Although long working hours, overtime, and sleep deprivation are problems in healthcare operations, the physical design of units is only now beginning to be considered seriously in evaluating patient outcomes. Access to a nature view and natural light for care-giving staff could bear direct as well as indirect effects on patient outcomes.
Flexibility in health care design is typically addressed from an architectural perspective without a systematic understanding of its meaning from the end-user's viewpoint. Moreover, the architectural perspectives have been generally focused on expandability and convertibility. This study explored flexibility needs in adult medical-surgical inpatient care with the objective to understand its meaning from an end-user perspective and identify characteristics of the physical environment that promote or impede stakeholders' requirements. Semistructured interviews were conducted using a qualitative design with 48 stakeholders in nursing and nursing-support services at 6 hospitals across the United States. Data were collected during September-November 2006. Findings suggest that adaptability influences more aspects of unit operations than convertibility or expandability. Furthermore, physical design characteristics affect 9 critical operational issues where flexibility is required, spanning nursing, environmental services, materials management, dietary services, pharmacy, and respiratory therapy.
Should power, medical gases, and monitoring and communications systems be located in a headwall or a ceiling-mounted boom in intensive care unit (ICU) rooms? Often, only the financial costs could be determined for the options, whereas data regarding its potential influence on teamwork, safety, and efficiency are lacking. Hence, purchase decisions are more arbitrary than evidence based. This study simulated care delivery in settings with a traditional headwall and a ceiling boom. Observed were the way the following elements were managed and the extent either system affected flexibility, ergonomics, and teamwork: tubing for intravenous fluids, medical gases, and suction drainage; monitoring leads and equipment power cords; and the medical equipment itself. Simulation runs involving 6 scenarios were conducted with the voluntary participation of 2 physicians, 2 nurse practitioners, 2 respiratory therapists, and 4 registered nurses at a children's tertiary care center in December 2007. Analysis suggests that booms have an advantage over headwalls in case of high-acuity ICU patients and when procedures are performed inside patient rooms. However, in case of lower-acuity ICU patients, as well as when procedures are not typically conducted in the patient room, booms may not provide a proportionate level of advantage when compared with the additional cost involved in its procurement.
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