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AAH1703: Lean Inpatient Unit Design Strategies: New Research on Best Design for Effective Nursing

Architects have seemingly tried everything to create the ideal inpatient care unit, but which ones work best to increase nurses' direct patient care time?

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Focus Search - Lean Inpatient Unit Design Strategies: New Research on Best Design for Effective Nursing Presenters Scott Combs, AIA Clark/Kjos Architects Tom Clark, FAIA, EDAC Clark/Kjos Architects Highly stressful Life & death conditions Precision Speed High Performance Environments “5 Reason Nurses Want To Leave Your Hospital”* Mandatory overtime Floating nurses to other units Bullying / toxic behavior Bad managers Non-nursing tasks & nursing interruptions *Source: HealthLeaders Media, August 9, 2011 Caregiver Work Environments Traditional Environments Waste: Nurses walk average 3 miles/shift* *Impact of Work Environments on Nursing and Patient Care; Marilyn Chow & Ann Hendrich Study MEDS CENTRAL STATION MEDS 1 2 5 3 4 6 7 50% of nurses’ work is gathering, transport & delay* Hoarding *Wisdom at Work: The Importance of the Older and Experienced Nurse in the Workplace; Robert Wood Johnson Foundation Study; June 2006 Supplies 17% of nurses’ time spent on medication administration* Distractions = errors Waiting = waste *Impact of Work Environments on Nursing & Patient Care; Ann Hendrich; Healthcare Design 2008 Medications 13 Undersized med rooms have problems… Medications “If I have to travel more than 15 feet for a piece of equipment I probably won’t do it.” ~ Staff Nurse Equipment …happens anywhere & everywhere Documentation 16 Impacts of inpatient care unit design upon patient care goals: Time for direct patient care Time for documentation Patient safety THE RESEARCH Support resources (Medications, supplies, linens, equipment, collaboration space, EMR) Is there a correlation between their location and patient care time, documentation time, & safety? Research Questions Literature review Enroll participants Floor plans Survey nurses Analysis Methodology Direct patient care time Aiken, et al, 2002: More nurse direct patient care = lower mortality Hendrich et.al., 2007, 2008: Only 19% of nurse time for direct patient care Literature Review Decentralization Howard and Malloch, 2007: Nurses spent more time at bedside in decentralized units but only if support resources decentralized Literature Review Documentation Hendrich, 2008: Nurses spend 56% of time on documentation Literature Review Collaboration Becker, 2007: Community of practice—mentoring & communications Tyson, et al., 2002: Decentralized units reduced communication Literature Review Floor Plan Analysis 24 Distance calculations Floor Plan Analysis 25 Nurse Survey 26 Supplies 27 Norton Brownsboro Good Sam Puyallup 4 Emory Johns Creek Hosp