Planning for patient-centred care

Hospital design has changed dramatically since the first recorded hospitals of 500 BC, with changes in technology, materials and models of care. A panel comprising Woodhead International’s National Director of Health, Professor Lyn Chenowyth, Professor of Aged Care and Extended Care Nursing at UTS, and Kerry Stubbs, Director of St Vincent’s Hospital, Sydney, looked at how evidence-based healthcare can be reflected in design.

Health systems have changed due to continued reforms in developed countries (governance, recurrent funding, capital investment approaches, social contexts and customer feedback) and these changes have influenced models of care, Professor Forbes said. Researchers in Europe and North America are looking at how to translate these new models of care into practical health facilities.

Ward designs are now actively designed to account for:

– Changes in technology

– Shortages of nurses and new models of care

– Patient and Family focus on wards

– Infection control after the SARS and Avian Flu threats

– OH&S issues especially falls, lifting and bariatric patients

Researchers in Canada and the US at the Centre for Health Design, California, Texas A&M university and the University of Montreal are all concerned with the effect of the physical environments and workplace design on health outcomes. In Scandinavia. at Karolinska Institute in Sweden and the International Academy for Design and Health, major concerns are quality of life issues, humanising health environments, integration with the community and aged care accommodation, and the examination of the physiological effects of poor environments on health.

The panel discussed the results of this research effort, and in particular the discussion about single bed rooms, two- and four-bed wards. Scandinavian attitude surveys of single rooms versus multi-bed rooms have shown a split in patient attitudes:
– Older people are concerned to be in single rooms because they don’t trust the staff to be there to help if they fall out of bed, and they don’t like being alone. They depend on others in the room for assurance and safety.
– On the other hand, younger people prefer the privacy and ability to have treatments and care provided without moving.

Professor Chenowyth said it was important to recognise older people’s discomfort at being put in single rooms, and this was a factor that should be considered by aged care facilities, which are trending to all single bedrooms.

The convenience of the single room as an important factor in reducing the need to move patients for procedures, reducing infection risk, the risk of falls in transfers and medication errors was emphasised by Kerry Stubbs. In the US, Clarian Methodist Hospital’s post-operative heart surgery room is designed on the ‘one patient – one room’ principle. Research shows benefits from less movement of patients, less transfers, less falls, less medication errors and increased satisfaction ratings.

However, other research from the US shows people in single rooms like to see action outside to assure them that they are not alone. Many calls for staff are determined to be for reassurance. Observation windows need to be positioned to allow for privacy, but also to reduce the sense of being isolated.

Recent ward designs

In the UK, ward design has gone from the ‘race track ward’ at the Royal Infirmary in Scotland in 1966 and generally accepted in UK, to the new Royal Infirmary PPP built in 2003. This has 50% single room and four-bed rooms in a 36 bed T-configuration along double loaded corridors, with 12 bed teams each with a substation.

In Europe, Forbes said, two major single room designs stand out. The Georges Pompidou Hospital in Paris has double-loaded corridors and all single rooms, with an emphasis on natural light. The hospital maximises vertical circulation.

In contrast, St Olav’s Hospital in Norway adopts the ‘Sengetun’ (bed-courtyard) approach with rooms strung along a wing ” like pearls on a string”¦” Each room opens to its own courtyard. This horizontal approach reduces walking by staff and also increases the amount of staff/patients/family social interaction possible.

In all countries, there is a continuation of revival of the ideas of Universal Design from the late 1990s. Flexible beds in universal spaces: one or two bed arrangement in multi-function standard spaces, universal rooms, modular relocatable furniture and loose fit wards which can be reconfigured

Family-friendly and non-clinical

Forbes showed several examples of new or refurbished facilities in the US which exemplify the trend to warm colours and finishes, soft lighting and family-friendly areas.
– Beth Israel Deaconess post partum ward uses timber patterned vinyl flooring to reduce the institutional effect, and the central staff base is open to families, providing library and electronic resources and encouraging interaction with patients.

– UC Davis Birthing Suite also uses wood wall unit with lights and matching vinyl floor to reduce the institutional effect. A domestic sink/beverage bay at the entry can be used for infection control.

– The sub-station observing beds at Packard Children’s Hospital provides a focal point for family interaction with carpeted floor and low counter for sitting and talking. Visitors and family can access the courtyard garden from the ward.

– Santa Clara California uses texture and materials to reduce institutional feel. A mix of task and room lighting produces a softer mood. A corridor-facing observation window is unobtrusive. Patient basin in the room space. Flexible head panel to add future services provides flexibility.

– Special care bays – use of warm tones and texture as well as curved walls soften the spaces

For the top private patients, hospitals in the US and Asia offer ‘hotel room’ suites, complete with full electronic connections, broadband and telephone systems. They provide both a public space and a private space especially for VIPs.

While not necessarily offering the full hotel experience, Forbes said similar approaches to warmth and family-friendliness while maintaining clinical excellence were evident in new Australian projects, notably Royal Women’s in Melbourne, King Edward Memorial in Perth, Flinders Hospital, Adelaide and Royal Adelaide Hospital.

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