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PDC_2012_ED Study

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PDC_2012_ED Study

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PDC_2012_ED Study

  1. 1. First Do No Harm… How Design Impacts Safe and Efficient Care in the Emergency Department ASHE-PDC 2012, Phoenix, AZ
  2. 2. Presenters Thomas E. Harvey FAIA, MPH, FACHA, LEED® AP Partner/Senior Vice President, HKS President, CADRE Debajyoti Pati PhD, FIIA, LEED® AP Associate Professor, Texas Tech University Executive Director of CADRE David Vincent AIA, ACHA, LEED® AP Principal/Senior Vice President, HKS
  3. 3. Acknowledgments Institutional Support and Funding  AIA Academy of Architecture for Health Foundation  Herman Miller, Inc.  HKS, Inc.  Texas Tech University  Participating Hospitals administration and staff Study Team  CADRE – Debajyoti Pati (PI) and Tom Harvey  HKS – David Vincent, Jennie Evans  Herman Miller – Doug Bazuin  Synurgy Healthcare Solutions - Mary Ann Derr
  4. 4. Agenda  Study questions  Research method  Safety and efficiency correlates  Next steps  Q&A
  5. 5. Questions In what way does the ED physical design facilitate or impede ED processes? What are the domains of physical design decisions that potentially influence the efficiency and safety of ED operations?
  6. 6. Method: Study Sites Palmetto Health in Columbia, South Carolina Palmetto Health Baptist Palmetto Health Richland Texas Health Resources - Fort Worth, Texas Harris-Methodist Southwest Intermountain Healthcare - St. George, Utah Dixie Regional Medical Center PH Baptist PH RichlandDixie Regional Medical CenterHarris-Methodist Southwest
  7. 7. Method: Data Types  Multi-disciplinary gaming  Semi structured interview  Touring interviews of frontline staff
  8. 8. Method: IRB / Quality Improvement  Approved as non “human subjects” study o Palmetto Health Baptist o Palmetto Health Richland o Intermountain  Approved as “human subjects” study o THR Harris-Methodist Southwest
  9. 9. Safety Safety Patient Staff Family/Visitor Security affects Safety in the care processes Security
  10. 10. Efficiency Nursing Support Physician Efficiency THROUGHPUT
  11. 11. Interactions SAFETY EFFICIENCY Security Safety and Efficiency are both affected by Security – real or perceived….
  12. 12. Findings…
  13. 13.  Entry / Public Waiting  Patient Intake  Patient Flow  Configuration  Room Standardization  Space Adequacy  Sub-waiting Domains of Consideration  Care-giver Work Area  Physician Work Area  Equipment Accessibility  Behavioral Health Support  Staff Respite  Corridor Width  D & T Adjacencies
  14. 14.  Entry / Public Waiting  Patient Intake  Patient Flow  Configuration  Room Standardization  Space Adequacy  Sub-waiting Primary Domains  Care-giver Work Area  Physician Work Area  Equipment Accessibility  Behavioral Health Support  Staff Respite  Corridor Width  D & T Adjacencies Top safety and efficiency priorities!
  15. 15. Red = Safety Concerns Potential safety breaches create both security concerns and inherently disrupt efficiency of the entire care process.
  16. 16. Blue = Efficiency Concerns Patient intake must be rapid and accurate to initiate and ensure efficiency and maximum throughput.
  17. 17.  Entry / Public Waiting  Patient Intake  Patient Flow  Configuration  Room Standardization  Space Adequacy  Sub-waiting Secondary Domains  Care-giver Work Area  Physician Work Area  Equipment Accessibility  Behavioral Health Support  Staff Respite  Corridor Width  D & T Adjacencies Second highest safety and efficiency priorities!
  18. 18. Blue = Efficiency Concerns Adequacy of work space for staff and physician work, within good line of sight of all exam/treatment rooms, was the second strongest point of emphasis.
  19. 19. Interactions SAFETY EFFICIENCY Security Every finding within this study affects both Safety and Efficiency to varying degrees!
  20. 20.  Visibility  Queuing sensitivity  Security provisions ENTRY/PUBLIC WAITING
  21. 21. ENTRY/PUBLIC WAITING…Visibility  Full visibility of all waiting areas  Immediate recognition by staff of patient’s walk-in urgent condition  Change in patient condition while waiting is detected and acted upon  Continuous monitoring of traffic and volume can improve efficient patient flow and throughput
  22. 22.  Provision of waiting areas in zones may promote efficiency. With a common waiting area, nurses may have to explain to patients why they are not seen in the order of arrival. ENTRY/PUBLIC WAITING…Queuing Sensitivity
  23. 23.  Visible security deters potential threat to hospital staff and patients.  Security concerns impact safety and efficiency - a psychological impact.  Bullet-proof glass for registration desk.  Metal detectors at the walk-in entrance. ENTRY/PUBLIC WAITING…Security Provisions Security Office
  24. 24.  Adequate counter provisions for IT equipment  Sufficient area for clinical equipment  Connectivity (pneumatic tube system)  Specimen collection resources PATIENT INTAKE
  25. 25.  Visibility  Teamwork  Staffing  Ancillary Tracking CONFIGURATION Linear – Single Door Linear – Double Door Pods
  26. 26. CONFIGURATION…Visibility  Safety by visibility between work zones and patient rooms  Efficiency and security by sight lines of clinicians to each other across acuity zones  Efficiency by sharing across the acuity zones  Caution! - Isolated exam/treatment rooms cut off from work core line of sight pose a safety problem
  27. 27.  Caution! - Obstructed visibility can impede teamwork of clinical staff when back-up assistance is needed  Caution! - Physicians noted smaller pods of patient rooms can lead to perceived and real isolation when they are so small that only one physician is warranted in the area CONFIGURATION…Teamwork
  28. 28.  Staffing adjustments associated with volume fluctuations over 24 hours can pose efficiency and real cost issues in the use of human resources.  Caution! - Pods become inefficient when only a few rooms are occupied.  Caution! - Morale and teamwork are perceived to be diminished when staff must split between pods. CONFIGURATION…Staffing
  29. 29. CONFIGURATION…Ancillary Tracking Sat Lab Rad Room Sat Pharmacy Imaging CT Scan  Multiple geographic pods can cause difficulty locating patients by support department staff from Imaging, Laboratory, Pharmacy and Respiratory Therapy.
  30. 30. LEAN operations improvement aside….provide sub-waiting  At intake for exam room queuing  In core for results waiting to free up exam rooms  In core to allow more flexible room staging  In core (or holding area) to await admission or discharge  Recommendation! Provide medical utility access in these areas SUB-WAITING
  31. 31.  Locate to optimize nurse-patient visibility for safety  Attenuate intelligible speech from reaching patient rooms – efficiency as well as privacy.  Design work stations to minimize potential distractions from family members CARE-GIVER WORK AREA
  32. 32.  Optimize visibility of patient rooms from physician workspace,  Mitigate potential uninitiated interaction with family members or patients PHYSICIAN WORK AREA
  33. 33. Patient Intake Configuration Care-giver Work Area Physician Work Area Sub-waiting Traffic Flow Corridor Width Space Adequacy Equipment Accessibility D & T Adjacencies Staff Respite Room Standardization Behavioral Health Support Summary Safety and Efficiency…14 domains of consideration are essential to excellence in ED design. Entry/ Public Waiting
  34. 34. Healthcare Thank You…

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