evidence for designing patient rooms at northwest community hospital
Post on 31-Oct-2014
1.712 Views
Preview:
DESCRIPTION
TRANSCRIPT
Evidence for Designing Patient Rooms at Northwest Community Hospital HCD.11 – Wednesday, November 16, 2011
PEP COUNCIL, VISION CENTER + PROTOTYPE
The development of the Guiding Principle PEP (Principles-Elements-Processes) Guide established a series of 11 goals for the project; elements that would be implemented as metrics that are used to define success. A PEP council, comprised of nursing directors, reviewed decisions for guiding principle compliance.
The size and configuration of the rooms have been shaped by the hospital’s Guiding Principles, including: standardization, adaptability, privacy, technology and patient/family-centered care. These were tested in the Vision Center (below). The design incorporates into the rooms the most recent research and trends that address patient safety, patient and family satisfaction, stress reduction and infection control protocols.
A Vision Center was created in an off-site warehouse for the design team, hospital and community groups to test assumptions within a full-scale prototype.
CLINICAL INITIATIVE SCORECARD: GUIDING PRINCIPALS, STRATEGIES, METRICS AND TARGETS
OWP/PFile: sm_080520 NCH Renaissance Score Card 1 of 1
IN
ID #
Guiding Principles/Objectives Strategies Metrics Source Targets
1
- Improve Satisfaction Private Patient Rooms Patient Satisfaction-Privacy,Crowding, PG-IP&ED: Staff concerned with your privacy Improve by x%- Enhance Privacy, Cultural Sensitivity- Improve Convenience, Accessibility- Respect for patient values, preferences, needs *
2
- Reduce Noise Levels Private Rooms Decibel Level Facilities: Decibel readings in units Reduce by x%- Reduce Staff Fatigue Decentralized Nursing Patient Satisfaction - Noise PG-IP: Noise level in and around room Reduce by x%- Reduce Staff Travel Distance Minimize overhead paging Staff Injuries Employee Health Reduce by x%
Ceiling Patient Lifts Cost of Staff Work-Related Injuries Employee Health Reduce by x%% of nosocomial pressure in ulcers/pt days
3
- Incorporate Natural Light Views of nature/outdoors Staff Satisfaction Scores GPTW: our facilities contribute to a good working environment
Improve by x%
- Consider sustainability of design, finishes Natural Light in Patient Room Pain Medicine Distribution PG-IP&ED: How well your pain was controlled Reduce by x%
- Incorporate Gardens Natural Light in Staff Areas Pain Medications / Variable Costs Pharmacy Reduce by x%- Provide Restorative Staff and Patient Areas Balconies- Obtain LEED certification- Physical Comfort*
4
- Standardize core elements, but allow for adaptability as needed
Acuity Adaptable / Universal Rooms
Physician Satisfaction Scores Improve by x%
- Accommodate changing models Use of Modular Furniture Staff Satisfaction Scores - Teamwork GPTW: There is a "family" or "team" feeling here Improve by x%
- Plan for contingencies Flexible Charting Areas
5
- Provide healing touch therapies Balconies Define Strategy - Pending- Provide horticulture therapy Healing Gardens
6
- Reduce Medical Errors Family Accommodations Nosocomial Infection Rates Inf. Cntrl: Reduce by x%- Reduce Patient Falls Decentralized nursing model Reduce by x%- Reduce Wrong patient Errors Handrails @ Bed to Toilet Rm Average Length of Stay Finance: Reduce by x%- Reduce Incidence of Duplicative Testing Observation Windows Number of Patient Falls/ Pt Day NDNQI: survey info from Risk Mgmt Reduce by x%- Continuity and Transition* Reduce by x%
7
- Standardize repetitive functions, spaces Same-handed Rooms Material Management Costs Materials management - Tom C? Reduce by x%
- Lower Operating Costs Standardized room layout Staff Walking Distance per Day- Improve Operational Efficiencies Standard support cores Hours per Patient Day Neutral?- Coordination and Integration of Care* Portable Nurse Servers- ED Triage Rooms ED Turnaround time(check-in to
discharge/bed)Reduce by x%
Barcoding/RF? ED Pts Presented, but Left Before Seen Reduce by x%OB - triage visits Increase By ?OB Inductions Increase By ?
8
- Test equipment/processes before PCA Patient Satisfaction - Existing Tower cleanliness, décor
PG-ED: Cleanliness of treatment area increase by x%
- Design to be translatable to exist. tower PG-IP: Room Cleanliness and Room Décor - Improve environment / patient experience across campus
9
- Reduce Patient Transfers Private Rooms Number of Patient Room Transfers Env Srvcs: Reduce by x%- Promote Family Participation in Care Family Accommodations Cost of Patient Room Transfers Reduce by x%- Enhance Patient Convenience OB Triage Area Family Satisfaction Scores PG-IP: Accomd. and comfort for visitors Improve by x%- Emotional Support* Balconies PG-ED: Comfort of waiting area - Involvement of Family and Friends*
PG-IP: Degree to which hosp. Staff addressed emotional and operational needs
10
- Create destination for more than acute care Specialized Retail Space Marketshare Planning Intelligence: Improve by x%- Meet visitor/patient life needs Meeting/Conference Space Philanthropy Donations Improve by x%- Attract community Education Space IP or cases / discharges Finance: Improve by x%- Increase marketshare- Access to Care*
11
- Automate when possible CPOE, EMR Define Strategy - Pending- Information and education
NOTES:1 "*" indicates Picker Institute principle.2 Will be conducting walking time measures as part of separate study.3 Potential research fellow to assist with Pain Medication Distribution reporting/study.4 PG = Press Ganey GPTW = Great Places to Work Survey
ED = Emergency Department Survey NDNQI = Nursing Staff SurveyIP = Inpatient Survey
Respect for Individual Needs of All Users
Incorporate Evidence-Based Design
Enable Processes through Technology
Promote Community Centricity
Improve Safety
Standardize Processes, Supplies, Design
Create Archetype for Design Elements
Enhance Patient/Family Centeredness
Incorporate Natural Environments
Design Adaptability in Facility
Integrate Holistic Care
PRESS GANEY RESULTS:PATIENT SATISFACTION INDICATORS
PATIENT SATISFACTION INDICATORS
May–August 2010
May–August 2009
South PavilionMean
Legacy TowerMean
Legacy TowerMean
Room cleanliness 91.1 74.3 78.7
Noise level in and around room 83.3 65.7 67.6
Std nurses 89.7 84.6 86.3
Nurses 90.3 84.3 86.7
Promptness of response to call 87.1 80.7 81.7
Accommodations and comfort for visitors 89.7 76.4 79.7
Staff concern for your privacy 89.2 82.0 83.0
Overall cheerfulness of hospital* 92.0 80.0 83.4
Likelihood of recommending the hospital 92.8 81.0 86.5Consistent Increases Decreased Satisfaction Likely
Due to Increased ExpectationsNOTE: Numerous requests to transfer patients from Legacy Tower to South Pavilion regularly occur each month (from physicians, patients, friends and family members).
PATIENT ROOM FEATURES: DIGNITY IN PATIENT CARE, ADVANCING PATIENT SAFETY
Environment
for Safety
and Comfort
distinctive zones for patient, family and care
[1] visible handwash sinks[2] “universal” footprint maximizes flexibility
[3] nurse server accessible via double door
[4] views to nature
[5] plant/personal items/artwork
[6] patient control of lighting, temperature
PATIENT ZONE
FAMILYZONE
[7] large entrances
[8] in-room charting
[9] family overnight space
[10] grab bars
[11] curbless showers
[12] comfortable, sturdy finishes
[13] patient lifts
1
2
3
4
4
2
5
5
6
7
7
7 2
8
1
9
9
10
10
10
11
11
13
12
NCH Patient Satisfaction per Quarter / Year
80
60
40
20
0
perc
entil
e ra
nk
1st Quarter 2010
2nd Quarter 2010
3rd Quarter 2010
4th Quarter 2010
12
South Pavilion opens
CAREZONE
2
PRESS GANEY RESULTS:LIKELIHOOD TO RECOMMEND, NOISE AND PRIVACY
PATIENT ROOM DESIGN AND RECOVERY FROM SURGERY: SUMMARY
The recovery of surgical patients in rooms with EBD features was faster and less painful than that of those in rooms without the features. (Differences in recovery process be-tween these two patient groups were clarified. The extent to which the evidence-based patient-room design contributes to postsurgical recovery was examined.)
Hypothesis
Methods
Findings
The average length of postsurgical hospital stay was 72.5 hours in the new-room group and in 74.2 hours in the old-room group. However, the difference was not statistically significant. The postsurgical analgesia uses in the two groups were not significantly different.
Postsurgical Pain Scores in Patient Rooms with/without EBD
3
1
0
54321
With EBD Without EBD
Post operation admission to the
patient-room floor
1st day pain score in the morning
1st day pain score at 11pm
2nd day pain score in the morning
2nd day pain score at 11pm
Last pain score prior to discharge, generally 20-30 hours after Score 5.
Notes: Pain scores were measured by using a 0-10 Likert rating scale and reported by using the group means. Length of stay was measured by hour. *: p<0.1
2.2 2.22
1.95
2.61
1.91
2.66
1.98 1.85
2.16
A before-after comparison was conducted by an interdisciplinary team, which was comprised of researchers, designers and caregivers. Northwest Community Hospital (NCH) recently opened its same-handed private patient rooms providing distinct zones for caregivers/ patients/ families, headwall-adjacent toilet rooms, large windows with view of nature, and controllable observation windows for nurses. Recent patients who have had a total knee replacement are assigned to these new rooms; previous patients who had the same surgery were assigned to opposite-handed semi-private old rooms without the aforementioned features. Medical record of patients in the new/old rooms was obtained. Objective data of the built environments in and around the new/ old patient rooms were collected.
The sample size was 120 in each patient group and a total of 61 matched pairs were identified among them. Patients were carefully matched so that one member of each pair has stayed in a new room and the other in an old room. The criteria for matching includes gender, age, race, smoker or not, obese or not, and previous pain-medicine user or not. Analysis of recovery differences between these matched pairs was conducted by using the Statistical Package for the Social Sciences (SPSS version 16.0), including paired sample T-tests.
Based on statistical analyses, this study found that the recovery of the patients in rooms with EBD features was less painful than that of those in rooms without the features. Among the 61 matched pairs, the self-reported pain scores on admission to the patient-room floors were not significantly different. However, the last pain scores reported prior to discharge was significantly lower in the new-room group (p<0.1).
2.65
1.942.08
n = number of respondentsmeanLikelihood of Recommending Hospital
100
95
90
85
75
70
65
OCT – DEC n=149
JAN – MAR n=164
APR – JUN n=142
JUL – SEP n=123
OCT – DEC n=141
JAN – MAR n=150
APR – JUN n=141
JUL – SEP n=104
OCT – DEC n=129
JAN – MAR n=108
APR – JUN n=100
JUL – SEP n=102
2008 2009 2010 2011
80
Noise Level in and Around Room
100
90
70
60
50
OCT – DEC n=150
JAN – MAR n=159
APR – JUN n=139
JUL – SEP n=125
OCT – DEC n=139
JAN – MAR n=152
APR – JUN n=138
JUL – SEP n=103
OCT – DEC n=129
JAN – MAR n=109
APR – JUN n=99
JUL – SEP n=199
2008 2009 2010 2011
80
Staff Concern for Privacy
100
95
90
85
75
70
65
OCT – DEC n=146
JAN – MAR n=153
APR – JUN n=135
JUL – SEP n=116
OCT – DEC n=130
JAN – MAR n=145
APR – JUN n=138
JUL – SEP n=102
OCT – DEC n=146
JAN – MAR n=106
APR – JUN n=98
JUL – SEP n=92
2008 2009 2010 2011
80
6
company logo
project name
www.cannondesign.com
top related