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Justice GovernmentVeracruz, MexicoEDRA 39
Impacts of different patient fi tiroom configurations on
patient care activities in adult medical-surgical unitsadult medical-surgical units
Debajyoti Pati PhD AIIADirector of ResearchHKS Architects
May 31, 2008
Study Team
Agenda
The configuration rating criteriaThe configuration rating criteriaStudy methodologyD i d iDesigners vs non-designersConfiguration assessments
The symposium
Objectives:Objectives:Assess relative importance of 23 criteriaIdentify key room configuration issues:
Inboard, outboard and nested toilet/shower locations,“Same-handed” rooms vs “back-to-back” mirrored room arrangement.
Participants
Integris Health (Clinician + Patient +Integris Health (Clinician + Patient + Patient advocate)MD Anderson (Clinician)MD Anderson (Clinician)U T Arlington School of Nursing (Ed t )(Educator) HKS (Design Professionals)
Six configurations: Layout A
@Layout A: Mirrored Inboard Toilet @ Headwall
Six configurations: Layout B
L B Mi d O b d T il @ F llLayout B: Mirrored Outboard Toilet @ Footwall
Six configurations: Layout C
L C Mi d N d T il @ F llLayout C: Mirrored Nested Toilet @ Footwall
Six configurations: Layout D
L D S H d I b d T il @ H d llLayout D: Same Hand Inboard Toilet @ Headwall
Six configurations: Layout E
L E S H d O b d T il @ H d llLayout E: Same Hand Outboard Toilet @ Headwall
Six configurations: Layout F
L F S H d O b d T il @ F llLayout F: Same Hand Outboard Toilet @ Footwall
Rating Criteria: Patient safety
Visibility of patientVisibility of patientAccess to toiletC iCaregiver accessToilet room configurationAuditory pathwayStandardizationStandardization
Rating criteria: staff efficiency
Clearance around bedClearance around bedAccess to suppliesA t d tAccess to data
Rating criteria: circulation
Access to patient headAccess to patient headAccess around patient
Rating criteria: patient consideration
Transport in/out of roomTransport in/out of roomVisibility to corridorVi l i f idVisual privacy from corridorView of exteriorDaylightingPatient storagePatient storagePrivacy
Rating criteria: infection control
Handwash location/separationHandwash location/separationHandwashing and work surface
Rating criteria: family amenities/space
View of TVView of TVProximity to patientF il d tiFamily accommodation
Study methodology
Criteria ranking round 1Criteria ranking round 1Layout assessmentC it i ki d 2Criteria ranking round 2Overall assessment
Criteria ranking Round One
Non-designers (Top 10) Designers (Top 10)Clearance around bedAccess to patient headA d ti t
Visibility of PatientCaregiver accessCl d b d
Non designers (Top 10) Designers (Top 10)
Access around patientVisibility of PatientPrivacy (auditory)A t t il t
Clearance around bedAccess around patientHand wash location/separationAccess to toilet
Proximity to patientCaregiver access
location/separationAccess to patient headView of ExteriorAccess to toiletHand washing and work
surfaceFamily accommodation
Access to toiletDay lightingAccess to supplies
Criteria ranking: Round One
Non-designers (Last 5) Designers (Last 5)View of ExteriorAccess to data
Proximity to patientToilet Room configuration
Non-designers (Last 5) Designers (Last 5)
View of TVStandardizationPatient Storage
View of TVPatient StorageStandardizationPatient Storage Standardization
Criteria ranking: Round One
Major disagreementsPrivacy (auditory)Proximity to patient
Major disagreements
Proximity to patientCaregiver accessFamily accommodationHand wash location/ separationVi f t iView of exteriorAccess to data
Criteria ranking: Round Two
Non-designers (Top 10) Designers (Top 10)Clearance around bedAccess to patient headA d ti t
Visibility of PatientClearance around bedC i
Non designers (Top 10) Designers (Top 10)
Access around patientAccess to toiletCaregiver accessVi ibilit f P ti t
Caregiver accessAccess around patientAccess to toiletA t ti t h dVisibility of Patient
PrivacyHand washing and work surface
Access to patient headHand wash location/separationTransport in/ out of roomsurface
Family accommodationTransport in/ out of room
Transport in/ out of roomToilet Room configurationPrivacy
Criteria ranking: Round Two
Non-designers (Last 5) Designers (Last 5)View of ExteriorAccess to data
Day lightingVisual privacy from corridor
Non designers (Last 5) Designers (Last 5)
View of TVPatient StorageStandardization
Patient StorageView of TVStandardizationStandardization Standardization
Criteria ranking: Round Two
Major disagreementsDay lightingHand wash location/
Major disagreements
Hand wash location/ separationToilet room configurationAccess to data
Round One vs Round Two
Round One Round Two
Total difference in ranking between non-designers
Total difference in ranking between non-designers
Round One Round Two
gand designers = 32.57%
C l ti b t th
gand designers = 25.75%
C l ti b tCorrelation between the two ratings: Spearman’s Rho = 0.691, significant
Correlation between rankings: Spearman’s Rho= 0.843, significant at , g
at 0.001 level, g
0.001 level
Configuration assessment
Layout A
Layout 'A' Mean Rating
Visibility of PatientAccess to toiletCaregiver access
Toilet Room configurationAuditory PathwayStandardization
Rating Scale
Layout 'A' Mean Rating
Clearance around bedAccess to supplies
Access to data
Access to patient headAccess around patient
Transport in/ out of roomTransport to toilet
Visibility to corridorVi l i f idss
essm
ent Criteria
Visual privacy from corridorView of Exterior
DaylightingPatient Storage
Privacy
Handwash location/separationHandwashing and work surface
View of TVProximity to patient
Family accomodation
Room
As
‐3.00 ‐2.00 ‐1.00 0.00 1.00 2.00 3.00
Family accomodation
L A Mi d I b d T il @ H d llLayout A: Mirrored Inboard Toilet @ Headwall
Layout B
Layout 'B' Mean Rating
Visibility of PatientAccess to toiletCaregiver access
Toilet Room configurationAuditory PathwayStandardization
Rating Scale
Layout B Mean Rating
Clearance around bedAccess to supplies
Access to data
Access to patient headAccess around patient
Transport in/ out of roomTransport to toilet
Visibility to corridorVisual privacy from corridor
Vi f E t iAssessm
ent Criteria
View of ExteriorDaylighting
Patient StoragePrivacy
Handwash location/separationHandwashing and work surface
View of TVProximity to patient
Family accomodation
Room
A
‐3.00 ‐2.00 ‐1.00 0.00 1.00 2.00 3.00
L B Mi d O b d T il @ F llLayout B: Mirrored Outboard Toilet @ Footwall
Layout C
Layout 'C' Mean Rating
Visibility of PatientAccess to toiletCaregiver access
Toilet Room configurationAuditory PathwayStandardization
Rating Scale
Layout C Mean Rating
Clearance around bedAccess to supplies
Access to data
Access to patient headAccess around patient
Transport in/ out of roomTransport to toilet
Visibility to corridorVisual privacy from corridorA
ssessm
ent Criteria
View of ExteriorDaylighting
Patient StoragePrivacy
Handwash location/separationHandwashing and work surface
View of TVProximity to patient
Family accomodation
Room
A
‐3.00 ‐2.00 ‐1.00 0.00 1.00 2.00 3.00
L C Mi d N d T il @ F llLayout C: Mirrored Nested Toilet @ Footwall
Layout D
Layout 'D' Mean Rating
Visibility of PatientAccess to toiletCaregiver access
Toilet Room configurationAuditory PathwayStandardization
Rating Scale
Layout D Mean Rating
Clearance around bedAccess to supplies
Access to data
Access to patient headAccess around patient
Transport in/ out of roomTransport to toilet
Visibility to corridorVisual privacy from corridor
f
Assessm
ent Criteria
View of ExteriorDaylighting
Patient StoragePrivacy
Handwash location/separationHandwashing and work surface
View of TVProximity to patient
Family accomodation
Room
A
‐3.00 ‐2.00 ‐1.00 0.00 1.00 2.00 3.00
L D S H d I b d T il @ H d llLayout D: Same Hand Inboard Toilet @ Headwall
Layout E
Layout 'E' Mean Rating
Visibility of PatientAccess to toilet
Caregiver accessToilet Room configuration
Auditory PathwayStandardization
Clearance aroundbed
Rating Scale
a Clearance around bedAccess to supplies
Access to data
Access to patient headAccess around patient
Transport in/ out of roomTransport to toilet
Visibility to corridorVisual privacy from corridor
View of Exterior
m Assessm
ent Criteria
DaylightingPatient Storage
Privacy
Handwash location/separationHandwashing and work surface
View of TVProximity to patient
Family accomodation
Room
‐3.00 ‐2.00 ‐1.00 0.00 1.00 2.00 3.00
L E S H d O b d T il @ H d llLayout E: Same Hand Outboard Toilet @ Headwall
Layout F
Layout 'F' Mean Rating
Visibility of PatientAccess to toiletCaregiver access
Toilet Room configurationAuditory PathwayStandardization
Rating Scale
Layout F Mean Rating
Clearance around bedAccess to supplies
Access to data
Access to patient headAccess around patient
Transport in/ out of roomTransport to toilet
Visibility to corridorVisual privacy from corridorA
ssessm
ent Criteria
View of ExteriorDaylighting
Patient StoragePrivacy
Handwash location/separationHandwashing and work surface
View of TVProximity to patient
Family accomodation
Room
A
‐3.00 ‐2.00 ‐1.00 0.00 1.00 2.00 3.00
L F S H d O b d T il @ F llLayout F: Same Hand Outboard Toilet @ Footwall
Key findings
Clinicians vs Design professionalsClinicians vs Design professionalsLayout assessment through a multi-dimensional performance approachdimensional performance approachThe process structuring decision-making
So which layout is optimum?
Suitability scores Broad conclusions
Order of suitability:B, F, E, C, A, D
y
B, F, E, C, A, DBoth negative rated layouts have inboard t il t
A Weighted
B Weighted
C Weighted
D Weighted
E Weighted
F Weighted
0 86 18 90 5 05 2 78 10 93 16 04 toilets-0.86 18.90 5.05 -2.78 10.93 16.04
Concluding remarks
Questions on reliability and validity ofQuestions on reliability and validity of findingsHow and where could the findings beHow and where could the findings be used
The power of performance thinking in programming and designThe power of performance thinking in programming and designTraditional decision-making process and the suggested frameworkPotential phases for application
Q U E S T I O N S
