Sara Bayramzadeh

Centralized vs. Decentralized Nursing Stations: An Evaluation of the Implications of Communication Technologies in Healthcare.

OBJECTIVE: This study aims to explore the relationship between the nursing station design and use of communication technologies by comparing centralized and decentralized nursing stations. BACKGROUND: The rapid changes in communication technologies in healthcare are inevitable. Communication methods can change the way occupants use a space. In the meantime, decentralized nursing stations are emerging as a replacement for the traditional centralized nursing stations; however, not much research has been done on how the design of nursing stations can impact the use of communication technologies. METHODS: A cross sectional study was conducted using an Internet-based survey among registered nurses in a Southeastern hospital in the United States. Two units with centralized nursing stations and two units with decentralized nursing stations were compared in terms of the application of communication technologies. A total of 70 registered nurses completed the survey in a 2-week period. RESULTS: The results revealed no significant differences between centralized and decentralized nursing stations in terms of frequency of communication technologies used. However, a difference was found between perception of nurses toward communication technologies and perceptions of the use of communication technologies in decentralized nursing stations. CONCLUSIONS: Although the study was limited to one hospital, the results indicate that nurses hold positive attitudes toward communication technologies. The results also reveal the strengths and weaknesses of each nursing station design with regard to communication technologies.

Safety, Performance, and Satisfaction Outcomes in the Operating Room: A Literature Review:

Objective: This review of empirical literature focuses on the design of operating rooms (ORs) by investigating the physical environmental features of ORs associated with patient and staff outcomes. Background: Many ORs built more than 30 years ago remain operational today. However, most are inadequately designed to handle the equipment, processes, and people that a contemporary OR needs to accommodate. However, the evidence base for designing ORs has been sorely lacking, and little guidance exists on how OR design can improve safety and performance outcomes. Method: A literature search was conducted using PubMed and the university’s linked databases. The inclusion criteria included peer-reviewed journal articles that reported some aspect of the physical environment of ORs along with outcomes. The study included empirical studies as well as nonempirical best practice papers. Results: This literature review uncovered 211 articles. The main themes that emerged include OR design-related factors, ventilation, temperature and humidity, acoustical environment, lighting, and materials. Some environmental threats to patient safety in the OR include frequent door openings, clutter, poor air quality, surface contamination, and noise. Further, staff performance and satisfaction were impacted by factors such as the OR layout and equipment and furniture ergonomics. Conclusion: This literature review provides an overview of the research organized into design-focused topic areas to support decision-making by architects and designers. This article highlights gaps in the research and identifies areas where best practice and design assumptions need to be evaluated using rigorous design research.

Setting the Stage: A Comparative Analysis of an Onstage/Offstage and a Linear Clinic Modules:

Objective: The purpose of this study was to understand how two different ambulatory design modules—traditional and onstage/offstage—impact operational efficiency, patient throughput, staff collaboration, and patient privacy. Background: Delivery of healthcare is greatly shifting to ambulatory settings because of rapid advancement of medicine and technology, resulting in more day procedures and follow-up care occurring outside of hospitals. It is anticipated that outpatient services will grow roughly 15–23% within the next 10 years (Sg2, 2014). Nonetheless, there is limited research that evaluates how the built environment impacts care delivery and patient outcomes. Method: This is a cross-sectional, comparative study consisted of a mixed-method approach that included shadowing clinic staff and observing and surveying patients. The linear module had shared corridors and publicly exposed workstations, whereas the onstage/offstage module separates patient/visitors from staff with dedicated patient corridors leading to exam rooms (onstage) and enclosed staff work cores (offstage). Roughly 35 hr of clinic staff shadowing and 55 hr of patient observations occurred. A total of 269 questionnaires were completed by patients/visitors. Results: The results demonstrate that the onstage/offstage module significantly improved staff workflow, reduced travel distances, increased communication in private areas, and significantly reduced patient throughput and wait times. However, patients’ perception of privacy did not change among the two modules. Conclusion: Compared to the linear module, this study provides evidence that the onstage/offstage module could have helped to optimize operational efficiencies, staff workflow, and patient throughput.

Using an integrative mock-up simulation approach for evidence-based evaluation of operating room design prototypes

This paper describes the process and tools developed as part of a multidisciplinary collaborative simulation-based approach for iterative design and evaluation of operating room (OR) prototypes. Full-scale physical mock-ups of healthcare spaces offer an opportunity to actively communicate with and to engage multidisciplinary stakeholders in the design process. While mock-ups are increasingly being used in healthcare facility design projects, they are rarely evaluated in a manner to support active user feedback and engagement. Researchers and architecture students worked closely with clinicians and architects to develop OR design prototypes and engaged clinical end-users in simulated scenarios. An evaluation toolkit was developed to compare design prototypes. The mock-up evaluation helped the team make key decisions about room size, location of OR table, intra-room zoning, and doors location. Structured simulation based mock-up evaluations conducted in the design process can help stakeholders visualize their future workspace and provide active feedback.

An Assessment of Levels of Safety in Psychiatric Units

Objectives: This article aims to understand the incident patterns in relation to different types of spaces within a psychiatric unit, which are discussed using the five levels of safety framework. Background: Implementing measures to improve patient safety is essential particularly in a psychiatric hospital, where limited research has been conducted on inpatient safety. Therefore, this article aims to understand the incident patterns from the lens of the five levels of safety framework, which categorizes spaces according to the level of patient supervision in psychiatric facilities, as follows: service areas, corridors, dayrooms, patient rooms and bathrooms, seclusions and admissions. Methods: In an 81-bed psychiatric hospital, this mixed-method study drew 7 years of incident reports and caregivers’ perceptions gathered through focus groups. Incident reports on physical safety were analyzed based on the five levels of safety framework (N = 1,316). Focus groups (n = 9) explored the caregivers’ viewpoints on patient safety and five categories of spaces. Results: Overall findings support the five levels of safety pattern, confirming that most incidents occurred in patient rooms and bathrooms; moreover, relatively fewer incidents happened in dayrooms and corridors. Elopements are higher in hallways and dayrooms. Suicide is most common in patient rooms and bathrooms, and violence is more frequent in dayrooms. Focus groups results yielded insightful recommendations. Conclusions: Levels of safety framework can be adapted to seven categories where seclusion room and admission area would be two of the spaces with least incidents.

Understanding Design Vulnerabilities in the Physical Environment Relating to Patient Fall Patterns in a Psychiatric Hospital: Seven Years of Sentinel Events:

BACKGROUND: The influence of the physical environment on patient falls has not been fully explored in psychiatric units, despite this patient population’s vulnerability and the critical role of the physical environment in patient safety. AIMS: The research objective is to describe the spatial and temporal pattern of falls occurrences and their location in relation to the levels of safety continuum model. METHOD: This article presents an exploratory case study design. Seven years of retrospective data on patient falls, yielding 818 sentinel events, in an 81-bed psychiatric hospital in the United States were collected and analyzed. Data focused on extrinsic factors for falls, emphasizing the physical environment. Through a content analysis of the sentinel event narratives, recorded by the hospital staff, this study explored patient falls related to location and elements of the physical environment. RESULTS: The analysis revealed that 15% of recorded falls were attributed to some aspect of or element within the physical environment. The most typical locations of falls were patient rooms (39%), patient bathrooms (22%), and dayrooms (20%). Also, the results identified patterns of environmental factors that appeared linked to increasing patients’ susceptibility to falls. Risk factors included poor nighttime lighting, flooring surfaces that were uneven, and spaces that inadvertently limited visual access and supervision. CONCLUSIONS: The physical environment plays an often-unexamined role in fall events and specific locations. These results are deserving of further research on design strategies and applications to reduce patient falls in psychiatric hospital settings.

Comparing the Effectiveness of Four Different Design Media in Communicating Desired Performance Outcomes With Clinical End Users

Objective: The purpose of this study was to compare the effectiveness of four different design communication media in helping clinical end users understand spatial and functional information and in supporting their ability to provide design feedback. Background: It is critical to involve clinical end users early in the design process to test design solutions and ensure the design of a new healthcare facility supports their ability to deliver high-quality care. Traditional architectural design communication media such as floor plans and perspectives can be challenging for clinical design team members to understand. Physical and virtual mock-ups are becoming more popular as design communication media. However, nominal evidence exists comparing the effectiveness of different design media in supporting clinical end-user engagement and contribution during the design process. Method: An exploratory, qualitative study was conducted with clinical end users to evaluate the effectiveness of four different media commonly used in design communication. Results: Traditional architectural representations convey limited useful information to clinical end users, impacting the amount and type of feedback they can provide. More immersive media, such as physical and virtual mock-ups, support an increasingly holistic understanding of proposed design solutions, inciting more design solutions that range from the inclusion and exclusion of design features to location, position, and functionality of those features. Conclusions: When used in combination, each media can contribute to eliciting clinical end-user feedback at varying scales. The overall preference and higher effectiveness in eliciting design feedback from clinical end users highlights the importance of physical mock-up in communicating healthcare design solutions.

The Impact of Operating Room Layout on Circulating Nurse’s Work Patterns and Flow Disruptions: A Behavioral Mapping Study:

Aim: To assess how the adjacencies of functionally different areas within operating rooms (ORs) can influence the circulating nurse’s (CN) workflow patterns and disruptions. Background: The CN plays a significant role in promoting patient safety during surgical procedures by observing, monitoring, and managing potential threats at and around the surgical field. Their work requires constant movement to different parts of the OR to support team members. The layout of the OR and crowded and cluttered environment might impact the CN’s workflow and cause disruptions during the surgery. Method: A convenience sample of 25 surgeries were video recorded and thematically coded for CN’s activities, locations, and flow disruptions. The OR layout was categorized into transitional zones and functional zones (workstations, supply zones, support zones, and sterile areas around the surgical table). CN’s activities were classified into patient-, equipment-, material-, and information-related activities. Flow disruptions included those related to environmental hazards and layout. Results: The CN traveled through multiple zones during 91% of the activities. The CN’s workstation acted as a main hub from which the CN made frequent trips to both sides of the surgical table, the foot of the OR table, supply zones, and support zones. Transitional zones accounted for 58.3% of all flow disruption that the CN was involved in whereas 28% occurred in areas surrounding the OR bed. Conclusion: The similarity of the movement and flow disruption patterns, despite variations in OR layout, highlighted the adjacencies required between major zones that CNs regularly visit. These optimum adjacencies should be considered while designing ORs such that they are more efficient and safer.

Minor flow disruptions, traffic-related factors and their effect on major flow disruptions in the operating room

Background Studies in operating rooms (OR) show that minor disruptions tend to group together to result in serious adverse events such as surgical errors. Understanding the characteristics of these minor flow disruptions (FD) that impact major events is important in order to proactively design safer systems Objective The purpose of this study is to use a systems approach to investigate the aetiology of minor and major FDs in ORs in terms of the people involved, tasks performed and OR traffic, as well as the location of FDs and other environmental characteristics of the OR that may contribute to these disruptions. Methods Using direct observation and classification of FDs via video recordings of 28 surgical procedures, this study modelled the impact of a range of system factors—location of minor FDs, roles of staff members involved in FDs, type of staff activities as well as OR traffic-related factors—on major FDs in the OR. Results The rate of major FDs increases as the rate of minor FDs increases, especially in the context of equipment-related FDs, and specific physical locations in the OR. Circulating nurse-related minor FDs and minor FDs that took place in the transitional zone 2, near the foot of the surgical table, were also related to an increase in the rate of major FDs. This study also found that more major and minor FDs took place in the anaesthesia zone compared with all other OR zones. Layout-related disruptions comprised more than half of all observed FDs. Conclusion Room design and layout issues may create barriers to task performance, potentially contributing to the escalation of FDs in the OR.

Using a systems approach to evaluate a circulating nurse's work patterns and workflow disruptions

The physical environment affects how work is done in operating rooms (OR). The circulating nurse (CN), in particular, requires access to and interacts with materials, equipment, and technology more than other OR team members. Naturalistic study of CN behavior is therefore valuable in assessing how OR space and physical configuration influences work patterns and disruptions. This study evaluated the CNs work patterns and flow disruptions (FD) by analyzing 25 surgeries across three different ORs. The OR layouts were divided into transitional and functional zones, and the work of CNs was categorized into patient, equipment, material, and information tasks. The results reveal that information tasks involve less movement than other types of work, while across all ORs, CNs were more likely to be involved in layout and environmental hazard FDs when involved in patient, material, or equipment-related tasks compared to information tasks. Different CN work patterns and flow disruptions between ORs suggest a link between OR layout and a CNs work. Future studies should examine how specific layout elements influence outcomes.