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

PEP COUNCIL, VISION CENTER + PROTOTYPE

The development of the Guiding Principle PEP (Principles-Elements-Processes) Guide established a series of 11 goals for the project; elements that would be implemented as metrics that are used to define success. A PEP council, comprised of nursing directors, reviewed decisions for guiding principle compliance.

The size and configuration of the rooms have been shaped by the hospital’s Guiding Principles, including: standardization, adaptability, privacy, technology and patient/family-centered care. These were tested in the Vision Center (below). The design incorporates into the rooms the most recent research and trends that address patient safety, patient and family satisfaction, stress reduction and infection control protocols.

A Vision Center was created in an off-site warehouse for the design team, hospital and community groups to test assumptions within a full-scale prototype.

CLINICAL INITIATIVE SCORECARD: GUIDING PRINCIPALS, STRATEGIES, METRICS AND TARGETS

OWP/PFile: sm_080520 NCH Renaissance Score Card 1 of 1

IN

ID #

Guiding Principles/Objectives Strategies Metrics Source Targets

1

- Improve Satisfaction Private Patient Rooms Patient Satisfaction-Privacy,Crowding, PG-IP&ED: Staff concerned with your privacy Improve by x%- Enhance Privacy, Cultural Sensitivity- Improve Convenience, Accessibility- Respect for patient values, preferences, needs *

2

- 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 Light Views of nature/outdoors Staff Satisfaction Scores GPTW: our facilities contribute to a good working environment

Improve by x%

- 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

- Standardize core elements, but allow for adaptability as needed

Acuity Adaptable / Universal Rooms

Physician Satisfaction Scores Improve by x%

- 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

- Provide healing touch therapies Balconies Define Strategy - Pending- Provide horticulture therapy Healing Gardens

6

- 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 repetitive functions, spaces Same-handed Rooms Material Management Costs Materials management - Tom C? Reduce by x%

- Lower Operating Costs Standardized room layout Staff Walking Distance per Day- Improve Operational Efficiencies Standard support cores Hours per Patient Day Neutral?- Coordination and Integration of Care* Portable Nurse Servers- ED Triage Rooms ED Turnaround time(check-in to

discharge/bed)Reduce by x%

Barcoding/RF? ED Pts Presented, but Left Before Seen Reduce by x%OB - triage visits Increase By ?OB Inductions Increase By ?

8

- Test equipment/processes before PCA Patient Satisfaction - Existing Tower cleanliness, décor

PG-ED: Cleanliness of treatment area increase by x%

- Design to be translatable to exist. tower PG-IP: Room Cleanliness and Room Décor - Improve environment / patient experience across campus

9

- 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

- 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

- 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 SurveyIP = Inpatient Survey

Respect for Individual Needs of All Users

Incorporate Evidence-Based Design

Enable Processes through Technology

Promote Community Centricity

Improve Safety

Standardize Processes, Supplies, Design

Create Archetype for Design Elements

Enhance Patient/Family Centeredness

Incorporate Natural Environments

Design Adaptability in Facility

Integrate Holistic Care

PRESS GANEY RESULTS:PATIENT SATISFACTION INDICATORS

PATIENT SATISFACTION INDICATORS

May–August 2010

May–August 2009

South PavilionMean

Legacy TowerMean

Legacy TowerMean

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

Accommodations and comfort for visitors 89.7 76.4 79.7

Staff concern for your privacy 89.2 82.0 83.0

Overall cheerfulness of hospital* 92.0 80.0 83.4

Likelihood of recommending the hospital 92.8 81.0 86.5Consistent Increases Decreased Satisfaction Likely

Due to Increased ExpectationsNOTE: Numerous requests to transfer patients from Legacy Tower to South Pavilion regularly occur each month (from physicians, patients, friends and family members).

PATIENT ROOM FEATURES: DIGNITY IN PATIENT CARE, ADVANCING PATIENT SAFETY

Environment

for Safety

and Comfort

distinctive zones for patient, family and care

[1] visible handwash sinks[2] “universal” footprint maximizes flexibility

[3] nurse server accessible via double door

[4] views to nature

[5] plant/personal items/artwork

[6] patient control of lighting, temperature

PATIENT ZONE

FAMILYZONE

[7] large entrances

[8] in-room charting

[9] family overnight space

[10] grab bars

[11] curbless showers

[12] comfortable, sturdy finishes

[13] patient lifts

1

2

3

4

4

2

5

5

6

7

7

7 2

8

1

9

9

10

10

10

11

11

13

12

NCH Patient Satisfaction per Quarter / Year

80

60

40

20

0

perc

entil

e ra

nk

1st Quarter 2010

2nd Quarter 2010

3rd Quarter 2010

4th Quarter 2010

12

South Pavilion opens

CAREZONE

2

PRESS GANEY RESULTS:LIKELIHOOD TO RECOMMEND, NOISE AND PRIVACY

PATIENT ROOM DESIGN AND RECOVERY FROM SURGERY: SUMMARY

The recovery of surgical patients in rooms with EBD features was faster and less painful than that of those in rooms without the features. (Differences in recovery process be-tween these two patient groups were clarified. The extent to which the evidence-based patient-room design contributes to postsurgical recovery was examined.)

Hypothesis

Methods

Findings

The average length of postsurgical hospital stay was 72.5 hours in the new-room group and in 74.2 hours in the old-room group. However, the difference was not statistically significant. The postsurgical analgesia uses in the two groups were not significantly different.

Postsurgical Pain Scores in Patient Rooms with/without EBD

3

1

0

54321

With EBD Without EBD

Post operation admission to the

patient-room floor

1st day pain score in the morning

1st day pain score at 11pm

2nd day pain score in the morning

2nd day pain score at 11pm

Last pain score prior to discharge, generally 20-30 hours after Score 5.

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 by hour. *: p<0.1

2.2 2.22

1.95

2.61

1.91

2.66

1.98 1.85

2.16

A before-after comparison was conducted by an interdisciplinary team, which was comprised of researchers, designers and caregivers. Northwest Community Hospital (NCH) recently opened its same-handed private patient rooms providing 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 these new rooms; previous patients who had the same surgery were assigned to opposite-handed semi-private old rooms without the aforementioned features. Medical record of patients in the new/old rooms was obtained. Objective data of the built environments in and around the new/ old patient rooms were collected.

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. Analysis of recovery differences between these matched pairs was conducted by using the Statistical Package for the Social Sciences (SPSS version 16.0), including paired sample T-tests.

Based on statistical analyses, this study found that the recovery of the patients in rooms with EBD features was less 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 discharge was significantly lower in the new-room group (p<0.1).

2.65

1.942.08

n = number of respondentsmeanLikelihood of Recommending Hospital

100

95

90

85

75

70

65

OCT – DEC n=149

JAN – MAR n=164

APR – JUN n=142

JUL – SEP n=123

OCT – DEC n=141

JAN – MAR n=150

APR – JUN n=141

JUL – SEP n=104

OCT – DEC n=129

JAN – MAR n=108

APR – JUN n=100

JUL – SEP n=102

2008 2009 2010 2011

80

Noise Level in and Around Room

100

90

70

60

50

OCT – DEC n=150

JAN – MAR n=159

APR – JUN n=139

JUL – SEP n=125

OCT – DEC n=139

JAN – MAR n=152

APR – JUN n=138

JUL – SEP n=103

OCT – DEC n=129

JAN – MAR n=109

APR – JUN n=99

JUL – SEP n=199

2008 2009 2010 2011

80

Staff Concern for Privacy

100

95

90

85

75

70

65

OCT – DEC n=146

JAN – MAR n=153

APR – JUN n=135

JUL – SEP n=116

OCT – DEC n=130

JAN – MAR n=145

APR – JUN n=138

JUL – SEP n=102

OCT – DEC n=146

JAN – MAR n=106

APR – JUN n=98

JUL – SEP n=92

2008 2009 2010 2011

80

6

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