia Ecoresin

Shapes

Versa

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advanced interventional
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product specifications

physician office fixtures

item manufacturer

product

price quantity

door knobs A.S.Hardware Limited, 13 Central Court, Finch Close, Lenton Lane Ind Est, Nottingham, NG7 2NN UK ASH900 copper solid round bar lever handle with 50mm dia. round rose $90 1

item manufacturer product

interior door Lynden Door IC6000FD60 Mineral Core/wood veneer ebony finish 36 x 96 $200 1

price quantity

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specifications

dining room furniture

item fabricator description material price quantity item fabricator description material seat cushion price quantity custom dining table Charleston Forge 48 diameter height 29 maple $800 10 custom barstool Charleston Forge width 16depth24, height 32 steel Sunbrella 5446 canvas green $200 5

item fabricator description

fabric price quantity

custom upholstery Michael Thomas Liberty, NC side chair depth 39, width 36 height 39, seat height 19, seat depth 20 Sunbrella 5446 canvas green $550 40

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specifications

dining room finishes

flooring ARMSTRONG P.O. Box 3001 Lancaster, PA 17604 CATEGORY Sheet ITEM NUMBER 88213 White Sand FORM Sheet CATEGORY Linoleum ITEM NUMBER LP153 Cool White FORM Sheet $5.25 per square foot gypsum walls to be painted

dining room fixtures

Benjamin Moore Paint Guilford Building Supply 1621 Battleground Avenue Greensboro, NC 27429 paint product: Natural paint color: Oxford White high gloss door and door hardware to be the same specifications as in physicians office 3form wall same specifications as in waiting room

item: manufacturer:

sink price: faucet price:

copper sink & plumbing fixtures Triflow Concepts Limited Gateway XIII Ferry Lane Rainham United Kingdom phone: 0207 079 0541 $650 $400

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specifications

dining room fixtures

item fabricator description

price

custom cabinetry The Cabinet Studio Winston-Salem, NC maple cabinets with concealed hinges copper countertops banded with steel 32 linear feet of base cabinets 17 linear feet of wall cabinets $12,000

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specifications

waiting room budget

item Benjamin Moore Paint 5/8 dry wall partition w/ metal studs 1/2 drywall ceiling refinish wood floor vinyl baseboard Halo recessed downlights copper & iron window detail dropped ceiling detail Lynden Doors interior doors A.S. Hardware Limited int. door handles Steiner Door exterior doors A.S. Hardware Limited ext. door handles 3form wall Michael Thomas sectional sofas Charleston Forge cocktail grand total quantity 3334 2220 1134 1134 103 137 1 3 2 2 2 1 1 1 2 units square feet square feet square feet square feet linear feet price per unit $1.91 3.76 1.67 1.30 0.71 16 2000 400 200 150 2000 300 18000 12000 1000 total $3461 5256 691 538 66 2192 2000 1200 400 300 4000 600 18000 12000 3000 $61773 item Benjamin Moore Paint 5/8 dry wall partition w/ metal studs 1/2 drywall ceiling refinish wood floor vinyl baseboard Lynden Doors interior doors A.S. Hardware Limited int. door handles 3form ceiling plywood s chair Michael Thomas sofa Charleston Forge desk Charleston Forge cabinets Michael Thomas desk chair Lighting Universe lamp Grand Total

physician office budget

quantity 1812 1398 414 414 93 1 1 1 2 2 1 1 1 1

units square feet square feet square feet square feet linear feet set

price per unit $1.91 3.76 1.67 1.30 0.71 200.00 90 1200 2000 2300 1000 2500 1000 53

total $3461 5256 691 538 66 200 90 1200 2000 2300 1000 2500 1000 53 $20356

set set

set

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budget

dining room budget

item Benjamin Moore Paint 5/8 dry wall partition w/ metal studs 1/2 drywall ceiling Armstrong Linoleum Flooring vinyl baseboard Lynden Doors interior doors A.S. Hardware Limited int. door handles 3form wal Halo recessed downlights Juno undercabinet lights Triflow kitchen sink and faucet Cabinet Studio cabinets square maple dining tables round maple dining tables bar stools GE slide in range Samsung refrigerator Samsung dishwasher GE microwave ceiling detail over island dining chairs grand total quantity 4543 2978 1565 1565 147 1 1 1 152 4 1 1 7 6 5 1 1 1 1 1 40 units square feet square feet square feet square feet linear feet set price per unit $1.91 3.76 1.67 1.30 0.71 200.00 90 1200 16 102 1000 22000 500 800 200 1349 2399 688 799 1000 250 total $3461 5256 691 538 66 200 90 1200 2000 2300 1000 22000 3500 4800 1000 1349 2399 688 799 1000 10000 $98928

set

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advanced interventional
pain management

budget