Architecture as a Therapeutic Tool: Acute Stroke Care in Our New Neurological Building

Among the many factors that shaped the design of Cleveland Clinic’s new Neurological Institute building set to open on its Main Campus in early 2027, the efficiency and quality of acute stroke care loomed large.

“Stroke care processes generally need to be retrofitted to the existing physical structure of the hospital where they’re carried out, even as those processes evolve with advances in practice and technology,” says Andrew Russman, DO, Head of the Stroke Program at Cleveland Clinic. “Stroke teams rarely get a chance to plan and design how the physical structure of their care spaces can help facilitate or augment the care of the patient, from assessment to treatment to monitoring. We recognized that the construction of our new 1-million-square-foot Neurological Institute building offered this rare opportunity, so our teams prepared and planned meticulously to make the most of it for the quality of our patients’ care and the efficiency of our workflows.”

Swifter transport to initial care

Many of the enhancements expected from the new building take the form of shorter transport distances, fewer patient handoffs and fewer logistical delays. The most fundamental change is the building’s proximity and connectivity to the emergency department (ED) on Cleveland Clinic’s Main Campus. The building sits directly across from the ED, with short enclosed aerial walkways connecting the ED/helipad area to the new building. For stroke patients arriving by helicopter, this reduces transport time by allowing them to land on the ED roof helipads and move quickly across the skyway into the neurological care environment.

The design also streamlines arrival for patients coming by critical care ground transport or Cleveland Clinic’s busy mobile stroke treatment unit (MSTU). Instead of first entering the ED and then being moved through hospital halls and skyways, these patients will be brought directly to a dedicated MSTU/ambulance entrance on the new building’s ground floor. From there, a dedicated service elevator swiftly transports them directly to either interventional suites on the sixth floor or the neurological ICU on the eighth floor, depending on their immediate needs.

Expanded and enhanced procedural capabilities

On the sixth floor, the cerebrovascular procedural environment will consist of one hybrid operating room (OR) and three biplane angiography suites. This represents an increase from the prior state on the Main Campus by adding the combined angio suite/OR. “This is a 33% increase in our angiography capabilities for stroke cases, in addition to the introduction of a fully equipped hybrid OR,” Dr. Russman notes.

As detailed in a previous Consult QD post, the hybrid OR combines the surgical functionality of a traditional OR with the real-time, high-resolution diagnostic imaging of an angiography suite. The space is ideal for patients requiring both endovascular and open surgical interventions, as it eliminates the risks and delays of transport between different procedural settings. It offers particular utility in cerebrovascular procedures that require high-quality intraprocedural imaging of the vasculature.

This procedural floor is also designed with a defined “landing spot” just outside the angio suites, which includes a bed alcove/workstation area where care teams can converge, update the neurologic examination and immediately move the patient into a suite for intervention.

Next-level neurointensive care

For patients whose immediate next step is advanced imaging or intensive care rather than intervention, the same dedicated elevator system takes them efficiently to the neuro ICU floor. Right off the elevator sits a state-of-the-art CT scanner capable of CT angiography, CT perfusion and other advanced neuroimaging techniques. This co-location of advanced CT capability within the neuro ICU facilitates detailed neurovascular evaluation without the need to transport critically ill patients.

Also located near the elevator on this neuro ICU floor is the “auto launch” arrival area — predesignated bed spaces for emergency management of critically ill stroke patients who meet rapid-transport criteria without need for additional administrative steps. This area consists of two rooms identified as ready beds for neurological emergency treatment. Instead of waiting to identify or clear an ICU bed after a qualifying patient is already en route, these arrival beds will provide a ready destination where the patient can be managed acutely and then moved to another bed space when stable enough. The result will be accelerated triage with streamlined communication. “The new building allows us to extend the auto-launch concept beyond transport to also include bed readiness,” Dr. Russman notes.

Neurointensive care capacity itself will expand substantially, from 24 neuro ICU beds in the current state to 36 such beds when the building opens. “This 50% increase will expand our capacity to take on transfers of high-complexity patients with cerebrovascular disease and other conditions requiring neurointensive care,” Dr. Russman says.

In fact, the neuro ICU rooms have been designed and equipped to support contemporary neurocritical care in a way current spaces may not. Every room in the new building is wired for tele-video evaluation and continuous video EEG/epilepsy monitoring, while neuro ICU-designated rooms are additionally wired for multimodal monitoring. This includes capability for intracranial pressure monitoring, arterial and central venous pressure monitoring, EEG data and other physiologic inputs.

The neuro ICU rooms are also physically designed to improve access to the patient. Larger room sizes and ceiling-mounted booms allow equipment, IV lines, monitoring infrastructure and other supports to descend from above rather than crowding the floor. This reduces obstruction around the bed and improves clinician access, especially to the head and upper torso areas central to neurocritical care. The ability to reposition beds and configure rooms more flexibly will also facilitate bedside procedures and improve nursing workflows.

Prioritizing flexibility and recovery

Bed flexibility goes beyond just positioning. Some neuro ICU beds can be converted to step-down unit status when a patient no longer requires intensive care; conversely, step-down beds can be escalated to neuro ICU status if the patient deteriorates. This reduces unnecessary patient transport, which can be disruptive and clinically risky. It also allows staffing and level-of-care designation to follow the patient’s clinical trajectory rather than forcing the patient to move to match a bed categorization.

Additionally, neuro ICU rooms are arranged along the building’s exterior, with floor-to-ceiling windows and enough space to reposition patients to optimize exposure to natural light. The rationale is that daytime bright light helps preserve sleep-wake cycling, supporting wakefulness during the day and sleep at night. “The aim is to maximize patients’ exposure to natural light to combat delirium, which is a risk for this patient population, and promote nighttime sleeping,” Dr. Russman explains.

Beyond the hyperacute phase

The new building also promises new benefits for stroke patients beyond the acute stages of care. Its inpatient floors include mini gyms for physical and occupational therapy that are placed close to patient rooms rather than isolated in a distant therapy area. This enables rehabilitation to begin in the hospital with localized equipment and reduces reliance on the patient room as the only therapy space.

Dr. Russman says the plan is to eventually replicate elements of the new building’s first-floor neurological assessment center in some of these inpatient mini gyms. The assessment center’s capabilities, as detailed in a prior Consult QD post, include detailed gait analysis, manual dexterity testing and other neuroperformance measures. The aim is to help tailor rehabilitation plans during hospitalization and to generate more-objective longitudinal data on recovery.

“We’ll be able to monitor patients’ recovery in ways we haven’t before,” Dr. Russman says, noting that this can improve patient counseling and expectation-setting. “A patient’s perception of their recovery is often different from their provider’s perception. They’re not aware of what normal levels of function are for healthy people or for people who’ve had a stroke. These objective measures can help us reassure patients that they may be functioning much closer to normative levels than they often think.”

The outpatient offices of Cleveland Clinic’s Cerebrovascular Center, located on the floor just below the ORs and angiography suites, have likewise been tailored and optimized in the new building design. They feature larger clinical spaces, a dedicated neurovascular ultrasound imaging area, and defined workflows for patient follow-up and multidisciplinary care.

“The new exam rooms are ideal for the multidisciplinary specialty clinics we offer,” Dr. Russman notes, citing the Cerebrovascular Center’s moyamoya angiopathy clinic, CNS vasculitis clinic, cerebrovascular obstetrics/maternal-fetal medicine clinic and other team-based cerebrovascular programs. “For example, when I see a patient in our moyamoya angiopathy clinic, these larger exam rooms enhanced with large, wall-mounted computer monitors will allow me to evaluate a patient together with a neurosurgery colleague, review imaging in great detail, and plan for surgical or nonsurgical care with the patient, all in the same room. It’s an approach that fosters and facilitates team-based management for these complex conditions requiring multispecialty care.”

He adds that it’s a prime example of how the new building is not just adding space but is rather reorganizing cerebrovascular care around the realities of patient needs. “It’s been a privilege to provide input to get these tailored considerations and capabilities designed into the building up front,” Dr. Russman concludes. “Our teams are excited to see exactly how they empower us to better manage our patients across the continuum of stroke care.”