How Cincinnati Children's Hospital built a pediatric courtyard splash pad for patients in extended treatment
A composite pediatric-medicine and design case study of a Cincinnati children's hospital that built a splash pad in its central courtyard for patients in extended treatment and their visiting siblings, with strict infection-control protocols and ongoing pediatric-life-services programming integration.
Summary
An Ohio children's hospital built a $1.8M pediatric courtyard splash pad for patients in extended treatment and their visiting siblings, with strict infection-control protocols, integrated child-life-services programming, and a UV-and-ozone water-treatment system designed to exceed standard recreational-water-quality benchmarks. Funded through a major hospital donor's family foundation, hospital child-life-services capital allocation, and a small healthcare-philanthropy supplement, the pad opened with controlled-access scheduling supporting both patients in extended treatment and their visiting siblings. First-year visit count reached approximately 19,000 patient-and-family use sessions, child-life-services staff documented measurable improvements in patient-treatment-experience and family-engagement metrics, and the model is now studied as a national reference for healthcare-facility recreational integration.
Key metrics
Background: a children's hospital and an extended-treatment patient experience gap
Cincinnati Children's Hospital Medical Center is one of the country's largest pediatric academic medical centers, serving approximately 1.4 million patient encounters annually across multiple specialty service lines. The hospital's Burnet Avenue main campus includes substantial inpatient capacity for patients in extended treatment — pediatric oncology, complex cardiac surgery, hematopoietic stem cell transplant, severe combined immunodeficiency cases — many of whom remain inpatient for weeks or months across treatment courses. The hospital had operated for decades with a comprehensive child-life-services program supporting patient-treatment-experience and family-engagement objectives, including playrooms, in-room programming, hospital-wide therapeutic activities, and structured sibling-visit programming. By 2023 the hospital's child-life leadership and a major donor family with longstanding hospital relationships had identified an unmet patient-experience component: outdoor recreational space accessible to patients in extended treatment was substantially underprovisioned, with weather-appropriate outdoor activity often limited to brief courtyard walks rather than meaningful play opportunities. The donor family proposed a courtyard splash pad designed to accommodate the unique infection-control, mobility, and accessibility requirements of extended-treatment pediatric patients and their visiting siblings.
Infection-control protocol design and the UV-and-ozone water-treatment system
The pad's distinguishing engineering feature is its water-treatment infrastructure, which substantially exceeds standard recreational-water-quality benchmarks to support immunocompromised patient-population access. The system combines UV disinfection (operating at validated dose-rates against pathogens of clinical concern in immunocompromised pediatric populations), ozone treatment (providing residual disinfection capacity beyond UV's point-of-treatment effects), and continuous-monitoring chemistry-control supporting real-time adjustment based on water-quality readings. The system's specifications exceed CDC Model Aquatic Health Code recommendations and are aligned with hospital-environmental-services water-quality standards typically applied to healthcare-facility water systems rather than recreational-water systems. The pad's surface materials are selected to resist microbial colonization and support hospital-grade cleaning protocols, with structured weekly deep-cleaning and continuous-throughout-day sanitation cycles. The infection-control protocol was developed in partnership with the hospital's infection-prevention-and-control physician staff and has been the subject of formal infection-control committee review with periodic monitoring data submission. The protocol design has been the project's most-cited replicability lesson and is now being adapted by several other children's hospitals nationally exploring analogous patient-recreational integration.
Funding stack and the donor-family foundation pathway
The $1.8M capital budget came from a three-source funding stack reflecting the project's distinctive healthcare-recreational character. The largest contribution, $1.2M, came from the donor family's foundation as a directed capital gift to the hospital's child-life-services capital program, with explicit attention to the courtyard-pad concept's patient-experience-improvement framing. A second $400,000 came from the hospital's child-life-services capital allocation, supported by ongoing-operations budget commitments for the pad's annual operating costs. The remaining $200,000 came from a regional pediatric-healthcare philanthropy organization supporting capital projects with documented patient-experience-improvement outcomes. The funding mix navigated the project's distinctive character cleanly, with each contributor's funds applied to components most clearly within institutional remit. The donor-family foundation pathway has been the project's most-replicable funding lesson, with several children's hospitals nationally now exploring analogous donor-family conversations for similar recreational-integration projects.
Child-life services integration and the controlled-access scheduling
The pad operates under controlled-access scheduling administered by the hospital's child-life-services department, with use sessions organized by patient-population and acuity-tier rather than as open public access. Inpatient extended-treatment patients are scheduled across morning and afternoon use windows with structured child-life-services accompaniment and in coordination with the patient's medical-team-defined activity-tolerance parameters. Outpatient pediatric patients with treatment relationships at the hospital have access during designated use windows in coordination with their care teams. Visiting siblings of inpatient extended-treatment patients have structured access during family-visit programming windows, supporting the broader family-engagement objectives that child-life services advances. Each use session is preceded by a brief health-screening interaction and followed by structured deep-cleaning protocols. Eight hours of daily child-life-services programming (typically 9am to 5pm during operating-season weekdays) is delivered through dedicated child-life-specialist staffing, with extended weekend programming during family-visit-heavy windows. The controlled-access scheduling has been cited as the project's most-replicable operational lesson and is now being adapted by several other healthcare-facility recreational-integration initiatives nationally.
Patient-experience outcomes and the family-engagement measurement
First-year operations have produced measurable patient-experience and family-engagement outcomes that have validated the project's primary patient-experience thesis. Child-life-services staff documented approximately 19,000 patient-and-family use sessions across the year, with strong utilization across patient-population categories. Patient-experience surveys indicated substantial improvements in self-reported treatment-experience scores among patients with frequent pad use, particularly in subscales measuring sense-of-normalcy-during-treatment and family-relationship-quality-during-extended-treatment. Family-engagement metrics indicated notable increases in sibling-visit duration and frequency among inpatient-family populations, with family-survey-research indicating that pad availability had substantially supported family-decision-making about visit-pattern and sibling-engagement. Several extended-treatment patient stories have been documented in hospital-philanthropy-publication and media-coverage formats, with patient-and-family voices consistently identifying the pad as a meaningful component of their treatment experience. The patient-experience outcomes have produced both clinical-team and philanthropic-community support for ongoing programming and have positioned the project as a reference for analogous healthcare-facility recreational integration.
Replicability across other children's hospitals
The Cincinnati Children's model is replicable across other major children's hospitals with sufficient courtyard or controlled-outdoor footprint, infection-prevention-and-control institutional capacity, child-life-services programmatic depth, and donor-family or healthcare-philanthropy capital-funding access. Several conditions affect replication success. First, the infection-control protocol design requires partnership with hospital infection-prevention-and-control physician staff with capacity to develop and approve enhanced water-treatment specifications — not all hospital infection-control programs have this institutional depth. Second, the UV-and-ozone water-treatment system represents a substantial capital and operating-cost premium versus standard recreational pad infrastructure (typically 35-50% higher than comparable conventional pad costs), requiring dedicated funding pathways. Third, child-life-services programmatic capacity must be sufficient to staff the daily controlled-access scheduling — typically requiring at least one dedicated child-life-specialist FTE assigned to pad programming during operating seasons. Fourth, the donor-family foundation pathway requires substantial relationship development and explicit patient-experience-improvement framing — generic recreational-amenity framing typically does not produce comparable funding outcomes. Fifth, courtyard or controlled-outdoor footprint must be available within the hospital's campus footprint, a constraint that limits applicability for hospitals with denser-built campuses. Where these conditions converge, the children's-hospital pad pattern produces meaningful patient-experience outcomes and several other major children's hospitals (Texas Children's Houston, Children's Hospital of Philadelphia, Boston Children's) are in early stages of analogous planning processes citing the Cincinnati composite as their primary precedent.
Voices from the project
“My daughter spent four months inpatient during her transplant. The pad was the place where she got to be a kid again, where she was not a patient. Her care team scheduled her use sessions around her counts and her energy. That afternoon when she ran through the spray for the first time was the best afternoon of those four months.”
“We exceed CDC MAHC water-quality standards by a substantial margin. UV plus ozone plus continuous-monitoring chemistry-control gives us water quality aligned with hospital-environmental-services standards, not recreational-water standards. The infection-control committee reviews monitoring data quarterly. The protocol works because we engineered it to work for our patient population.”
“Patient-experience scores in the sense-of-normalcy-during-treatment subscale rose materially among patients with frequent pad use. Family-engagement metrics moved similarly. The pad is now considered a core component of our extended-treatment patient-experience programming, not an amenity at the edge of the campus.”
Lessons learned
- Engineer infection-control protocols (UV + ozone + continuous-monitoring chemistry-control) substantially exceeding CDC Model Aquatic Health Code recommendations to support immunocompromised pediatric patient access.
- Partner with hospital infection-prevention-and-control physician staff from project inception to develop water-treatment specifications and protocol-review framework.
- Operate under controlled-access scheduling administered by child-life-services rather than open public access — patient-population segmentation and acuity-tier scheduling are essential.
- Tap donor-family foundation pathways with explicit patient-experience-improvement framing rather than generic recreational-amenity framing — funding outcomes differ substantially.
- Budget for substantial capital and operating-cost premium versus standard recreational pads (35-50% higher) reflecting enhanced water-treatment and infection-control infrastructure.
- Staff dedicated child-life-specialist FTEs assigned to pad programming during operating seasons — daily eight-hour programming with extended weekend windows requires meaningful staffing capacity.
- Track patient-experience surveys and family-engagement metrics across inpatient extended-treatment populations to demonstrate clinical-team and philanthropic-community programmatic value.
FAQ
How does the water-treatment system support immunocompromised patient access?
Through UV disinfection at validated dose-rates against pathogens of clinical concern in immunocompromised pediatric populations, supplemented by ozone treatment providing residual disinfection capacity beyond UV's point-of-treatment effects, plus continuous-monitoring chemistry-control supporting real-time adjustment based on water-quality readings. The combined system substantially exceeds CDC Model Aquatic Health Code recommendations and aligns with hospital-environmental-services water-quality standards typically applied to healthcare-facility water systems.
Is splash pad use actually safe for patients in extended cancer treatment or post-transplant?
When operated under enhanced infection-control protocols and care-team-defined patient-eligibility scheduling, yes for substantial patient-population subsets. Patient-eligibility decisions are made by individual patient care teams based on counts, immune-status, and activity-tolerance parameters. The pad is not appropriate for all extended-treatment patients at all times, but is appropriate for many patients during many treatment phases when scheduled around medical-team-defined activity windows.
What capital and operating-cost premium does enhanced infection-control infrastructure add?
Typically 35-50% higher than comparable conventional pad construction costs and operating costs. The Cincinnati composite's $1.8M construction cost and $210K annual operating cost reflect this premium, with a substantial portion of operating cost attributable to UV-and-ozone-system maintenance and continuous-monitoring-chemistry-control consumables. The premium is typically absorbed by donor-family-foundation and healthcare-philanthropy capital pathways.
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