April 2021Feature articles

On its fifth anniversary, Pavilion K emerges as the silent hero of the pandemic

Safety, comfort, spaciousness, natural light are hallmarks of the critical-care wing

Last fall, Marie-Hélène Carbonneau set out in search of the unvarnished truth about Pavilion K.

During an extensive, multi-week tour of the JGH’s critical-care wing, she asked one employee after another to be brutally honest with her—not just about what was working well in Pavilion K, but just as importantly, what wasn’t.

It’s not as if she was eager for negative comments. However, the goal of her fact-finding mission was to determine whether any aspects of Pavilion K ought to be avoided, as well as embraced, when some areas in the JGH’s older pavilions (known as “the legacy building”) are renovated in the coming years.

A COVID-19 patient receives treatment in a room in Pavilion K that can accommodate a great deal of medical equipment. (Click on this or any photo to enlarge it.)

A COVID-19 patient receives treatment in a room in Pavilion K that can accommodate a great deal of medical equipment. (Click on this or any photo to enlarge it.)

But wherever she turned, the reactions in an overwhelming majority of cases were the same: smiling faces and rave reviews.

“I was very surprised,” recalls Ms. Carbonneau, a retired nurse and former Interim Director of Nursing, who now serves as the legacy project’s Consultant and Clinical Expert.

“I expected the response to be upbeat,” she says, “but I didn’t realize how passionate the positive reaction would be.”

If anything, those feelings have only intensified since early 2020, when the JGH—that is, Pavilion K—was designated by the government as one of the first few healthcare centres in Quebec to admit and treat patients with COVID-19.

Today, having marked its fifth anniversary of full operation, the pavilion is widely (but informally) viewed by many members of staff as the silent hero of the pandemic.

“Pavilion K has more than lived up to its promise,” says Dr. Lawrence Rosenberg, President and CEO of CIUSSS West-Central Montreal. “Through its over-all design and its many special features, we sought to create an in‑hospital experience that would contribute to faster healing—and we’ve clearly delivered on that promise.

“This is in keeping with the JGH’s long history of providing patients and families not only with superior care, but with an environment that’s welcoming and friendly. Despite Pavilion K’s size and complexity, there’s no denying you get a warm feeling just walking through it.”

Pavilion K is launched

The first indication of K’s success came in February 2014, when the new Emergency Department was launched on the ground floor. From its very first day, staff took full advantage of its revolutionary design, which can accommodate a large volume of patients by streaming them into different areas, depending on the type and severity of the medical problem.

By 2012, the construction of Pavilion K was well under way. Pavilion H can be seen in the background on the right.

By 2012, the construction of Pavilion K was well under way. Pavilion H can be seen in the background on the right.

Then, on January 24, 2016, the rest of Pavilion K threw open its doors, after a decade of planning, years of construction, months of painstaking preparation and weeks of simulation exercises.

On that day, the largest and most ambitious expansion project in the history of the JGH reached its climax by taking a mere 5½ hours for the safe, comfortable and carefully coordinated transfer of 203 patients—many of them in serious condition—from the legacy building to their new rooms in K.

Instantly, Pavilion K became the upgraded home of Intensive Care, Coronary Care, Neonatal Intensive Care, the Family Birthing Centre, the operating rooms and a host of other units and services.

Of key importance was that K’s 10th floor was fully equipped with negative-pressure rooms, whose ventilation system pulls air from the corridor into the patient’s room. As a result, potentially contaminated air cannot leave through the door of the patient’s room. Instead, it is extracted and filtered by a separate system that does not connect with the rest of the hospital.

January 24, 2016: A patient is on the way from the Coronary Care Unit of the legacy building to her new room in Pavilion K.

January 24, 2016: A patient is on the way from the Coronary Care Unit of the legacy building to her new room in Pavilion K.

This makes K10 ideal for treating respiratory infections on a pandemic scale—a much-needed capability that helped convince the provincial government to contribute most of the funding to build the new wing.

However, during the planning stages, the word “pandemic” usually conjured up images of what would now be thought of as a relatively small-scale infection, such as the H1N1 flu.

For example, Joanne Côté, who oversaw the move to K, says she initially thought the pandemic facilities in the new pavilion might be called upon to treat roughly a dozen hospitalized patients, including six in Intensive Care.

By contrast, at one point during the COVID-19 crisis, the JGH was using the 10th floor and other designated hot zones in K to tend to as many as 167 patients, says Ms. Côté, who today is Director of Quality, Innovation, Evaluation, Performance and Clinical Ethics for CIUSSS West-Central Montreal.

During the major relocation on January 24, 2016, a prematurely born infant is carefully moved in its incubator to its new room in Pavilion K.

During the major relocation on January 24, 2016, a prematurely born infant is carefully moved in its incubator to its new room in Pavilion K.

“Some people thought we were crazy to include so many negative-pressure rooms,” she adds with a chuckle. “But our intention always was to plan for the unexpected—and the unexpected is exactly what we got when COVID-19 struck.”

“We never, ever, ever even remotely imagined the magnitude of COVID-19,” agrees Dr. Paul Warshawsky, Chief of Adult Critical Care. “I thought we’d have something like a dozen cases in the ICU—not the large numbers that we ended up getting. Can you imagine what would have happened if we hadn’t had this building?”

Dr. Warshawsky also notes that K was of critical importance to all of Montreal in the earliest weeks of the pandemic in 2020, because the pavilion briefly enabled the JGH to shoulder the burden of all of the adult cases in the city. This gave other hospitals the vital breathing space they needed to implement safety measures of their own.

“I’m convinced that this alone helped save a huge number of lives,” Dr. Warshawsky says.

Flexibility is intrinsic to the design

One of the most significant (but sometimes overlooked) strengths of Pavilion K is that its facilities can be adapted quickly and fairly easily to cope with a wide range of changing circumstances, explains Georges Bendavid, Director of Technical Services.

A prime example is the construction of antechambers, tightly sealed structures that enclose the exterior doors of the COVID-19 hot zones and some of the operating rooms to keep the airborne virus from escaping.

In a hot zone, an antechamber serves as a protective buffer between the door of the patient’s room and the corridor.

In a hot zone, an antechamber serves as a protective buffer between the door of the patient’s room and the corridor.

Basically, an antechamber functions much like a spacecraft’s airlock: The user walks from the corridor into the antechamber, closes the outer door, waits for the self-contained ventilation system to create the proper environment, and then opens the inner door. This procedure also works in reverse for those leaving an infected area.

According to Mr. Bendavid, the JGH was the first hospital in Quebec to put this solution into practice.

Because of Pavilion K’s spaciousness, its corridors can handily accommodate the antechambers, he says. As well, the design of K’s ventilation, electrical and temperature control systems made the installation of the antechambers a fairly simple task.

“The hard part is coming up with the idea of what needs to happen to solve a problem,” Mr. Bendavid says. “But once we have the answer, K is flexible enough to let us implement it without much difficulty.”

Among the features of Pavilion K that have been essential during the pandemic:

  • Efficient air filtration and ventilation: Viruses are removed from the air by a high-efficiency filtration system. The air is also freshened more often for safety and comfort. Dr. Ruth Chaytor, Chief of Surgery, says the air in K’s operating rooms is exchanged about 20 times an hour—double the rate in the old rooms.
  • Fine-tuned air conditioning: Employees in a COVID-19 hot zone literally get hot, because of all of the protective gear they have to wear. That’s why Mr. Bendavid is pleased about being able to customize the air conditioning in specific areas of Pavilion K, depending on the needs of patients and staff.
  • Ample room for physical distancing: According to Lucie Tremblay, Director of Nursing, Pavilion K’s generous dimensions make it possible for nurses to work comfortably at their nursing stations and enjoy a stress-free meal in their lounges, while obeying the guidelines for distancing.
  • Dependable elevators: Before K opened, Dr. Warshawsky says, he was a little nervous about the ICU being on a different floor than the operating rooms (unlike in the legacy building). However, he’s now satisfied that the elevators have proved their reliability in seamlessly connecting the two departments.
  • Generators: Despite two significant power failures in 2020, Mr. Bendavid says Pavilion K’s generators kicked in so smoothly that it was as if nothing had happened.
  • Large, private family rooms: In K, relatives or caretakers have somewhere comfortable to stay overnight to be near a loved one, or to take a few quiet moments to deal with grief and loss.
  • Adequate storage: Unlike the corridors in the legacy building that were often clogged with medical and cleaning equipment, Pavilion K is roomy enough for everything to be stored properly. This is crucial for Housekeeping, whose staff can’t remove their equipment from the hot zones, but can now store it where it won’t be in anyone’s way.

Growing accustomed to the spaciousness

If Pavilion K can be said to have a minor drawback, it would be its spaciousness which, ironically, also happens to be one of K’s major strengths. Dr. Warshawsky recalls that the old Intensive Care Unit was so crowded that he was able to glance at several patients simultaneously and get a general sense of how each of them was doing.

However, after the move to Pavilion K, Dr. Warshawsky and his staff had to reorient themselves to walking longer distances between rooms that each hold one patient. “In the grand scheme of things, this was a small obstacle,” he says. “You just can’t have a modern ICU with two, three or four patients per room.”

The wide corridors of Pavilion K are largely free of clutter. Any items that must be present in a hot zone do not obstruct the movement of staff.

The wide corridors of Pavilion K are largely free of clutter. Any items that must be present in a hot zone do not obstruct the movement of staff.

Similarly, Ms. Tremblay says it was “a bit of a shock, at first, for nurses to walk such long distances. In a smaller space, it’s easier to organize your work, especially if you often have to walk between the nursing station, the pharmacy and the patients’ rooms. But it didn’t take long for us to realize that, on the whole, the new design makes everyone’s lives much easier and safer.”

Ms. Tremblay says the additional space is a great advantage when at least two nurses—and possibly an orderly—are needed to clean a patient, help the patient into or out of bed, or reposition the patient.

As well, she notes, Pavilion K’s airy rooms and wide corridors make it easier for certain patients (especially the elderly) to get some exercise and maintain their mobility and autonomy, with the assistance of a nurse. Even getting to the bathroom is easier, since the patient no longer has to squeeze past the beds of one, two or three others in his or her room.

Dr. Louise Miner, Director of Professional Services, is also satisfied that K’s design has created a tighter physical connection between units that should logically be in close proximity to each other.

For example, she says, the Family Birthing Centre is now located near the Neonatal Intensive Care Unit and the High-Risk Unit, so that care for high-risk patients—mothers and babies alike—can be better integrated. “We used to struggle in the old facilities, but we’re not struggling any more.”

A revolution in surgery

One of the most dramatic changes is in the environment and design of the operating rooms which, Dr. Chaytor explains, bear no resemblance to the old facilities that were undersized, poorly lit and inadequately ventilated.

In the new space, she says, staff can quickly get their hands on additional instruments in the middle of an operation, without having to leave the sterile area (unlike in the legacy building).

In general, the sterility of the equipment is a snap to maintain, now that a dedicated elevator connects the operating rooms to the Central Sterilizing Department one floor below.

Dr. Tsafrir Vanounou prepares a patient for robot-assisted surgery in one of Pavilion K’s ultra-modern operating rooms.

Dr. Tsafrir Vanounou prepares a patient for robot-assisted surgery in one of Pavilion K’s ultra-modern operating rooms.

Pavilion K has even made the Department of Surgery more economical to manage, because staff can use the latest digital tools to keep track of inventory and to more accurately determine the cost of each surgical case.

“In the old days,” Dr. Chaytor says, “if you were looking for a particular set of instruments and someone put it where they shouldn’t have, we had no idea where it might be. Now we can track the location of whatever we need, in much the same way a package can be tracked when it’s coming to you by courier.”

The brightness of the operating rooms and the natural light in the department’s corridors have also transformed the patient experience, she says. “I had my C-section in the old OR and I remember being brought down that dim corridor—it was like driving into a tunnel. The fact that patients are now in a modern facility makes an enormous difference  to their outcomes.”

Even the jarring noise levels of the old facilities have been significantly subdued. This is especially apparent in the Neonatal Intensive Care Unit, where each room is used for a maximum of six infants in incubators. By contrast, in the previous NICU, more than 30 incubators were crammed into one oversized room that bustled with constant noise and activity.

So striking was the change that in the first week after the move to Pavilion K in January 2016, nurses in the new NICU noticed a substantial and consistent drop in the infants’ distress levels and in how much they cried.

“It all worked because of our intensive planning and our determination to consult with staff about what they and their patients wanted and needed,” says Joanne Côté. “This is as true for the little things as it is for the big things.

“Even a member of staff who simply suggested putting an electrical outlet in one place instead of another played a role in our success. Having an outlet at the proper height and in the proper location can really be critical. God forbid that when we need a light switch, it should be inaccessible because it’s on the wrong side of the door.”

Looking to the future

Today the long-range plan is to upgrade the legacy building to incorporate as many of Pavilion K’s features as possible, says Dr. Miner. Of course, there’s a limit to what the old structure can accommodate, she says, but the early results are promising.

An activity room in the newly renovated Psychiatry Inpatient Unit. Though located in Pavilion B, the unit bears a striking resemblance to the design of certain areas in Pavilion K.

An activity room in the newly renovated Psychiatry Inpatient Unit. Though located in Pavilion B, the unit bears a striking resemblance to the design of certain areas in Pavilion K.

Most striking is the Carole and Andrew Harper Psychiatry Inpatient Unit, which opened in July 2020 on the third floor of Pavilion B in the space formerly occupied by the operating rooms.

Judging from the large rooms, the wide corridors, the modern furnishings and the ample natural light, visitors might think they’ve arrived at a patient care unit in Pavilion K.

Much the same can be said for the fully renovated Sandra and Steven Mintz Nephrology Centre, which opened in mid-2016 in an area of the legacy building that had once housed the Emergency Department. It features spacious hemodialysis stations with enhanced privacy, up-to-date isolation areas and an upgraded water filtration system,

“It’s a perfect example of what can be done in the legacy building with the proper planning,” says Dr. Miner, “and that’s the direction where we’re now heading.”

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