Improving patient care through efficient medical-surgical unit design solutions
With increasing emphasis on quality, safety and profitability in today’s healthcare marketplace, industry leaders are intensifying their focus on design that supports effective operations. The objectives are to maximize staff efficiency by right-sizing and “right-fitting” patient care units with layouts that are efficient for nurses and the care team, to provide safe environments for patients and to foster collaborative team environments.
Design solutions for new and renovated medical-surgical units may be unique for each facility due to site and existing structure and footprints; however, they should enable efficient patient care by incorporating these key considerations:
1) Optimize efficiency
Efficient flow and convenient access for common staff support areas, such as supply and medication rooms, is important to reduce caregiver walking distances. As one nurse manager stated, nurses often spend excessive “sneaker time” walking for supplies and equipment that are not located close to where they are needed.
The most common “hunting and gathering” trips that nurses make are for supplies and medications. These support areas should ideally be located within 40 to 50 feet from the farthest patient room on the unit. A reliable benchmark is to have one medication room per 12-16 patient rooms. Even if routine medications are secured in drawers in patient rooms, they still need to be supported by medication rooms for controlled and refrigerated drugs. Nourishment rooms near medication rooms are helpful for staff when medications need to be administered with food.
Healthcare planners and designers have multiple options to improve efficiency when considering supplies. Nurse servers, or bedside storage casework, provide caregivers access to needed supplies in the patient room. The design goal is to facilitate access to most commonly used supplies while avoiding excess inventory. A good rule of thumb is the 80/80 rule, where 80 percent of supplies used to treat 80 percent of patients are stored closest to the point of care. There are a variety of access options for supplies and medications: corridor access only, patient room access only or a pass-through from the corridor to the patient room. During the planning phase, calculate the walking distance for common trips, such as medication and supply rooms, soiled holding and nourishment areas. These can be graphically represented prior to design and organized based on projected use and walking distance goals of the organization.
Elevator placement is also important for staff and material flow, as well as for visitors. A central location that is equidistant from two or more units is ideal. Service elevator placement should also consider the flow of materials to the unit and removal of soiled linens and trash in an off-stage path.
2) Unit size + space considerations
The ideal unit size varies based on service lines, patient population and size and type of the facility. The unit should be large enough to keep staff productive (24-32 beds for a medical-surgical unit), while not so large that it creates long walking distances. Units with too few rooms are inefficient from a staffing perspective. It is an important safety consideration to have enough staff on the unit to provide peer support and backup. Considering the average nurse to patient ratios of 1:5, 24 beds allows for four caregivers to be present when the unit is 85 percent occupied, which is a typical occupancy goal.
Adjoining units offer the opportunity to share spaces such as staff lounges, family waiting areas and conference rooms. For example, a hospital in the central U.S. planned their medical-surgical units on a 48-bed floor with two adjoining 24-bed units each organized in 12-bed “neighborhoods.” Each of the neighborhoods has its own supply and medication rooms, while conference rooms, administrative space and centrally located public and service elevators serve the entire floor. Getting the unit size right is important, but effective layout is key to improving operations.
Unit size, or the perception of unit size, may be unintentionally altered by design, especially exterior wall features. For example, elevators, stairwells and lounges placed on outside walls, between rooms within a unit, create a break in the contiguous flow of patient rooms, which impacts staffing flexibility.
3) Visibility
Providing visibility to patient rooms and to other members of the care team is another important safety consideration. To foster visibility, it is important to avoid blind corners and isolated rooms. With higher-acuity patient populations today, care team stations with views to groups of rooms and substations between rooms allow nurses to monitor and observe their assigned patients while working from documentation areas.
Peer-to-peer visibility on the unit should not be underestimated. This is especially important when nurses are mentoring newer team members who need team support. Design that fosters visibility is also important at night, when fewer staff are present.
4) Staff support spaces
Natural daylight is a requirement in patient rooms. However, the staff workspaces often receive less natural light as exterior walls with windows for patient rooms take precedence in design space. Research has demonstrated that natural light improves well-being and mood for patients, family members and staff. Daylighting options include windows at the ends of corridors to allow light into the unit and borrowed light from other exterior windows. This also aids in wayfinding and orientation.
With trends toward more open visitation policies, families spend more time in patient rooms, thus large waiting areas become wasted space. While some visitor waiting space is appropriate for families to decompress, space on units can be better allocated to staff lounges, replacing windowless break rooms and allowing the staff a chance to connect with the outside world and relieve stresses of their jobs.
In addition to calming lounges with outdoor views, staff can benefit from small, solitary focus or retreat rooms, with comfortable chairs, that allow for rest and personal decompression. hese spaces are especially important for staff working long shifts. Providing quiet places where they can take a short power nap can make a significant difference. Spa-like amenities such as music, artwork and calming finishes with relaxing colors and materials add to a soothing environment. The same design themes can carry over into public spaces, where family members can go when they need a moment to gather their thoughts amidst the demands of supporting loved ones.
5) Care team collaboration spaces
What has been known as the nurse station is now the care team collaboration station, in keeping with the culture of a multidisciplinary care collaboration model. For example, in a 24-bed unit, there may be two care team collaboration stations, each accommodating 6-8 spaces for nurses, providers, case managers, dieticians and other members of the care team. These spaces are typically not assigned but are flexible enough so that staff can work individually or consult as a team.
Acoustical privacy should be provided within the care team stations for private conversations. This can be accomplished through small touchdown stations with sliding doors or small conference areas deeper into the care team station.
6) Documentation
Patient medical records are another area where privacy is critical. Patient charts are electronic today, which allows more streamlined processes for accessing them. This can be done in multiple locations: at the bedside, at care team stations and in corridor alcoves. Between-room charting alcoves have become more popular as electronic medical records have taken hold.
The key to efficient utilization of electronic medical records is to create redundant locations in which charting can occur. In the patient-centric approach, the emphasis will always be on bedside charting, which increases face time with patients. From there, charting may move to an alcove outside the room, from which the patient can be observed. These are especially useful for patients who need closer observation, such as those at risk of falls. Additional charting may take place at the care collaboration station, or even in staff lounges. From a design perspective, the most significant challenge is to avoid creating complex spaces that are inflexible, don’t fit the needs of staff and, as a result, don’t get used and ultimately require renovation.
Making the care delivery space easy to work in and move through requires future-focused detailed planning before design and construction. Think through operations, use Lean concepts, know what equipment will be used on the unit and plan storage spaces to keep clutter out of hallways. Keep up to date on new technology and design to accommodate future changes. Don’t design around how the units function today, but around how they should ideally function in the future for maximum efficiency. In an increasingly competitive marketplace, industry leaders are intensifying their focus on efficient operations that synthesize these key factors to create the ideal medical unit design. The result will be money saved by planning it right the first time, time saved for staff and visitors and greater patient satisfaction.
