Evidence for Designing Patient Rooms at Northwest Community Hospital
Evidence for Designing Patient Roomsat Northwest Community HospitalHCD.11 – Wednesday, November 16, 2011
PEP COUNCIL, VISION CENTER + PROTOTYPE CLINICAL INITIATIVE SCORECARD: The development of the Guiding Principle The size and configuration of the rooms have been GUIDING PRINCIPALS, STRATEGIES, PEP (Principles-Elements-Processes) Guide established a series of 11 goals shaped by the hospital’s Guiding Principles, including: standardization, adaptability, privacy, technology and METRICS AND TARGETS IN for the project; elements that would be patient/family-centered care. These were tested in the implemented as metrics that are used to Vision Center (below). The design incorporates into the ID Guiding Principles/Objectives Strategies Metrics Source Targets define success. A PEP council, comprised rooms the most recent research and trends that address # 1 Respect for Individual Needs of All Users of nursing directors, reviewed decisions for patient safety, patient and family satisfaction, stress - - Improve Satisfaction Enhance Privacy, Cultural Sensitivity Private Patient Rooms Patient Satisfaction-Privacy,Crowding, PG-IP&ED: Staff concerned with your privacy Improve by x% guiding principle compliance. reduction and infection control protocols. - - Improve Convenience, Accessibility Respect for patient values, preferences, needs * 2 Incorporate Evidence-Based Design - 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 Environments - Incorporate Natural Light Views of nature/outdoors Staff Satisfaction Scores GPTW: our facilities contribute to a good working Improve by x% environment - 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 Design Adaptability in Facility - Standardize core elements, but allow for adaptability as Acuity Adaptable / Universal Physician Satisfaction Scores Improve by x% needed Rooms - 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 Integrate Holistic Care - Provide healing touch therapies Balconies Define Strategy - Pending - Provide horticulture therapy Healing Gardens 6 Improve Safety - 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 Processes, Supplies, Design - Standardize repetitive functions, spaces Same-handed Rooms Material Management Costs Materials management - Tom C? Reduce by x%A Vision Center was created in an off-site warehouse - Lower Operating Costs Standardized room layout Staff Walking Distance per Dayfor the design team, hospital and community groups - Improve Operational Efficiencies Standard support cores Hours per Patient Day Neutral? - Coordination and Integration of Care* Portable Nurse Serversto test assumptions within a full-scale prototype. - ED Triage Rooms ED Turnaround time(check-in to Reduce by x% discharge/bed) Barcoding/RF? ED Pts Presented, but Left Before Seen Reduce by x% OB - triage visits Increase By ? OB Inductions Increase By ? 8 Create Archetype for Design Elements - Test equipment/processes before PCA Patient Satisfaction - Existing Tower PG-ED: Cleanliness of treatment area increase by x% cleanliness, décor - Design to be translatable to exist. tower PG-IP: Room Cleanliness and Room Décor - Improve environment / patient experience across campus 9 Enhance Patient/Family Centeredness - 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 Promote Community Centricity - 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 Enable Processes through Technology - 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 Survey IP = Inpatient Survey
PATIENT ROOM FEATURES: PRESS GANEY RESULTS:DIGNITY IN PATIENT CARE, PATIENT SATISFACTION INDICATORSADVANCING PATIENT SAFETYEnvironment distinctive zones for patient, family and care  large entrances May–August May–August  visible handwash sinks  in-room chartingfor Safety  “universal” footprint maximizes flexibility  family overnight space PATIENT SATISFACTION 2010 2009  nurse server accessible via double door  grab bars INDICATORSand Comfort  views to nature  curbless showers South Pavilion Legacy Tower Legacy Tower Mean Mean Mean  plant/personal items/artwork  comfortable, sturdy finishes  patient control of lighting, temperature  patient lifts 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 4 Accommodations and comfort for visitors 89.7 76.4 79.7 9 Staff concern for your privacy 89.2 82.0 83.011 Overall cheerfulness of hospital* 92.0 80.0 83.4 FAMILY ZONE Likelihood of recommending the hospital 92.8 81.0 86.5 NOTE: Numerous requests to transfer patients from Legacy Consistent Increases Decreased Satisfaction Likely Tower to South Pavilion regularly occur each month (from Due to Increased Expectations physicians, patients, friends and family members). 1 10 12 12 PATIENT 5 ZONE 6 CARE 1 ZONE 3 NCH Patient Satisfaction per Quarter / Year 7 5 8 80 percentile rank 60 7 2 40 13 4 20 10 9 0 10 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter 11 2010 2010 2010 2010 South Pavilion 7 2 opens 2
PATIENT ROOM DESIGN AND RECOVERY PRESS GANEY RESULTS:FROM SURGERY: SUMMARY LIKELIHOOD TO RECOMMEND, NOISE AND PRIVACY mean n = number of respondentsHypothesis The recovery of surgical patients in rooms with EBD features was faster and less painful Likelihood of Recommending Hospital than that of those in rooms without the features. (Differences in recovery process be- 100 tween these two patient groups were clarified. The extent to which the evidence-based 95 patient-room design contributes to postsurgical recovery was examined.) 90 85Methods A before-after comparison was conducted by an interdisciplinary team, which was comprised of researchers, designers 80 and caregivers. Northwest Community Hospital (NCH) recently opened its same-handed private patient rooms providing 75 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 70 these new rooms; previous patients who had the same surgery were assigned to opposite-handed semi-private old 65 rooms without the aforementioned features. Medical record of patients in the new/old rooms was obtained. Objective 2008 2009 2010 2011 OCT – JAN – APR – JUL – OCT – JAN – APR – JUL – OCT – JAN – APR – JUL – data of the built environments in and around the new/ old patient rooms were collected. DEC MAR JUN SEP DEC MAR JUN SEP DEC MAR JUN SEP n=149 n=164 n=142 n=123 n=141 n=150 n=141 n=104 n=129 n=108 n=100 n=102 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. Noise Level in and Around Room Analysis of recovery differences between these matched pairs was conducted by using the Statistical Package for the 100 Social Sciences (SPSS version 16.0), including paired sample T-tests. 90Findings Based on statistical analyses, this study found that the recovery of the patients in rooms with EBD features was less 80 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 70 discharge was significantly lower in the new-room group (p<0.1). Postsurgical Pain Scores in Patient Rooms with/without EBD With EBD Without EBD 60 3 2.65 50 2.66 2008 2009 2010 2011 2.61 2.2 2.22 2.16 OCT – JAN – APR – JUL – OCT – JAN – APR – JUL – OCT – JAN – APR – JUL – 2.08 DEC MAR JUN SEP DEC MAR JUN SEP DEC MAR JUN SEP 2 1.94 n=150 n=159 n=139 n=125 n=139 n=152 n=138 n=103 n=129 n=109 n=99 n=199 1.95 1.98 1.85 1.91 1 Staff Concern for Privacy 100 0 95 1 2 3 4 5 6 90 Post operation 1st day pain score 1st day pain score 2nd day pain score 2nd day pain score Last pain score prior to admission to the in the morning at 11pm in the morning at 11pm discharge, generally 20- 85 patient-room floor 30 hours after Score 5. 80 75 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 70 by hour. *: p<0.1 65 2008 2009 2010 2011 The average length of postsurgical hospital stay was 72.5 hours in the new-room group and in 74.2 hours in the old- OCT – JAN – APR – JUL – OCT – JAN – APR – JUL – OCT – JAN – APR – JUL – DEC MAR JUN SEP DEC MAR JUN SEP DEC MAR JUN SEP room group. However, the difference was not statistically significant. The postsurgical analgesia uses in the two groups n=146 n=153 n=135 n=116 n=130 n=145 n=138 n=102 n=146 n=106 n=98 n=92 were not significantly different.