Streamlining Patient Care Processes through Flexible Room and Equipment Design

Gallant, Dennis; Lanning, Karen

doi:10.1097/00002727-200111000-00006

Cited by 35 publications

(40 citation statements)

References 2 publications

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“…139 The transfer time from a critical care room to a patient room is approximately 7 person-hours, so the provision of a single acuity-adaptable care room reducing the need to move a patient may lead to a reduction in costs. 142,156 In a US study conducted in a new hospital with 348 single rooms, there was a reduction of US$500,000 per year in transfer costs compared with the old multiple occupancy hospital. 144 …”

Section: Transfer Costsmentioning

confidence: 99%

Evaluating a major innovation in hospital design: workforce implications and impact on patient and staff experiences of all single room hospital accommodation

Maben

Griffiths

Penfold

et al. 2015

Health Services and Delivery Research

177

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BackgroundNew hospital design includes more single room accommodation but there is scant and ambiguous evidence relating to the impact on patient safety and staff and patient experiences.ObjectivesTo explore the impact of the move to a newly built acute hospital with all single rooms on care delivery, working practices, staff and patient experience, safety outcomes and costs.Design(1) Mixed-methods study to inform a pre-/post-‘move’ comparison within a single hospital, (2) quasi-experimental study in two control hospitals and (3) analysis of capital and operational costs associated with single rooms.SettingFour nested case study wards [postnatal, acute admissions unit (AAU), general surgery and older people’s] within a new hospital with all single rooms. Matched wards in two control hospitals formed the comparator group.Data sourcesTwenty-one stakeholder interviews; 250 hours of observation, 24 staff interviews, 32 patient interviews, staff survey (n = 55) and staff pedometer data (n = 56) in the four case study wards; routinely collected data at ward level in the control hospitals (e.g. infection rates) and costs associated with hospital design (e.g. cleaning and staffing) in the new hospital.Results(1) There was no significant change to the proportion of time spent by nursing staff on different activities. Staff perceived improvements (patient comfort and confidentiality), but thought the new accommodation worse for visibility and surveillance, teamwork, monitoring, safeguarding and remaining close to patients. Giving sufficient time and attention to each patient, locating other staff and discussing care with colleagues proved difficult. Two-thirds of patients expressed a clear preference for single rooms, with the benefits of comfort and control outweighing any disadvantages. Some patients experienced care as task-driven and functional, and interaction with other patients was absent, leading to a sense of isolation. Staff walking distances increased significantly after the move. (2) A temporary increase in falls and medication errors within the AAU was likely to be associated with the need to adjust work patterns rather than associated with single rooms, although staff perceived the loss of panoptic surveillance as the key to increases in falls. Because of the fall in infection rates nationally and the low incidence at our study site and comparator hospitals, it is difficult to conclude from our data that it is the ‘single room’ factor that prevents infection. (3) Building an all single room hospital can cost 5% more but the difference is marginal over time. Housekeeping and cleaning costs are higher.ConclusionsThe nature of tasks undertaken by nurses did not change, but staff needed to adapt their working practices significantly and felt ill prepared for the new ways of working, with potentially significant implications for the nature of teamwork in the longer term. Staff preference remained for a mix of single rooms and bays. Patients preferred single rooms. There was no strong evidence that single rooms had any impact on patient safety but housekeeping and cleaning costs are higher. In terms of future work, patient experience and preferences in hospitals with different proportions of single rooms/designs need to be explored with a larger patient sample. The long-term impact of single room working on the nature of teamwork and informal learning and on clinical/care outcomes should also be explored.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Transfer Costsmentioning

confidence: 99%

Evaluating a major innovation in hospital design: workforce implications and impact on patient and staff experiences of all single room hospital accommodation

Maben

Griffiths

Penfold

et al. 2015

Health Services and Delivery Research

177

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“…The considerable advantages of creating an environment that promotes privacy and satisfaction for patients and relatives, as has been observed for several decades, are also desirable outcomes for the professionals (Ulrich et al, ). Flexibility and adaptability are key factors in creating a work environment that promotes patient‐centred care processes (Gallant & Lanning, ; McCormack & McCance, ). There are, of course, counterarguments to this: two of these relate to the difficulties associated with control and observation and the fact that single‐patient rooms may require more space and work efforts (Apple, ).…”

Section: Philosophical and Theoretical Frameworkmentioning

confidence: 99%

Is it possible to feel at home in a patient room in an intensive care unit? Reflections on environmental aspects in technology‐dense environments

2019

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This paper focuses on the patient's perspective and the philosophical underpinnings that support what might be considered optimal for the future design of the intensive care unit (ICU) patient room. It also addresses the question of whether the aspects that support at‐homeness are applicable to ICU patient rooms. The concept of “at‐homeness” in ICUs is strongly related to privacy and control of space and territory. This study investigates whether the sense of at‐homeness can be created in an ICU, when one or more patients share a room. From an interdisciplinary perspective, we critically reflect on various aspects associated with conflicts surrounding the use of ICU patient rooms. Thus, from an architectural and a caring perspective, the significance of space and personal territory in ICU patient rooms is emphasized. Recommendations for further research are suggested. In conclusion, privacy and control are deemed to be essential factors in the stimulation of recovery processes and the promotion of well‐being in situations involving severe illness or life‐threatening conditions.

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“…[5,7] This room concept is suited for population of patients that are homogenous with predictable outcomes. [17][18][19][20] With this study our study population were renal transplant patients.…”

Section: Review Of the Literaturementioning

confidence: 99%

Acuity-adaptable patient room from the patient’s perspective

Bonuel¹

2017

JNEP

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Acuity-Adaptable Patient Room is a single room concept where a patient is cared for in the same room during the entire hospital stay at any level of acuity. This room concept has demonstrated benefits with regards to patient safety, patient experience, and decrease length of stay. A descriptive study on renal transplant patients was done to describe the patient's perspective about this room concept. Content-validated questionnaires were provided to 36 consenting renal transplant patients and 33 were completed and returned. Twenty-five patients claimed that the monitoring device in the room made them feel safe. One patient complained of discomfort because his feet hung off the bed. Another felt that transition from the operating room to the floor was noisy. Although most patients felt that the room temperature was adequately controlled, however the room temperature did fluctuate from hot to cold. Most patients expressed that the care they received was exceptional and the room provided a healing environment.

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Streamlining Patient Care Processes through Flexible Room and Equipment Design

Cited by 35 publications

References 2 publications

Evaluating a major innovation in hospital design: workforce implications and impact on patient and staff experiences of all single room hospital accommodation

Evaluating a major innovation in hospital design: workforce implications and impact on patient and staff experiences of all single room hospital accommodation

Is it possible to feel at home in a patient room in an intensive care unit? Reflections on environmental aspects in technology‐dense environments

Acuity-adaptable patient room from the patient’s perspective

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