Questions Log – AAH1602 webinar “Increasing Your HCAHPS Scores Through Design”   

Q: The patient monitor outside the patient room: is this a privacy concern? Is the name of the patient displayed, diagnosis, etc.? 
A: No patient names are displayed on the monitors

Q: Why the copper sheeting on the wall section slide re: acoustics? 
A: This particular section happened to be taken through one wall of the MRI suite, which is the reason for having the copper sheeting.

Q: You mentioned that the IP unit support core is narrow. During planning and programming how did you determine the amount of support space was sufficient? Now after occupancy what are impressions on the size and layout of support spaces? 
A: Office spaces were based on the number of staff, and the space needed to support their functions. Huddle rooms were sized to accommodate three to six people; number of rooms (3) were based on locating them within easy reach from any part of the unit. Med rooms and nourishment rooms are all designed the same (respectively), and number three each in total, based on how close staff needed to be to a med room / nourishment room from anywhere on the unit. The clean and soiled utility rooms number two each, and are located at one-third points along the north side of the unit, rather than in the core; square footages were based on an analysis of storage needs. Post-occupancy impressions of the arrangement are favorable. 

Q: You mentioned that the patient room doors were staggered, but they don't look that way on the plan shown. Can you please show us on the plan? 
A: “Staggered” was probably the wrong word. We worked toward minimizing the amount of cross-noise between patient rooms by how the core was arranged, but were not able to eliminate all instances. It’s a good goal to shoot for.

Q: How did you address infection control with the privacy curtains since they are touched frequently? Or are they auto-operated only? 
A: The curtains are opened and closed using either a button on the wall (for staff) or a button on the pillow speaker (for the patient), so they don’t need to be touched.

Q: How did you keep water in the shower? 
A: There is a very slight pitch of the shower floor, to a continuous flush drain between the shower and the rest of the room.

Q: Drapes at the exterior windows. Removed and cleaned often? Each patient? 
A: The drapes on the exterior windows of the room are only cleaned 2x per year

Q: How does the facility handle the distributed medications at each room? Was this a new philosophy or already in existence? Did you have to increase your FTE of pharmacy staff to include this feature? Do the pull out cabinets block the means of egress when they are being pulled out and stocked? Presumably there would be an associated cart with the stocking supplies. Do you schedule this to occur at a specific time? Where is the sharps container located in the room? Often staff want it on the footwall and of course that becomes visual clutter but it is considered a safe location. 
A: Sharps containers are on the side of one of the nurse server cabinets located adjacent to where the medications are kept. We did not increase FTE’s in the pharmacy to accomplish the task. They were expected to absorb the revised work stream. Cabinets are not unattended when they are being stocked but they are not allowed to be left open. Very little occurrence of this in the first year. Stocking occurs in the early morning hours (4-5am).

Q: The amount of storage and size of trash cans seems rather small from the photos. How often are supplies restocked in the nurse servers and how often does housekeeping collect the trash? 
A: Trash is emptied on every shift as needed.  

Q: Does Christ Hospital utilize LEAN? Was LEAN design used for planning? 
A: Yes, LEAN design principles were used in the design process and in the workflow analysis

Q: Was the glass on the corridor wall fire-rated? 
A: The glass is not fire-rated. The partitions meet the requirement for preventing the passage of smoke.

Q: What is the staff satisfaction in being "de-centralized"? Often we hear that they feel isolated from co-workers in this planning option.  
A: This took while for staff to get used to. We did provide “huddle rooms” for them. The benefits have been increase in patient satisfaction related to responsiveness and a reduction in patient falls.  

Q: What amount of improvement have you observed in HCAHPS scores? Has one or multiple design improvements lead to the most improvement in scores?  
A: The unit overall scores at the 99th percentile in Press Ganey. We did however see increases in our responsiveness scores which were not at the 99th percentile but now exceed the 95th percentile

Q: What is the nurse to patient ratio?
A: 1-4 on day shift and 1-5-6 on the night shift

Q: What is the room size? 
A: The rooms are approximately 280 sf.

Q: What is the structural bay spacing? 
A: The structural bay spacing for the patient units is 18’-5” the east-west direction (patient room width direction) and 22’-0” in the north-south direction.

Q: Are patient lifts in every room? If so, do they go into the bathroom? 
A: Every room has a patient lift. Only the bathrooms for the bariatric rooms have lifts. The lifts are separate from each other. The idea is to assist/lift the patient as needed, but not to “transport” them from one space to the other.

Q: Are sharps containers located inside the nurse servers and does that require the nurse to open a cabinet door to access it?  
A: The sharps containers are located adjacent to the nurse servers, not behind doors.

Q: Did staff already or previously function as de-centralized or did this present new operational opportunities?  
A: We did not have a decentralized nurse’s station in the “old” units. So this was a new change for them

Q: In the patient rooms, which types of supplies and meds are kept in the room vs. central storage in unit? 
A: All of the scheduled medications are kept in the room, routine dressing change supplies and also medication administration supplies. There are central supply rooms for all CHARGEABLE items.

Q: Have you conducted a cost-analysis between patient space (value/sq.ft) vs. non-clinical space?   
A: No.

Q: Have you done any post-occupancy evaluations of all these great hypotheses?   
A: We currently have a research project underway to do just that.

Q: Do you have a before and after campus plan?  
A: Before and after aerial images are provided at the end of this document.

Q: How does that plan allow for future flexibility/changes in healthcare? 
A: The patient rooms are designed for acute care (joint and spine). However, they are sized with the clearances to meet critical care requirements. Also, using nested bathrooms instead of inboard/outboard allows optimal use for either acute or critical care. The headwall units are modular and designed for easy modification, if gases were needed to be added to accommodate a higher level of acuity. The glass partitions in the core area are reconfigurable. Immovable elements such as shafts and electrical rooms are located outside of the core, tucked in areas that are not in the way of future potential renovations.