|
|
|
Healthcare Facility Planning Tools and Guidelines Volume 1, Number 3 |
Summer 2008
|
|
|
|
In This Issue
|
Evaluating Emergency Department Expansion Not Many Physicians Are Using Electronic Medical Records Assessing the Capacity of Clinical Services |
||||||||||||||||||||||||||||||||||||
|
► |
Feature Print (PDF) |
||||||||||||||||||||||||||||||||||||
|
|
Evaluating Emergency Department Expansion BACKGROUND Midwest Hospital (MH) planned to expand (and potentially replace) their emergency department (ED) in response to increased crowding and congestion. Although the current number of annual visits (40,000) was not expected to grow significantly in the near future, the patient/visitor waiting room was frequently overflowing during the evening hours. ED staff also began creating "hall beds" by labeling and assigning defined stretcher bays in their hallways to gain additional treatment space during peak periods. The relocation of an adjacent occupational medicine clinic was viewed as an option for ED expansion in lieu of total ED replacement. Specific facility expansion goals included expanding the patient/visitor waiting space with enhanced amenities; providing adequate exam and treatment space; triaging nonurgent patients into a separate "fast track" area; and developing a holding area for patients to be admitted who are waiting for an inpatient bed to become available. Although facility expansion and operational improvement were deemed necessary by all members of the planning team, the CFO was concerned about spending significant capital dollars when ED revenues were relatively flat. ED staff were also not in agreement regarding the extent of required expansion ― some wanted to almost double the size of the current ED while others were concerned that significant expansion would required additional staff at a time when budgets were tight and staff recruiting was difficult. Others were concerned about the long ED length of stay and its impact on customer satisfaction. However, all members of the planning team agreed that a detailed analysis of the relationship between improvements in treatment room turnaround time and resulting space need and construction cost was warranted prior to initiating the detailed operational and space programming process for a major construction project. PLANNING APPROACH A detailed database was assembled and a number of operational issues were identified that would ultimately impact the overall size of the upgraded ED as follows:
ANALYSIS An overview analysis of the impact of treatment room turnaround time on required ED treatment rooms, total department gross square feet (DGSF), and total project cost was performed. The analysis revealed that even minor improvements in ED turnaround time would have a significant impact on the space and resulting renovation/construction costs as shown in the figure below:
Impact of Treatment Room
Turnaround Time on
Source: Hayward, C. 2005. Healthcare Facility Planning: Thinking Strategically. Chicago: Healthcare Administration Press. |
||||||||||||||||||||||||||||||||||||
|
CONCLUSION Due to the high cost of replacing the existing ED, particularly if 30 or more treatment rooms and support space were provided, the ED planning team ultimately decided to focus their operations improvement efforts on improving ED treatment room turnaround time, with a target of 120 minutes, before embarking on a major renovation/construction project. Since the adjacent occupational health clinic (with six exam rooms and support space) schedules patients only on Monday through Friday and is typically closed at 4:00 p.m. each day ― and ED demand for nonurgent (fast track) space is typically from 4:00 p.m. until 11:00 p.m. ― an operational plan was developed to use this space to triage and treat nonurgent ED patients during the evenings and on weekends. With the diversion of these nonurgent patients out of the main ED, the smallest ED treatment bays were reconfigured resulting in 25 appropriately-sized ED treatment rooms/cubicles along with the six fast track exam/treatment rooms (using the occupational health clinic). A modest expansion of the patient/family waiting area was undertaken using adjacent office space. This interim solution allowed MH to monitor trends in ED volume and evaluate the success of its operations improvement efforts. Hospital leadership agreed to reevaluate the need for a major ED expansion or replacement project again in another year. back to top Cynthia Hayward, AIA, ACHA, FAAHC Principal Hayward & Associates LLC |
|||||||||||||||||||||||||||||||||||||
|
► |
In the News |
||||||||||||||||||||||||||||||||||||
|
Not Many Physicians Are Using Electronic Medical Records OVERVIEW A recent report published online in the New England Journal of Medicine indicates that fewer than one in five physicians in the U.S. have started using electronic medical records. In fact, only four percent of the physicians surveyed have a fully-functional electronic medical records system, despite the fact that those who use electronic medical records say overwhelmingly that such records have improved the quality and timeliness of care. The slow adoption of this technology is primarily economic since most doctors in private practice do not have the financial incentive to invest in costly computerized record systems. The time and energy it takes to convert from paper to computer records is also a factor. ABOUT THE STUDY In late 2007 and early 2008, a government-sponsored survey of 2,758 physicians was conducted to determined the proportion of physicians who were using electronic medical records in an office setting and the relationship between adoption and the characteristics of individual physicians and their practices. SUMMARY OF RESULTS Four percent of respondents reported having a fully functional electronic-records system and 13 percent reported having a basic system. Of the small number of respondents who had a fully functional system, 71 percent reported that their system was integrated with the electronic system at the hospital where they admit patients, as compared with only 56 percent of respondents with a basic system. Among the 83 percent of respondents who did not have electronic health records, 16 percent reported that their practice had purchased but not yet implemented such a system at the time of the survey. An additional 26 percent of respondents said that their practice intended to purchase an electronic-records system within the next two years. The study concluded that physicians who use electronic medical records believe such systems improve the quality of care and are generally satisfied with the systems. However, as of early 2008, electronic systems had been adopted by only a small minority of U.S. physicians, who may differ from later adopters of these systems. Among larger practices with 50 or more physicians, 51 percent used electronic medical records. Electronic medical records are particularly pervasive in large integrated medical groups like Kaiser Permanente, the Mayo Clinic, the Cleveland Clinic, and others who have deep pockets. For smaller practices, the initial cost of upgrading the office’s personal computers, buying new software, and obtaining technical support may be $15,000 to $20,000 per doctor. back to top |
|||||||||||||||||||||||||||||||||||||
|
► |
Trendline Print (PDF) |
||||||||||||||||||||||||||||||||||||
|
Assessing the Capacity of Clinical Services BACKGROUND Healthcare organizations vary in the number of expensive procedure rooms and equipment units that they use to accommodate similar numbers of annual procedures. This is why it is important to look at the current capacity of specific clinical services prior to deciding to expand the number of procedure rooms and related support space, particularly those services that use expensive equipment and uniquely-designed procedure rooms. CURRENT TREND Prior to committing significant dollars to expand or upgrade an existing clinical department, healthcare organizations are routinely asking key questions such as the following:
DETERMINING CAPACITY An analysis of facility capacity for clinical services involves identification of the current workload volumes and major treatment spaces and then applying industry benchmarks and rules-of-thumb. The annual capacity can also be built up by first identifying the number of procedures or visits that can optimally be scheduled in an hour, the number of hours per day that the department will be staffed, and then assuming 50 weeks per year of operation (allowing for about 10 holidays). Some examples of factors that influence procedure room turnaround time include:
CONCLUSION It should be noted that even with adequate facility capacity, many healthcare organizations are limited in their weekly hours of operation due to the availability of physician, technical, and support staff (e.g., scheduling difficulties, recruiting in a tight job market, and regulatory or union issues with cross-training staff). back to top Cynthia Hayward, AIA, ACHA, FAAHC Principal Hayward & Associates LLC chayward@hayward-assoc.com |
|||||||||||||||||||||||||||||||||||||
|
► |
Technology |
||||||||||||||||||||||||||||||||||||
|
Touch Screen Kiosks Provide Patient Self-Service OVERVIEW We can check in for our flight when we arrive at the airport using a kiosk. We use an ATM to get cash from our bank or to make a deposit. But when we go to our local hospital or doctor’s office, we get a pencil, clipboard, and a multi-page form to fill out. We may even have to go to one or more different departments where we will be asked to fill out the same form again … and again! This is not the case at progressive healthcare organizations like the Heritage Valley Health System who are reducing wait times and congestion at the front desk, reducing the need for clipboards, and lowering the risk of patient misidentification and clerical errors at data entry using the MediKioskTM technology by Galvanon. With a seamless process for sharing information between patients, physicians offices and hospitals, patient satisfaction is increased while staff and space are used more efficiently. ABOUT HERITAGE VALLEY HEALTH SYSTEM Almost two-thirds of the patients in the Heritage Valley Health System also make their visit faster by swiping a Care Card in addition to using the kiosks. With a Care Card, a patient can electronically check-in or check-out for an appointment, schedule future appointments, sign consent forms, print directions, and use a credit card for co-payments. The MediKiosk provides positive patient identification features supports by thumbprint, electronic signatures, and card scanners to provide multiple patient authentication options. Galvanon’s self-service technology includes a wireless e-ClipboardTM as well as desktop and freestanding kiosks. A number of health systems around the country are using the Galvanon self-service technology including the University of Pittsburgh Medical Center, Valley Baptist Health System, and others. back to top |
|||||||||||||||||||||||||||||||||||||
|
► |
Rule-of-Thumb |
||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||
|
|
Note: DGSF represents the "footprint" of a department or functional area and includes the net square feet of the individual rooms as well as the space occupied by internal circulation corridors, walls/partition, and minor utility shafts; DGSF excludes common areas such as shared public corridors and lobbies, elevator banks, stairwells, major mechanical spaces, and the space occupied by the building's exterior wall. Source: SpaceMed Guide (Second Edition). |
||||||||||||||||||||||||||||||||||||
|
Copyright ©2008 SpaceMed. All rights reserved. |
