“Translational research appears to be the way of the future for medical research facilities,” says Margaret DeBolt, a partner of the architectural firm Zimmer Gunsul Frasca Partnership (ZGF).

She credits the increase in governmental funding, particularly the doubling of the NIH budget since 1996, and the recent breakthroughs made possible by the unbuckling of the human genome as two of the driving forces behind the increased emphasis on translational research.

“Cancer patients are four times more likely than patients with other diseases to be involved in a clinical trial” says DeBolt. “Besides research dollars from the NIH, other influential research funding comes from pharmaceutical companies, biotech companies, and private individuals and institutes hoping to build on new genomic and proteomic discoveries.”

Case Studies

DeBolt and her colleague Hugh Campbell, a principal at ZGF, point to four of their firm’s recent projects to illustrate several design issues and complexities involved in translational research facilities. The examples are:

• National Institutes of Health (NIH), Mark O. Hatfield Clinical Research Center
• University of California, San Diego, Rebecca and John Moores UCSD Cancer Center
• Mount Sinai School of Medicine, Translational Research Building
• Dana-Farber Cancer Institute, Center for Cancer Care

Layout

Campbell explains that most translational research facilities share many of the same program elements including clinical care areas with patient exam rooms and infusion areas; clinical research space with wet, dry, and animal research labs; and basic research labs for disease oriented research. However, the layout of these elements varies based on the facility’s location, institutional history, and funding.

He adds that translational research facilities can be part of a campus setting with separate buildings for distinct functions such as research, animal housing, or patient clinics. Translational research facilities with a limited footprint, in an urban setting for example, can house all research and clinical components in one building, with separate functions stacked side-by-side or vertically in a multi-level approach.

ZFG’s work for the Clinical Research Center (CRC) at NIH and the Cancer Center at the University of California, San Diego are both examples of translational research facilities with all components in one building using a side-by-side approach. For the Dana-Farber Cancer Institute and the Mount Sinai School of Medicine, ZFG provided design studies that, if built, would have both been examples of the vertical stacking approach.

“The idea of high-rise research facilities may seem unusual to many researchers,” says Campbell. “But there can be tremendous efficiencies of stacking wet and dry labs as alternating floors. It creates easy access between researchers working with the computational and statistical analysis and researchers working on the corresponding wet bench studies.”

Flexibility

“Since translational research is constantly evolving, facilities should be flexible enough to support ever-changing research needs,” says DeBolt. “Converting research space into clinical space is fairly straight-forward since it just ends up being over-designed space from a services and mechanical standpoint. However, preparing clinical space for future use as a lab involves more pre-investment in order to meet these increased requirements.”

She points to the NIH’s CRC to illustrate flexibility since the spaces were all designed to be able to change from lab spaces to clinical, from clinical to lab spaces, and back and forth.

“To further accommodate change we incorporated a universal room concept in some spaces that allows NIH clinicians to easily switch the type of patient bed needed, ranging from acute care beds, intensive care beds, or day hospital beds typically used in outpatient clinic spaces,” says DeBolt.

“Some areas within the old NIH Building 10, to which the CRC is an addition, are the highest expression of translational research since there are literally patient beds on one side of the corridor and labs on the other,” says DeBolt.

Systems

Campbell explains that although the mechanical systems for translational research facilities are usually not unique compared to other medical or research facilities, there is the added challenge of taking two complicated facilities—healthcare and research—and combining them into yet another complicated facility.

“Air handling systems can be a little more difficult for translational research facilities since research spaces typically use once-through air and clinical spaces usually have recycled or re-circulated air,” says Campbell. “For this reason NIH chose to use once-through air for its clinical spaces as well, mainly due to immunology and epidemiology concerns. NIH also included larger penthouses for the new clinical area to accommodate future exhaust fans in case it was converted to research labs.”

He also points to the UCSD Cancer Center as an example of how facilities can incorporate a large mechanical penthouse on the top floor to service a block of lower laboratory floors.

“At UCSD, the Cancer Center’s first floor primarily houses space for clinical care and treatment. The second and third floors include spaces for clinical trials, cancer prevention, and community outreach, as well as cancer center administrative offices,” says Campbell. “Levels two through five in the tower include wet-bench research labs and associated support and office space. A penthouse above the five-story laboratory block houses all of the lab air handlers and exhaust fans.”

Collaboration

“Although the goal of translational research is to find results that affect patient care, in reality there is not much interaction between the patient and the wet-bench researcher,” says DeBolt. “The key interaction is really between clinician-caregivers, clinician-researchers, and the wet-bench researchers. That is the heart of translational research.”

She adds that with the ease of computers and Internet transfers there are fewer easy opportunites for research people to interact in person with clinicians. DeBolt feels that this intensifies the need to design environments where researchers and clinicians are almost forced to bump into each other, talk about findings, and ultimately collaborate.

“The design we created for Mount Sinai is a vertically-stacked facility with a dry bench floor sandwiched between two wet bench floors,” says DeBolt. “There are also three floors of clinical space at the base of the building.”

DeBolt explains that to bring the researchers and clinicians together, design elements may also include atrium space with seating areas, coffee bars, or a central cafeteria. Numerous informal meeting spaces can be included such as larger stairwells, recesses along corridors outside lab entries, or conference rooms and staff lounges located near mail rooms, water fountains, and elevators to encourage natural and immediate interaction along the path to and from the work place.

Circulation Flow

“To determine the proper flow of translational facilities, designers should consider all of the various people working at and visiting the facility, and the diverse materials and supplies coming in as well as waste going out.” says Campbell. “On the people side, there are patients and their families coming to see clinicians, plus the researchers, and support and service staff.”

He adds that designers need to take into account security and contamination requirements related to researchers visiting their research animals in the vivarium and occasional visits of the animals to the labs. They should also outline the range of supplies being used and review all related biohazardous waste and radioactive issues.

“Since all patients at NIH are there because they are taking part in clinical trials, the patient rooms are located near the labs,” says Campbell. “This means that patients and their families are often together with researchers and clinicians in public circulation and in the patient rooms. It is important that patients not be exposed to unusual lab smells and loud equipment.”

Campbell explains that in the NIH Clinical Research Center ZGF took steps to improve the patient environment yet keep the research component easily accessible. The central public circulation spine brings the patients and their visitors into the clinical environment from one end of the patient care unit while the service elevators are located at the opposite end for delivery of food, linen, and supplies. Beyond the service elevator cores are the main corridors connecting to the new CRC laboratories and back to the labs in the original Building 10. This zones the project from public to private, and maintains the feeling that the patient care environment is separate, but easily accessible from the research environment.

He also points to ZGF’s Dana-Farber proposal, which originally stacked the labs under the patient care areas. The key design challenges included installing supply and exhaust mechanical shafts from the lower lab levels up through the clinical spaces, and creating distinct pedestrian traffic patterns to separate patients and their families from research investigators, staff, and service. As the Dana-Farber project developed further, the clinical floors moved to be adjacent to the research labs in a neighboring building, evolving into a side-by-side model similar to NIH.

Clinical Trials

“Typically clinical trials require higher staffing levels since there are research nurses and staff who monitor and record patient reactions to treatments much more intensely than in a typical clinical care operation,” says DeBolt. “Clinical trials are often funded by outside agencies or pharmaceutical companies where it is critical to do either a procedure or a test or some study on a group of patients while following very specific requirements.”

She explains that there are two degrees of clinical trials. Early phases of clinical trials typically take place in controlled environments where drugs are tested for their efficiency or side effects in patients. This phase may require actions such as infusion or continual monitoring and recording of changes to a patient’s vital signs. Usually the later phases of clinical trials are conducted in outpatient settings as part of a patient’s routine clinical visits.

“In contrast to the NIH where the focus is solely on clinical trials, the UCSD Cancer Center is primarily concerned with ongoing patient treatment,” says DeBolt. “The design includes distinct space that caters to the special accommodations necessary for clinical trials and ongoing patient care, including outdoor gardens that offer a relaxing setting for patients and their families, and a unique community outreach kitchen that offers monthly cooking classes aimed at educating patients about nutritional information and meal planning.”

By Amy Cammell

We welcome your Questions and Comments

Copyright 2008 Tradeline Inc.
All Rights Reserved
ISSN: 1096-4894