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WHD_2014_Where Research Meets Design

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WHD_2014_Where Research Meets Design

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WHD_2014_Where Research Meets Design

  1. 1. WHERE RESEARCH MEETS DESIGN Using Parametric Modeling to Optimize Walking Distances and Enhance Workflow
  2. 2. • Adeleh Nejati, MArch, EDAC • Tom Harvey, FAIA, MPH, FACHA, LEED AP • Upali Nanda, PhD, Assoc. AIA, EDAC • Heath May, AIA • Ryan Gathmann, AIA
  3. 3. WHY RESEARCH IS “IN”
  4. 4. 3 INITIATIVES
  5. 5. PARAMETRIC MODELING
  6. 6. • Designing a process rather than a form • Designing a reusable and configurable process • Creating a nearly infinite number of variations from one rule set of inputs, decisions and actions • Optimizing by quickly creating, testing and comparing multiple options IMAGE PARAMETRIC MODELING
  7. 7. THEORETICAL FRAMEWORK
  8. 8. DRIVER (MANIPULATED FEATURE) Distance from a Patient Room to: • Medication Room • Clean Supply room • Soiled Utility Room • Equipment Holding room • Crash Cart Alcoves • Documentation Station(s) DRIVEN LEVEL 1 ENVIRONMENTAL QUALITY • Walking Distance - PR to Support Area - Support to Support - Support to PR DRIVEN LEVEL 2 HUMAN OUTCOME • Time in Bed-side Care • Time in Non-Value Added Activities • Nurse Fatigue DRIVEN LEVEL 3 HUMAN/ ORGANIZATIONAL OUTCOME • Med Errors • Falls • HCAHPS • Nurse Retention CONSTRAINT (CONTROL/CONFOUND) • Room Size • Unit Size • Minimum Clearances (patient bed, toilet) • Maximum Distance THEORETICAL FRAMEWORK
  9. 9. CASE STUDY Centralized vs. Decentralized Nurse Stations
  10. 10. PATIENT ROOMS CENTRALIZED NURSE STATIONS 36 3 METHODIST CHARLTON HOSPITAL DALLAS, TX DECENTRALIZED NURSE STATIONS 18 Each nursing unit in this hospital has:
  11. 11. IMAGE METHODIST CHARLTON HOSPITAL DALLAS, TX Scenario 1 Scenario 2 Scenario 3 36 Bed Unit
  12. 12. METHODIST CHARLTON HOSPITAL DALLAS, TX Scenario 1
  13. 13. Location Activity Minimum Roundtrips per Primary Shift1 Documentation Station(s) Documentation 10.0 Consultation/Collaboration Socialization Medication Room Meds Management/Admin 5.0 Med Prep Med Supply Acquisition Clean Utility Room Supply Use Management/Admin 3.0 Medical Supply Acquisition Clean Linen Acquisition Soiled Utility Room Waste Disposal 2.0 Dirty Equipment Holding Soiled Linen Holding Equipment Holding Room Equipment Storage 1.0 Broken Equipment Holding Nourishment Room - Meals Food Tray Hold/Retrieval 3.0 Used Tray Holding Nourishment Room - Ice/Snacks Snack/Drink Acquisition 4.0 Ice Pack Acquisition Break Room Personal Effects Access/Toilet 3.0 Education Respite Patient Transport (Service Elevators) Link to Surgery, Imaging, Other D&T 0.2 Link to other Bed Units Link to Discharge (Lobby) 1These figures are theoretical assumptions for purposes of this study. Actual trip counts measured through shadowing in the field often show higher frequencies. Round Trip and Distance Parameters for Nurse Travel from Patient Rooms METHODIST CHARLTON HOSPITAL DALLAS, TX
  14. 14. Patient Room 1 Patient Room 2 Patient Room 3 Patient Room 4 TOTAL Centralized 0.673 0.708 0.681 0.819 2.881 Scenario 1 Decentralized 0.491 0.549 0.55 0.67 2.26 % reduced %27.0 %22.5 %19.2 %18.2 %21.6 Centralized 0.857 0.831 0.805 0.796 3.289 Scenario 2 Decentralized 0.702 0.635 0.56 0.509 2.407 % reduced %18.0 %23.6 %30.4 %36.0 %26.8 Centralized 1.346 1.183 1.167 0.952 4.647 Scenario 3 Decentralized 1.063 0.942 0.929 0.795 3.729 % reduced %21.0 %20.3 %20.4 %16.5 %19.8 METHODIST CHARLTON HOSPITAL DALLAS, TX Walking Distance for Centralized vs. Decentralized Nurse Stations
  15. 15. METHODIST CHARLTON HOSPITAL DALLAS, TX 0.000 0.200 0.400 0.600 0.800 1.000 PR1 PR2 PR3 PR4 Scenario 1 0.000 0.200 0.400 0.600 0.800 1.000 PR1 PR2 PR3 PR4 Scenario 2 0.000 0.500 1.000 1.500 PR1 PR2 PR3 PR4 Scenario 3 0.000 0.500 1.000 1.500 2.000 2.500 3.000 3.500 4.000 4.500 5.000 Scenario 1 Scenario 2 Scenario 3 Centralized Nurse Station Decentralized Nurse Station Walking Distance for Centralized vs. Decentralized Nurse Stations 21.6% 26.8% 19.8%
  16. 16. IMPLEMENTATION IN PRACTICE
  17. 17. WINGS NURSE STATIONS 2 4 PROMEDICA TOLEDO HOSPITAL TOLEDO, OH PATIENT ROOMS 40 Each nursing unit in this hospital has:
  18. 18. 20 Beds 20 Beds
  19. 19. 200.075 115 83 81.55 79.725 68.25 59.875 59.325 50.8 24.125 0 50 100 150 200 250 Break Room Nourishment Conference Soiled Work Equipment Ice Main Nurse Station Meds Linen Wow Stations AVERAGE DISTANCE FROM PR TO SUPPORT SPACES
  20. 20. NURSE WALKING DISTANCES Excessive Distance Reasonable Distance UNIT AREAS PATIENTROOMS
  21. 21. IMPLICATIONS FUTURE RESEARCH
  22. 22. • Increased value of care giver time – by optimizing time with the patient rather than time wasted in hunting and gathering activities. • Enhanced understanding of design implications – informed by quality data relative to spatial configurations on the workflow, unit organization and human behavior • Enabled purposeful scenario planning of workflow, space allocation and spatial configurations that then inform operational planning and space programming that drive design goals. IMPLICATIONS
  23. 23. • Building a tool providing the planner/designer with the ability to set a specific criteria of maximum threshold for walking distances, and input parameters related to the specific site and program to generate geometry within a parametric model. • Building a generic solver to automate the process of iteration and allow for numerous alternates to be tested against user-defined criteria and sorted for fitness. IMAGE FUTURE RESEARCH
  24. 24. Thank you for your attention 

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