Healthcare facilities are busy, intense environments as well as active workplaces in which the most personal and complex services are rendered—sometimes resulting in stressful conditions for patients, visitors and staff. For nurses on the front lines of patient care, the work environment can have significant negative impacts, contributing to fatigue, distractions, medication errors, patient falls and other issues that affect patient care.
However, while environmental factors can play a harmful role, research also suggests that unit layout and design can positively impact the quality of the nursing work experience, quality of patient care, and critical outcomes such as medication errorsn and patient falls.
This conclusion is based on a study in which Knoll and HOK jointly investigated the impact of medical-surgical inpatient unit design on quality of patient-centered care (PCC), measured by distractions, correct equipment operation, and walking distances; and by patient outcomes, measured by falls, near falls and pain levels. In a three-phased research program, this project gathered and analyzed qualitative and quantitative data from hundreds of patients and staff that identified beneficial design attributes, conducted problem-solving sessions with nurses, and from these activities developed a design concept that might improve patient outcomes.
A typical medical-surgical inpatient unit consists of patient rooms, nurse stations, hallways, and a core of support spaces. Nursing units of the past were designed with one centralized nursing station. This approach has a variety of shortcomings related to effective use of nurses’ time, long walking distances, and low patient contact time. More recently, decentralized nurse stations have become commonplace, because they increase the efficiency of nurses’ work and time spent on patient care. These stations may include medication and supply storage, hand washing facilities, worksurfaces for charting, a computer, and telecommunication devices. Typically, decentralized nurse stations are located in close proximity to patient rooms. An observation window enables nursing staff to look directly into some patient rooms while other rooms on the unit are just steps away.
Decentralized nurse stations may lead to fewer patient falls because nurses work in closer proximity to their patients and are better able to identify when they need assistance. In addition, decentralized nursing stations reduce staff walking and increase patient care time, especially when supply spaces are also decentralized and placed nearby.
While the decentralized approach to placement of nursing stations is now accepted practice, there is a healthy debate about how to best configure these elements on a unit for optimal operations and care delivery.
The aim of this study was to explore relationships between conditions such as unitdesign and layout, and the impact of those elements on nursing workflow and patient care outcomes—and to translate those results into design concepts that could improve upon the decentralized nursing space model. The study consisted of three phases and used a variety of qualitative and quantitative methods.
The study site was a US, academically affiliated teaching hospital located in an urban area. The hospital has 247 adult medical surgical inpatient beds located in seven units, all of which were included in the study. All of the units have computers-on-wheels and balanced headwalls with identical locationsfor gasses, outlets, and call buttons on both sides of the patient beds.