Optimizing rooms for patients and staff

The healthcare industry is full of challenges. Healthcare providers are tasked with meeting numerous patient requirements, while also satisfying the needs of staff. Healthcare professionals must supply the best possible care in the face of frequent staff deficiencies. Staffing shortages are a critical situation looming over the industry, with nursing being a chief concern.

Consider these predictions provided in the March-April Inside ASHE article on “Warm and Welcoming Spaces”: By 2020, 44 states and the District of Columbia will have nursing shortages, according to a July report by the Health Resources and Services Administration. And a million replacement nurses will be needed by 2012, reports the U.S. Bureau of Labor Statistics.

The scarcity of nurses and other staff presents somewhat of a Catch 22: Facility design must maximize efficiency while minimizing barriers to providing care. The conventional approach to patient room design causes too much time to be spent on getting equipment or supplies, instead of providing care. But new strategies in patient room design strategically position nurses and other personnel in greater proximity to patients and the resources they need to deliver care. The updated approach also focuses more on privacy and involving family members in patient care.

Strategies that make a difference
There are a number of effective ways to optimize healthcare settings to benefit patients and hospital staff. The patient room—which occupies the core of hospital care—is the prime place to start. Important benefits can be achieved for patients, families and staff by adopting a new approach to patient design and other related features. Following are eight strategies, from the March-April Inside ASHE article that can allow hospital administrators and facility personnel to enhance patient rooms.

#1: Private Rooms
Private rooms are commonplace in patient rooms. They offer important advantages and should be the norm whenever possible. In fact, this issue was addressed by the American Institute of Architects (AIA) and the Facility Guidelines Institute (FGI) in the 2001 edition of the guidelines for Design and Construction of Hospital and Health Care Facilities. Design and healthcare professionals reference these guidelines when planning new or renovated projects. Also, authorities in more than 40 states and in other countries utilize these guiding principles as a reference code or standard when reviewing construction designs and completed facilities.

The guidelines are updated on a four-year cycle by the multidisciplinary Health Guidelines Revision Committee (HGRC). Individuals knowledgeable about health care practices and health care facility design (doctors, nurses, facility managers, architects, and engineers) and those who apply the document in the field (state and federal authorities having jurisdiction, or AHJs) serve on the committee. The new edition of the Guidelines will be published in June 2006. A major change in the document is the adoption of single-bed private rooms as a minimum standard for new hospital construction.

In terms of private rooms, the guidelines uphold that they are preferred over semi-private rooms for numerous reasons. The guidelines maintain that private rooms:

• offer more privacy and control
• lower the risk of cross infection
• minimize noise, distractions, crowding, which can elevate patients’ stress level and blood pressure
• reduce switching patients to other rooms to accommodate gender differences or patient conflicts
• decrease operating costs compared with multi-occupancy rooms due to reduction in transfer cost, higher bed occupancy rates and reduction in labor cost

Surprisingly, having private rather than semi-private rooms can actually reduce the total number of beds up to 12 percent. That’s because private rooms can be designed very efficiently. The square footage—which the hospital determines according to its needs—can range from 260 to 400 square feet. A square footage of 300 to 310 is considered an adequate range.

#2: Same-handed rooms
Patient rooms should be “same-handed”, meaning the design should be the same from room to room. All features, such as the heads of the beds and bath, should be located in the same place in all the rooms—on both sides of the hall.

The obvious benefit is that staff members don’t have to learn multiple layouts for rooms. When they change halls or floors, which can happen often, they can spend less time searching for supplies and more time administering patient care.

#3: Dedicated, centralized workstations
It’s ideal to have one workstation for each two-patient room. This allows for better point of care and minimizes travel time between rooms. Workstations can include a computer, work area and storage. Direct visual contact into each room can be provided through a window, which can help reduce patient falls. However, visual contact is not allowed by some states because of privacy concerns. At any rate, having stations right outside patients’ rooms increases the availability of nurses during doctors’ rounds and to visiting family.

#4: Wider doorways
Wider doorways can facilitate moving patients in or out of a room. Having a wider opening can accommodate larger equipment and furnishings, as well as make it easier to help patients from the bed to the bath. The ideal door size is a 4-foot plus a 2-foot door, which can swing together or individually.

#5: More space, clear path
Providing more space and a clear path in each room is a simple, yet essential strategy. Clutter should be eliminated as much as possible because it can convey a sense of disorganization that can diminish the healing process. Items like built-in bedside tables might be used in lieu of those on wheels. Staff can customize the environment to patients’ unique situation by repositioning movable objects in the room to clear a path.

#6: Flooring
When it comes to making flooring selections, practicality and safety are key. Flooring selections should be chosen based on slip resistance, comfort and maintenance requirements. Flooring options range from linoleum to vinyl composition and Pergo wood laminate. Carpet, which is generally reserved for hallways, can help reduce noise and provide a comfortable, cushioned walking surface.

#7: Windows
Most facilities recognize the importance of providing windows that provide natural light, which enhances the healing process. Windows should be wide and low as possible for patients to enjoy the view. Blinds should also be included, so the room can be darkened as needed.

#8: Moveable furniture
The furniture in patients’ rooms should be moveable, so that it can be shifted to accommodate visitors and staff members. Typical furnishings include a bed, night stand, sofa/sleeper sofa and chair/sleeper chair.

There are numerous issues to consider concerning patient room design and other required services. Creating a mock-up of proposed design concepts is highly recommended to avoid design inadequacies. Inexpensive mock-ups can be made using cardboard. Patients, families, staff and other stakeholders should evaluate the mock-up and suggest improvements. This can be more economical than making adjustments during the construction stage or after the project is completed.

This article was reproduced for educational purposes from a March-April 2006 Inside ASHE article entitled “Warm and Welcoming Spaces” by Cyndi McCullogh, MSN.