Exploring the Impact of a Dual Occupancy Neonatal Intensive Care Unit on Staff Workflow, Activity, and Their Perceptions

Abstract

In 2012, a tertiary neonatal intensive care unit (NICU) transitioned from an open plan (OP) to a dual occupancy (DO) NICU. The DO design aimed to provide a developmental appropriate, family-centered environment for neonates and their families. During planning, staff questioned the impact DO would have on staff workflow and activity. To explore the impact of changing from an OP to a DO NICU, a prospective longitudinal study was undertaken from 2011 to 2014, using observational, time and motion, and surveys methods. Main outcome measures included distance walked by staff, minutes of staff activity, and staff perceptions of the DO design. Results highlighted no significant difference in the distances clinical nurses walked nor time spent providing direct clinical care, whereas technical support staff walked further than other staff in both designs. Staff perceived the DO design created a developmentally appropriate, family-centered environment that facilitated communication and collaboration between staff and families. Staff described the main challenges of the DO design such as effective staff communication, gaining educational opportunities, and the isolation of staff and families compared to the OP design. Our study provides new evidence that DO provides an improved developmentally environment and has similar positive benefits to single-family room for neonates and families. Such design may reduce the larger floor plan's impact on staff walking distance and work practices. Challenges of staff transition can be minimized by planning and leadership throughout the development and move to a new design.

Mapping Healthcare Spaces: A Systematic Scoping Review of Spatial and Behavioral Observation Methods

“…Many of the publications in our sample, however, used complimentary data collection methods, such as interview or questionnaire, to supplement and enhance their observation (see right-hand column Table 2). Some of the studies which produced nonspecific findings from their observation data were able to draw more specific conclusions once these findings were merged with results from other data collection methods (Johnson & Delaney, 2006; Macdonald et al, 2012), especially where mixed methods were used (Anåker et al, 2018; Broom et al, 2019; McLaughlan et al, 2019; Shepley, 2002). For example, McLaughlan et al used surveys, drawings, and photo-elicitation interviews to complement spatial observation methods in their study of children’s behavior in waiting areas of a pediatric hospital (2019).…”

“…For example, in an ethnographic study of the places that people occupy throughout their cancer care trajectory, Hughes observed participants continuously, for many hours across multiple inpatient and outpatient visits from diagnosis to end-of-life, and recorded detailed field notes about her impressions of the environment and all aspects of the participant’s behavior (Hughes et al, 2017). However, quantitative data were collected in 28% of the studies that utilized continuous observation ( n = 15), most often via a structured data collection form like that employed in snapshot methods, but with data recorded on the form throughout the observation period, rather than at intervals (Broom et al, 2019; Brown et al, 1997; Cloutman-Green et al, 2014; Gharaveis et al, 2020; Lim et al, 2020; Maben et al, 2016; Mazzei et al, 2014; Nanda et al, 2012; Pachilova & Sailer, 2020; Rashid et al, 2016; Shepley, 2002; Zadeh et al, 2014). For example, in a study of how spatial planning impacts visibility and staff communication in an emergency department, the frequency and duration of face-to-face communication between staff was recorded on a form continuously over multiple hours and compared across four hospitals with different floor plans and levels of visibility (Gharaveis et al, 2020).…”

“…There were, however, important exceptions to these trends. In addition to the Blennerhassett et al (2018) pre and post ward redesign study, there were other targeted studies with quantitative observation data that similarly did not produce specific conclusions about the environment from their observation methods (Anåker et al, 2018; Broom et al, 2019; Edgerton et al, 2010; Lu & Zimring, 2012; Miller & Keith, 1973; Newall et al, 1997; Pachilova & Sailer, 2020; Scrivener et al, 2019; Shannon et al, 2019; Shepley, 2002; Stahler et al, 1984), and there were some notable examples of exploratory studies with qualitative observation data which did produce specific conclusions (Eriksson et al, 2010; Hamilton, 2019; Karlsson et al, 2019; Kelley et al, 2011; O’Hara et al, 2018). The conclusions drawn from these exploratory studies tended to be layered, with multiple implications for hospital design.…”

The effects of education levels of developmental care in Australia: Perceptions and challenges

“…An Australian study exploring the experience of staff and families in a redesigned unit, found dual occupancy pods maintained patient confidentiality and supported more effective communication between staff and families when compared to an open unit design. 34 Further exploration of the impact of unit design on FCC practices in Australia is warranted. The perception of peer support towards skin to skin presented the lowest level of agreement for participants in this study.…”

The impact of design on workflow: a comparative case study of level I trauma rooms

“…Despite the critical need for understanding the complexity of care delivered in Level I trauma rooms, a limited number of studies have examined the impact of the physical environment on disruptions to the workflow in the context of trauma rooms that jeopardize care (Ahmad et al , 2016; Bayramzadeh et al , 2018a; Bayramzadeh et al , 2021b; Cohen et al , 2016; Frellesen et al , 2015; Joseph et al , 2019; Neyens et al , 2019; Palmer et al , 2013; Stahl et al , 2006). Existing literature is primarily focused on investigating workflow disruptions and their relationship between the physical environment and team performance within the operating rooms (ORs) and intensive care units (ICUs) and neonatal intensive care units (Broom et al , 2019; Doede et al , 2018). Although similar, the unpredictable nature of trauma rooms is unique and requires a new lens for examination.…”