Letter to the Editor

Abstract

To the Editors of HERD: In his editorial “Unsupportable Claims” (HERD 2019, Vol. 12(4) 22–25), D. Kirk Hamilton addresses the issue of design “concepts supported by evidence and those based only upon logical or plausible assumptions.” While I agree with his premise, I am concerned that his example of the same-handed patient room may be misconstrued to eliminate this room configuration from consideration. I agree that there has not been definitive evidence that same handedness in patient rooms reduces medical errors: The first hypothesis that brought this configuration significantly into the marketplace. However, there has been credible research that other qualities may warrant a same-handed design. For instance, one study (Watkins, N., Kennedy, M., Ducharme, M., & Padula, C. (2011). Same-Handed and Mirrored Unit Configurations: Is There a Difference in Patient and Nurse Outcomes? Journal of Nursing Administration, 41(6)) indicated several important attributes. The study concluded that patients in the same-handed rooms reported lower noise levels than in mirrored rooms that shared a headwall, allowing for better sleep quality. This could be attributed to both less sound transmission through wall penetrations by the patient’s head and the spacing of doorways. More consistent righthanded approaches to the patient improved nurses’ satisfaction with organization of the bedside workspace, perhaps because of their training. The study also associated the right-handed approach with fewer near falls, speculating it was related to the predominance of right-handed patients. HERD most recently published “Exploring the Relationships Between Patient Room Layout and Patient Satisfaction” (HERD 2019, Vol. 12(1) 91–107) where the authors found the highperforming rooms (as rated by staff and patients) were where the patient’s right side was facing the entry door (right handed). This seems to substantiate the earlier study. One major concern regarding same-handed patient rooms has been the additional cost because plumbing risers are not shared. Interestingly, an unintended, but fruitful consequence has been the potential for repetitive, modular design that has reduced cost and schedule and improved installation quality. In a same-handed patient room, theoretically every component can be identical such as headwalls and casework. We have seen premanufactured toilet pods and now whole patient rooms on the market that benefit from this concept. It is important to distinguish for our clients when proposed innovation is based on “plausible assumptions” and when actual research exists so we can all make informed decisions. In the case of same-handed patient rooms, there are many positive characteristics that are evidence based beyond the plausible assumption that the design reduces error. Another example may better state the author’s case.