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Patient SafetyPatient Safety
An Empirical Examination of the
Safety and Efficiency Implications ofy y p
Patient Room Hande...
Learning Objectives
• Assess the potential impacts of same-handed
patient rooms from the first ever empirical data
ll t d ...
Presenters
• HKS, Inc.
– Tom Harvey, AIA,
MPH FACHA
• UTA, School of
Nursing
MPH, FACHA
– Debajyoti Pati, PhD,
FIIA
– Caro...
Acknowledgments
• Academy of Architecture for Health
Foundation Research Grant
• Herman Miller Inc. Research Grant
• Unive...
Acknowledgments
• Dr DL Hawkins, Associate Professor &
Associate Chair, Dept of Math, UTA
• Mark Ricard, Professor, Depart...
Agenda
• Background
• Key Conceptsy p
• Study Design
• Anal tical Methods• Analytical Methods
• Key Findings
• Conclusions...
Origin of the Issue
• IOM reports
highlighting medical
errors
• AHRQ reports
d iunderscoring
inefficient and
unsafe care p...
Architectural Response
• Standardization:
– Same-Handed care
i tenvironment
– Patient Rooms
identical in allde t ca a
resp...
Underlying Logic
• Experience in aero-
space industry
– Flight deck
standardization
resulting in safetyg y
improvement
200...
Issue
• Lack of empirical evidence in healthcarep
settings to support or refute safety or
efficiency impact of handednessy...
KEY CONCEPTS
Standardization : Handedness : Behavior
KEY CONCEPTS
2009 PDC Conference & Exhibition
Leading the Way to Bett...
Levels of Standardization
• Level 1: Headwall
– identical array of
tiliti i lutilities is always
provided on the
corridor ...
Levels of Standardization
• Level 2: Headwall
– consistently placing a
t i fcertain array of
utilities on the
patient’s le...
Levels of Standardization
• Level 3: Caregiver
Zone
– design and relative
locations of all
elements provided top
support t...
Levels of Standardization
• Level 4: Patient
Room
– patient rooms are
designed identical
and all elements in the
patient r...
Levels of Standardization
• Level 5: Unit
– patient rooms and all
tsupport spaces are
standardized across
all units in a h...
Note # 1
• Standardization MAY or MAY NOT
involve handednessinvolve handedness
2009 PDC Conference & Exhibition
Leading th...
Handedness TypesHandedness Types
Right handed environment Left handed environmentRight-handed environment Left-handed envi...
Note # 2
• Standardized patient room (level 4) with
Right-Handed care environment is
currently recommended to address
effi...
2009 PDC Conference & Exhibition
Leading the Way to Better Health Care Design
Behavior
• Handedness
recommendation is
di t d thpredicated on the
belief that care
behavior is knownbehavior is known
and...
Behavior
• There exists a
knowledge gap in
i lit tnursing literature on
how nurses deliver
care (how theycare (how they
ap...
Note # 3
• Without understanding care behavior, it isg ,
difficult to assert that a certain physical
configuration will op...
THE HANDEDNESS STUDYTHE HANDEDNESS STUDY
2009 PDC Conference & Exhibition
Leading the Way to Better Health Care Design
Study Questions
• Are there natural patterns of care
behavior?
• Would standardization and/or
handedness facilitate or imp...
Study Setting
• University of Texas
Arlington, Smart
H it lTMHospitalTM
– Team Training Room
2009 PDC Conference & Exhibit...
Patient and Subjects
• Patient:
– Patient actor
• Subject Attributes:
– Age: 21 – 62; median
53• Subjects:
– 20 right hand...
Physical Configurations
IV IV
Scenario 1 Scenario 2 Scenario 3
OBT OBT OBT
S i 4 S i 5 S i 6
O O
IV
O
Scenario 4 Scenario ...
Nurse Station
• Equipment:
– Dinamap
– Suction Kit
C t l ith• Control room with
A/V control
2009 PDC Conference & Exhibiti...
Tasks
Tasks InstructionsTasks Instructions
Vitals Please take your patient’s vital signs
and return to the nurse station
S...
Simulation & Sequence
• 9 settings x 3 tasks =
27 simulation runs
bj tper subject
• Setting sequence and
t ktask sequence
...
2009 PDC Conference & Exhibition
Leading the Way to Better Health Care Design
DATA CODINGDATA CODING
2009 PDC Conference & Exhibition
Leading the Way to Better Health Care Design
Nursing
• Two independent
RNs coded each
id t
• Coded behavior:
– Approach direction
video segment
• A third RN reviewed
d...
Nursing
• Coded behavior:
– Stretch
– Bend
– Unstable
Lift– Lift
– Twist
– RepositionReposition
2009 PDC Conference & Exhi...
Kinesiology
• Kinesiology expert
coding of video
t t id tif
• Actions:
– Stretch
segments to identify
harmful/stressful
ac...
Additional Data
• Subject interviews focused on:
– Work flow
– Awkward posture or movement
– More supportive settingspp g
...
2009 PDC Conference & Exhibition
Leading the Way to Better Health Care Design
DATA ANALYSISDATA ANALYSIS
2009 PDC Conference & Exhibition
Leading the Way to Better Health Care Design
Analytical Methods
• Logistic regressions for binary response
variables
• Poisson regression for frequency counts
• Explor...
LEFT HANDED NURSES
WITHIN GROUP ANALYSIS
LEFT HANDED NURSES
2009 PDC Conference & Exhibition
Leading the Way to Better Hea...
Behavior Pattern
h b h iQ: Is there any behavior pattern among left-handed nurses?
se
djust
Adjust
Approach
Hesitation
OBT...
Inference # 1
• Within left-handed nurses there appears to
be a pattern of predictable behavior across
the nine settings
2...
RIGHT HANDED NURSES
WITHIN GROUP ANALYSIS
RIGHT HANDED NURSES
2009 PDC Conference & Exhibition
Leading the Way to Better H...
Behavior Pattern
h b h iQ: Is there any behavior pattern among right-handed nurses?
e
ust
Adjust
djust
pproach
esitation
B...
Inference # 2
• Within right-handed nurses there appears
to be a pattern of predictable behavior
across the nine settings
...
LEFT – RIGHT COMPARISON
BETWEEN GROUP ANALYSIS
LEFT RIGHT COMPARISON
2009 PDC Conference & Exhibition
Leading the Way to B...
Behavior Difference
Q: Are there differences between left and right handed nurses?Q: Are there differences between left an...
Inference # 3
• Large number of statistically significant
differences between left-handed and right-differences between le...
FACTORS AFFECTING
WHERE DO NURSES POSITION VIS-À-VIS THE PATIENT?
FACTORS AFFECTING
CAREGIVER POSITION
2009 PDC Conference...
Task: Vitals
Q: Left-handed nurses’ position vis-à-vis the patient
Position: Left-Handed Nurses
Set ID 1 2 3 4 5 6 7 8 9
%...
Task: Vitals
Q: Right-handed nurses’ position vis-à-vis the patient
Position: Right-Handed Nurses
Set ID 1 2 3 4 5 6 7 8 9...
Inference # 4
• In Task = Vitals
– Location of IV
d t i idetermines caregiver
location
– In absence of IV, OBTabse ce o V,...
Task: Suction
Q: Left-handed nurses’ position vis-à-vis the patient
Position: Left-Handed Nurses
Set ID 1 2 3 4 5 6 7 8 9
...
Task: Suction
Q: Right-handed nurses’ position vis-à-vis the patient
Position: Right-Handed Nurses
Set ID 1 2 3 4 5 6 7 8 ...
Inference # 5
• In Task = Suction
– One or more of three
f t i fl dfactors influenced
caregiver’s position:
• Obstructions...
Task: Sitting
Q: Left-handed nurses’ position vis-à-vis the patient
Position: Left-Handed Nurses
Set ID 1 2 3 4 5 6 7 8 9S...
Task: Sitting
Q: Right-handed nurses’ position vis-à-vis the patient
Position: Right-Handed Nurses
Set ID 1 2 3 4 5 6 7 8 ...
Inference # 6
• In Task = Sitting
– One or more of three
f t i fl dfactors influenced
caregiver’s position:
• IV location:...
STRESSFUL/ HARMFULSTRESSFUL/ HARMFUL
ACTIONS
2009 PDC Conference & Exhibition
Leading the Way to Better Health Care Design
Sitting Task
Stretch Bend Unstable Lift Twist Repos
/Bed
ation
l
/Bed
ation
l
/Bed
ation
l
/Bed
ation
l
/Bed
ation
l
/Bed
...
Suction Task
Stretch Bend Unstable Lift Twist Repos
/Bed
ation
l
/Bed
ation
l
/Bed
ation
l
/Bed
ation
l
/Bed
ation
l
/Bed
...
2009 PDC Conference & Exhibition
Leading the Way to Better Health Care Design
INTERVIEW DATA
Corroborating Evidence
INTERVIEW DATA
2009 PDC Conference & Exhibition
Leading the Way to Better Health Car...
Subject Interview
• Top factors affecting nurses decision on
location vis-à-vis the patient:
– Location of IV
– Entrance l...
Subject Interview
• Best configuration:
– Configurations without partitionsg p
– Offered immediate visual assessment of th...
CONCLUSIONSCONCLUSIONS
2009 PDC Conference & Exhibition
Leading the Way to Better Health Care Design
Handedness
• Right-handed and left-handed nurses
behave differently
• Approach and position depends on:
– Task typeTask ty...
Handedness
• Preferred side varies within each group
– There is no consistent preference for eitherp
the left or the right...
Standardization Types
Level 1 Level 2
Level 3 Level 4
2009 PDC Conference & Exhibition
Leading the Way to Better Health Ca...
Standardization
• Level 2 (Headwall) standardization( )
supported:
– Standardized headwall with redundant outletsStandardi...
Standardization
• Level 3 (Caregiver Zone) standardization( g )
unexplored:
– Advantages of standardization of theAdvantag...
Standardization
• Level 4 (Patient Room) standardization:
– A key room level concept examined:y p
Direction of approach
– ...
QuestionsQuestions
2009 PDC Conference & Exhibition
Leading the Way to Better Health Care Design
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PDC_2009_Samehanded Study

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PDC_2009_Samehanded Study

  1. 1. Patient SafetyPatient Safety An Empirical Examination of the Safety and Efficiency Implications ofy y p Patient Room Handedness 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  2. 2. Learning Objectives • Assess the potential impacts of same-handed patient rooms from the first ever empirical data ll t d th t icollected on the topic. • Develop an understanding on the natural tt f ipatterns of nursing care. • Identify how same-handedness of the physical environment might benefit or impede careenvironment might benefit or impede care delivery. 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  3. 3. Presenters • HKS, Inc. – Tom Harvey, AIA, MPH FACHA • UTA, School of Nursing MPH, FACHA – Debajyoti Pati, PhD, FIIA – Carolyn Cason, PhD, RN – Jennie Evans, RN, BS 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  4. 4. Acknowledgments • Academy of Architecture for Health Foundation Research Grant • Herman Miller Inc. Research Grant • University of Texas Arlington Smart• University of Texas Arlington, Smart HospitalTM • Dr Nancy Rowe Manager Statistical• Dr Nancy Rowe, Manager, Statistical Services, OIT, UTA 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  5. 5. Acknowledgments • Dr DL Hawkins, Associate Professor & Associate Chair, Dept of Math, UTA • Mark Ricard, Professor, Department of Kinesiology, UTAgy, • Andrea Erwin, RN, Kathryn Daniel, PhD, A/GNP-BC and Linda Denke RN SchoolA/GNP-BC, and Linda Denke, RN, School of Nursing, UTA 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  6. 6. Agenda • Background • Key Conceptsy p • Study Design • Anal tical Methods• Analytical Methods • Key Findings • Conclusions 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  7. 7. Origin of the Issue • IOM reports highlighting medical errors • AHRQ reports d iunderscoring inefficient and unsafe care practicesunsafe care practices 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  8. 8. Architectural Response • Standardization: – Same-Handed care i tenvironment – Patient Rooms identical in allde t ca a respects 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  9. 9. Underlying Logic • Experience in aero- space industry – Flight deck standardization resulting in safetyg y improvement 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  10. 10. Issue • Lack of empirical evidence in healthcarep settings to support or refute safety or efficiency impact of handednessy p 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  11. 11. KEY CONCEPTS Standardization : Handedness : Behavior KEY CONCEPTS 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  12. 12. Levels of Standardization • Level 1: Headwall – identical array of tiliti i lutilities is always provided on the corridor side of each room (irrespective of patient side) Level 1Level 1 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  13. 13. Levels of Standardization • Level 2: Headwall – consistently placing a t i fcertain array of utilities on the patient’s left, and another on the right 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  14. 14. Levels of Standardization • Level 3: Caregiver Zone – design and relative locations of all elements provided top support the care process within the caregiver zone are Level 3Level 3 caregiver zone are standardized across all patient rooms 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  15. 15. Levels of Standardization • Level 4: Patient Room – patient rooms are designed identical and all elements in the patient rooms are designed, located and oriented in identicaloriented in identical manner 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  16. 16. Levels of Standardization • Level 5: Unit – patient rooms and all tsupport spaces are standardized across all units in a hospital 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  17. 17. Note # 1 • Standardization MAY or MAY NOT involve handednessinvolve handedness 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  18. 18. Handedness TypesHandedness Types Right handed environment Left handed environmentRight-handed environment Left-handed environment 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  19. 19. Note # 2 • Standardized patient room (level 4) with Right-Handed care environment is currently recommended to address efficiency and safety • Left-Handed care environment is also being designedg g 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  20. 20. 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  21. 21. Behavior • Handedness recommendation is di t d thpredicated on the belief that care behavior is knownbehavior is known and documented 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  22. 22. Behavior • There exists a knowledge gap in i lit tnursing literature on how nurses deliver care (how theycare (how they approach conducting a procedure)p ) 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  23. 23. Note # 3 • Without understanding care behavior, it isg , difficult to assert that a certain physical configuration will optimize care processesg p p and promote efficiency and safety 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  24. 24. THE HANDEDNESS STUDYTHE HANDEDNESS STUDY 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  25. 25. Study Questions • Are there natural patterns of care behavior? • Would standardization and/or handedness facilitate or impede carep process? • Are there harmful actions that could beAre there harmful actions that could be linked to the physical environment? 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  26. 26. Study Setting • University of Texas Arlington, Smart H it lTMHospitalTM – Team Training Room 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  27. 27. Patient and Subjects • Patient: – Patient actor • Subject Attributes: – Age: 21 – 62; median 53• Subjects: – 20 right handed nurses 53 – Education: 1 BSN; remaining at least a – 20 left handed nurses e a g at east a master’s degree in nursing E i 1– Experience: <1yr – 30+; median 25 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  28. 28. Physical Configurations IV IV Scenario 1 Scenario 2 Scenario 3 OBT OBT OBT S i 4 S i 5 S i 6 O O IV O Scenario 4 Scenario 5 Scenario 6 OBT OBT OBT IV IV Scenario 7 Scenario 8 Scenario 9 IV OBT OBTOBT 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  29. 29. Nurse Station • Equipment: – Dinamap – Suction Kit C t l ith• Control room with A/V control 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  30. 30. Tasks Tasks InstructionsTasks Instructions Vitals Please take your patient’s vital signs and return to the nurse station Suction Your patient is a new admission who has a tracheotomy and will need to be i d Pl t d tsuctioned now. Please pretend to suction your patient. Sitting Please sit your patient on the edgeSitting Please sit your patient on the edge of the bed and return to semi fowler’s position 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  31. 31. Simulation & Sequence • 9 settings x 3 tasks = 27 simulation runs bj tper subject • Setting sequence and t ktask sequence randomized • Total 540 simulation• Total 540 simulation runs 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  32. 32. 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  33. 33. DATA CODINGDATA CODING 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  34. 34. Nursing • Two independent RNs coded each id t • Coded behavior: – Approach direction video segment • A third RN reviewed d d d t f – Hesitation in approach – Over bed table use B d il dj t tcoded data for inconsistencies and mistakes – Bed rail adjustment – Bed height adjustment – Bed angle adjustmentmistakes Bed angle adjustment 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  35. 35. Nursing • Coded behavior: – Stretch – Bend – Unstable Lift– Lift – Twist – RepositionReposition 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  36. 36. Kinesiology • Kinesiology expert coding of video t t id tif • Actions: – Stretch segments to identify harmful/stressful actions – Bend – Unstable Liftactions – Lift – Twist – RepositionReposition 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  37. 37. Additional Data • Subject interviews focused on: – Work flow – Awkward posture or movement – More supportive settingspp g – Factors affecting approach decision 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  38. 38. 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  39. 39. DATA ANALYSISDATA ANALYSIS 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  40. 40. Analytical Methods • Logistic regressions for binary response variables • Poisson regression for frequency counts • Exploratory data analysis• Exploratory data analysis • Content analysis of interview data 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  41. 41. LEFT HANDED NURSES WITHIN GROUP ANALYSIS LEFT HANDED NURSES 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  42. 42. Behavior Pattern h b h iQ: Is there any behavior pattern among left-handed nurses? se djust Adjust Approach Hesitation OBTableUs BedRailAd BedHeight Adjust BedAngleA tretch Bend Unstable Lift Twist Reposition A H O B B A B S B U L T R Vitals Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Suction Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Sitting NO Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  43. 43. Inference # 1 • Within left-handed nurses there appears to be a pattern of predictable behavior across the nine settings 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  44. 44. RIGHT HANDED NURSES WITHIN GROUP ANALYSIS RIGHT HANDED NURSES 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  45. 45. Behavior Pattern h b h iQ: Is there any behavior pattern among right-handed nurses? e ust Adjust djust pproach esitation BTableUse edRailAdju edHeightA edAngleAd retch end nstable ft wist eposition Ap He OB Be Be Be Str Be Un Lif Tw Re Vitals NO Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes S ti Y Y Y Y Y Y Y Y Y Y Y YSuction Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Sitting Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  46. 46. Inference # 2 • Within right-handed nurses there appears to be a pattern of predictable behavior across the nine settings 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  47. 47. LEFT – RIGHT COMPARISON BETWEEN GROUP ANALYSIS LEFT RIGHT COMPARISON 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  48. 48. Behavior Difference Q: Are there differences between left and right handed nurses?Q: Are there differences between left and right-handed nurses? se just Adjust djust pproach esitation BTableUs edRailAdj edHeightA edAngleAd tretch end nstable ift wist eposition Ap H OB Be Be Be St Be Un Li Tw Re Vitals Yes no no Yes no no no no no no no Yes Suction Yes no Yes Yes no no Yes no no no no no Sitting Yes no no no Yes no no Yes no no Yes no 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  49. 49. Inference # 3 • Large number of statistically significant differences between left-handed and right-differences between left-handed and right- handed nurse behavior 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  50. 50. FACTORS AFFECTING WHERE DO NURSES POSITION VIS-À-VIS THE PATIENT? FACTORS AFFECTING CAREGIVER POSITION 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  51. 51. Task: Vitals Q: Left-handed nurses’ position vis-à-vis the patient Position: Left-Handed Nurses Set ID 1 2 3 4 5 6 7 8 9 % Right 20 100 0 10 50 100 0 100 0 % Left 80 0 100 90 50 0 100 0 100 Factor Natural Preference IV IV Dist/ Pref IV IV IV IV OBT IV OBT IV OBT OBT OBT IV OBT IV OBT IV OBT IV OBT 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  52. 52. Task: Vitals Q: Right-handed nurses’ position vis-à-vis the patient Position: Right-Handed Nurses Set ID 1 2 3 4 5 6 7 8 9Set ID 1 2 3 4 5 6 7 8 9 % Ri ht 50 100 10 20 80 100 0 100 20 Right % Left 50 0 90 80 20 0 100 0 80 Factor Natural Preference IV IV Dist Dist IV IV IV IV OBT IV OBT IV OBT OBT OBT IV OBT IV OBT IV OBT IV OBT 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  53. 53. Inference # 4 • In Task = Vitals – Location of IV d t i idetermines caregiver location – In absence of IV, OBTabse ce o V, walking distance determines caregiver locationlocation 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  54. 54. Task: Suction Q: Left-handed nurses’ position vis-à-vis the patient Position: Left-Handed Nurses Set ID 1 2 3 4 5 6 7 8 9 % Right 30 60 0 0 40 50 0 60 10 % Left 70 40 100 100 60 50 100 40 90 Factor Natural Preference IV IV Dist/ Pref Dist/ Pref IV Dist/ Pref/ IV IV/ Dist IV/ Pref IV OBT IV OBT IV OBT OBT OBT IV OBT IV OBT IV OBT IV OBT 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  55. 55. Task: Suction Q: Right-handed nurses’ position vis-à-vis the patient Position: Right-Handed Nurses Set ID 1 2 3 4 5 6 7 8 9 % Right 80 100 40 60 90 90 40 100 80 Right % Left 20 0 60 40 10 10 60 0 20 Factor Natural Preference IV/ Pref IV Dist/ Pref Dist/ Pref IV/ Pref IV/ Dist Dist/ Pref Pref Pref Pref Pref Pref Dist Pref OBT IV OBT IV OBT OBT OBT IV OBT IV OBT IV OBT IV OBT 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  56. 56. Inference # 5 • In Task = Suction – One or more of three f t i fl dfactors influenced caregiver’s position: • Obstructions (IV OBT location) • Walking Distance • Preferred side 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  57. 57. Task: Sitting Q: Left-handed nurses’ position vis-à-vis the patient Position: Left-Handed Nurses Set ID 1 2 3 4 5 6 7 8 9Set ID 1 2 3 4 5 6 7 8 9 % Right 30 10 60 20 70 20 50 40 80 % Left 70 90 40 80 30 80 50 60 20 Factor Natural Preference IV IV Dist/ Pref Dist IV IV Dist/ IV IV OBT IV OBT IV OBT OBT OBT IV OBT IV OBT IV OBT IV OBT 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  58. 58. Task: Sitting Q: Right-handed nurses’ position vis-à-vis the patient Position: Right-Handed Nurses Set ID 1 2 3 4 5 6 7 8 9 % Right 60 40 80 30 90 50 50 30 70 % Left 40 60 20 70 10 50 50 70 30 Factor Natural Preference IV IV/ Pref Dist Dist/ Pref IV IV IV/ Dist/ P fPref OBT IV OBT IV OBT OBT OBT IV OBT IV OBT IV OBT IV OBT 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  59. 59. Inference # 6 • In Task = Sitting – One or more of three f t i fl dfactors influenced caregiver’s position: • IV location: dangling OBT on same side as IV • Preferred side • Walking Distanceg 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  60. 60. STRESSFUL/ HARMFULSTRESSFUL/ HARMFUL ACTIONS 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  61. 61. Sitting Task Stretch Bend Unstable Lift Twist Repos /Bed ation l /Bed ation l /Bed ation l /Bed ation l /Bed ation l /Bed ation l Headwall/ Configura Total Headwall/ Configura Total Headwall/ Configura Total Headwall/ Configura Total Headwall/ Configura Total Headwall/ Configura Total Right 22 10 31 78 10 88 0 1 1 4 1 5 96 8 112 0 0 0Right- Handed 22 10 31 78 10 88 0 1 1 4 1 5 96 8 112 0 0 0 Left- Handed 25 15 25 82 11 90 0 3 3 2 1 2 101 12 108 9 3 9 Total 47 25 160 21 0 4 6 2 197 20 9 3 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  62. 62. Suction Task Stretch Bend Unstable Lift Twist Repos /Bed ation l /Bed ation l /Bed ation l /Bed ation l /Bed ation l /Bed ation l Headwall/ Configura Total Headwall/ Configura Total Headwall/ Configura Total Headwall/ Configura Total Headwall/ Configura Total Headwall/ Configura Total Right 1 0 1 32 1 32 5 2 7 0 0 0 74 2 74 0 1 1Right- Handed 1 0 1 32 1 32 5 2 7 0 0 0 74 2 74 0 1 1 Left- Handed 0 0 0 14 0 14 1 2 3 0 0 0 41 4 45 0 0 0 Total 1 0 46 1 6 4 0 0 115 6 0 1 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  63. 63. 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  64. 64. INTERVIEW DATA Corroborating Evidence INTERVIEW DATA 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  65. 65. Subject Interview • Top factors affecting nurses decision on location vis-à-vis the patient: – Location of IV – Entrance location – Walking Distance – Requirement of hand precisionequ e e o d p ec s o 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  66. 66. Subject Interview • Best configuration: – Configurations without partitionsg p – Offered immediate visual assessment of the caregiver zone and equipment location • Positive attribute across all settings: – Redundant medical gas and utilityRedundant medical gas and utility connections on both sides of the patient 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  67. 67. CONCLUSIONSCONCLUSIONS 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  68. 68. Handedness • Right-handed and left-handed nurses behave differently • Approach and position depends on: – Task typeTask type – Equipment location – Walking DistanceWalking Distance – Nurses’ Preferred side 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  69. 69. Handedness • Preferred side varies within each group – There is no consistent preference for eitherp the left or the right side within left-handed or right-handed nurses • Handedness of the physical environment may not have any association with care efficiency or safety 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  70. 70. Standardization Types Level 1 Level 2 Level 3 Level 4 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  71. 71. Standardization • Level 2 (Headwall) standardization( ) supported: – Standardized headwall with redundant outletsStandardized headwall with redundant outlets on both sides of the patient across all care settings 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  72. 72. Standardization • Level 3 (Caregiver Zone) standardization( g ) unexplored: – Advantages of standardization of theAdvantages of standardization of the caregiver zone across all rooms is implied by the data – To be examined in future phases 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  73. 73. Standardization • Level 4 (Patient Room) standardization: – A key room level concept examined:y p Direction of approach – Evidence suggest that fixed direction of approach may not be associated with care efficiency 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design
  74. 74. QuestionsQuestions 2009 PDC Conference & Exhibition Leading the Way to Better Health Care Design

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