1. Evidence for Designing Patient Rooms
at Northwest Community Hospital
HCD.11 – Wednesday, November 16, 2011

2. 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 Day
for 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 Servers
to 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

3. PATIENT ROOM FEATURES: PRESS GANEY RESULTS:
DIGNITY IN PATIENT CARE, PATIENT SATISFACTION INDICATORS
ADVANCING PATIENT SAFETY
Environment distinctive zones for patient, family and care [7] large entrances
May–August May–August
[1] visible handwash sinks [8] in-room charting
for Safety [2] “universal” footprint maximizes flexibility [9] family overnight space PATIENT SATISFACTION 2010 2009
[3] nurse server accessible via double door [10] grab bars
INDICATORS
and Comfort [4] views to nature [11] curbless showers South Pavilion Legacy Tower Legacy Tower
Mean Mean Mean
[5] plant/personal items/artwork [12] comfortable, sturdy finishes
[6] patient control of lighting, temperature [13] 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 83.0
11 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

4. PATIENT ROOM DESIGN AND RECOVERY PRESS GANEY RESULTS:
FROM SURGERY: SUMMARY LIKELIHOOD TO RECOMMEND, NOISE
AND PRIVACY
mean n = number of respondents
Hypothesis 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
85
Methods 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.
90
Findings 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.

5. company logo
project name
www.cannondesign.com