SpaceMed Newsletter

How well do we orient the customers as they arrive on the campus and circulate through the facilities?
Are the facilities configured to use staff efficiently and allow the sharing of valuable space and expensive equipment?
Is the space organized and configured to provide the most cost-effective setting for any given function?

PERFORM AN ASSESSMENT

You can perform a mini-assessment of the current functional layout of a hospital facility and identify potential issues by comparing the current site and facilities to the following ten facility configuration principles:

1	Separate key types of campus traffic. Site access points should be clearly marked with directional signage to relevant parking lots and easily identifiable building entrance points for emergency traffic, service traffic, and public and visitor traffic heading for patient intake and admission, medical office buildings, or various outpatient services. External signage should be reviewed with the fresh eyes of someone who is unfamiliar with the campus to identify issues relative to misleading, incomprehensible, or inconsistent destination names and directional signs that are unreadable or absent.
2	Clearly define the front door. Just as most shopping centers are designed with a single prominent entrance to assist first-time customers who are unfamiliar with the overall layout and require orientation, healthcare centers should generally have a clearly defined main entrance or “front door” supplemented by ancillary entrances that patients will be encouraged to use on subsequent visits (leading directly to their service destination). Ideally, with a well-designed patient information and communication system, patients should be provided with a campus map and directions to their destination prior to their arrival.
3	Coordinate and co-locate customer intake and access services. A single, one-stop-shopping location should be provided at the main entrance (such as a customer service center, for patient and visitor reception; information dissemination; admitting, registration, and insurance verification; family support services; and amenities), generally adjacent to the front door from which other patient and visitor services and satellite registration points can be coordinated (hub and spoke concept).
4	Optimize the use of prime real estate. Services that involve customer interaction and face-to-face contact should be concentrated on the grade-level floor adjacent to the front door or major outpatient entrances. The use of this prime real estate for administrative offices and other support services that could be located remote should be discouraged.
5	Minimize the total number of outpatient destinations. Related clinical services should be grouped around a centralized reception and intake area or “destination” marked with clear and consistent directional signage. For example, patients can be directed to a Diagnostic Center reception and waiting area from which they are escorted to the point-of-care ― radiology, nuclear medicine, CT, MRI, and so on ― when the staff and procedure room are available. Diagramming the current number of possible outpatient destinations and the routes required to reach them also identifies inconvenient service locations and wayfinding issues.
6	Position diagnostic and treatment services for changing technology and future operational flexibility by co-locating services with similar facility needs such as the following: Routine, quick-turnaround procedures ― for example, phlebotomy and simple X-rays Specialty imaging, interventional services, and surgery Same-day medical procedures
7	Minimize inpatient transfers by providing private patient rooms (to the extent possible), organizing inpatient nursing units by specialty rather that acuity (depending on volumes), and implementing the acuity-adaptable patient room concept (where possible).
8	Unbundle high-volume, recurring outpatient services to an off-site location. If contiguous parking and convenient access cannot be achieved on the main campus, high-volume, recurring, outpatient services should be relocated off-site; examples include outpatient physical therapy, behavioral health, intravenous/infusion therapy, and renal dialysis.
9	Unbundle building support services. Space for building support services should be located in inexpensive construction (on or off site) while facilitating efficient material distribution to key users such as the inpatient nursing units and the surgery suite.
10	Provide flexible generic administrative office space. Larger office suites should be planned (on or off site) in lieu of smaller pockets of offices throughout the hospital campus. Flexible, generic office space should be planned to accommodate various department staff who do not require face-to-face contact with customers so that offices and workstations can be reassigned periodically as programs and staffing levels change. back to top

Cynthia Hayward, AIA, ACHA, FAAHC

Principal

Hayward & Associates LLC

chayward@hayward-assoc.com

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In the News

Hospitals Ease ED Crowding With Hall Beds

OVERVIEW

Even though hospitals have been trying for decades to eliminate the practice of temporarily parking patients on stretchers in corridors, a recent study at Stony Brook University Medical Center in Stony Brook, New York, found that no harm was caused by moving emergency patients to upper-floor nursing unit hallways when they were ready for admission. It may not sound like the ideal healthcare setting, but the study’s lead author is urging hospital officials nationwide to consider hallway medicine as a way to ease emergency department crowding.

ABOUT THE STUDY

Holding patients in the ED can cause deaths, doctors say. In a 2007 survey of nearly 1,500 emergency doctors by the American College of Emergency Physicians, 13 percent said they personally experienced a patient dying as a result of boarding in the emergency department. The new study is based on four years of Stony Brook’s experience with more than 2,000 patients admitted to nursing unit hallways from the ED. The study concluded that the common practice of “boarding” patients in the ED after they have been admitted creates an “out of sight, out of mind” situation. Once the patients are moved to the nursing unit corridors, nursing staff get a lot more creative and aggressive with workflow practices.

ENTIRE ARTICLE

The entire article is titled "Hospitals Ease ER Crowding With Ward Beds in Halls" by Carla K. Johnson, October 27, 2008 and can be found at Yahoo! News.

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Trendline Print (PDF)

All Outpatients Are Not the Same

BACKGROUND

There is a tendency to simplistically divide a healthcare organization’s customers into inpatients and outpatients. Inpatients vary from the acutely-ill with life threatening conditions to the short-stay patient undergoing a routine procedure. Outpatients also have different needs and expectations depending on their acuity and the nature of the care that they require. At the same time, the distinction between an inpatient and outpatient is blurring with new care delivery models, alternate care settings, and technological advances. Today, unless admitted through the emergency department, most patients arrive at the hospital as an outpatient and are generally admitted post-procedure. With the trend toward minimally-invasive surgery and shorter lengths of stay, the only difference between an inpatient and an outpatient may be the length of their recovery ― four, six, eight hours versus a 30-hour stay or discharge the next day. These patients require the same pre-procedure preparation, experience the same reception and intake processes, and require the same pre-discharge instructions regardless of whether they are classified as an inpatient or an outpatient.

UNDERSTANDING THE DIFFERENT TYPES OF OUTPATIENTS

There are also different types of outpatients (as shown in figure below) ranging from those seeking care for life-threatening conditions to those focused on fitness or wellness, with the various types of outpatients in between:

Life threatening or emergent care that requires immediate treatment for life-threatening or urgent conditions as well as care for patients who consider themselves to be in immediate need of medical care.
Routine/episodic care which may involve an occasional or once-a-year visit to the healthcare campus for routine care such as an annual physical or a chest X-ray.
Acute ambulatory/short-stay care that may involve a once-in-a-lifetime experience such as outpatient surgery or an outpatient cardiac catheterization.
Chronic or recurring ambulatory care involving frequent or ongoing visits ― multiple times per week or month ― for services such as physical therapy, cancer care, and dialysis.
Fitness or wellness activities that may include exercise regimens and health education for individuals who do not perceive themselves as “patients."

CONCLUSION

Each type of outpatient has different needs and expectations relative to site access and wayfinding, convenience, recognition by staff, and discharge instructions. The sharing of space by different types of outpatients also needs to be considered. Viewing recovering patients exercising in a cardiac rehab area may be inspirational and reassuring for a patient undergoing a heart catheterization or pre-surgery testing for open-heart surgery. However, it may not be advisable to mix patients undergoing chemotherapy with healthy patients undergoing annual health screening procedures. back to top

Cynthia Hayward, AIA, ACHA, FAAHC

Principal

Hayward & Associates LLC

chayward@hayward-assoc.com

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Technology

Hospitals Jump on the Biometrics Bandwagon

OVERVIEW

BayCare Health System, Tampa bay’s largest hospital group, is the first health care system in the state of Florida and the second in the country to use biometric palm scanning technology to register patients. When a patient places her hand on a little black box on the registration desk, a tiny built-in camera beams infrared light into her palm. The camera scans an image of the veins inside the patient’s palm ― a signature that is supposed to be as unique as a fingerprint ― and a computer records it in digital code.

HOW IT WORKS

The palm scanning technology used by BayCare is manufactured by Fujitsu Computer Products of America, Inc. and is integrated with BayCare’s information and data systems. Called PalmSecure^TM, the system uses near infrared light to map an image of the vein pattern in a person's palm. The digital image is then converted into a number that correlates with the patient's medical record.

Upon registration, patients place their right palm into a scanning device which scans the hand to capture an image of the blood flowing through the veins. The hand rests palm-side down just above the scanner with the veins appearing as a unique black pattern on a light background. Then, the image is scanned, converted into a number and registered into the hospital’s system. From that point forward, the patient can be identified by his or her unique vein pattern, minimizing the need to present other identifying information, such as a driver's license and Social Security number, each time they register at one of BayCare’s hospitals. Patients who choose not to participate are registered using the current method at each visit by providing name, address, date of birth, Social Security number and other information.

WHY PALM VEINS?

The vein pattern on a hand is unique to each person. In fact, vein patterns can be 100 times more distinctive than fingerprints. In addition, once a patient is registered, his or her identity can be verified with a painless, hassle-free scan that takes only a few moments. Banks in Japan use palm identification for ATMs instead of personal identification (PIN) numbers.

PATIENT BENEFITS

Use of the PalmSecure vein authentication device can benefit patients in several ways,
such as:

Improved speed for patient registration
Minimizes the amount of personal information communicated verbally or through forms during registration
Improves accuracy of patient identification
Helps prevent misuse of Social Security numbers and insurance cards
Rapid identification in emergencies

PROJECT STATUS

Patient Secure Identity was first launched in July 2008 at St. Anthony's Hospital in St. Petersburg, Florida. The project is scheduled to roll out to other BayCare hospitals and facilities through the next year. back to top

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Rule-of-Thumb

Women and Infants Services Capacity and Preliminary Space Need

Component	Capacity	Department Gross Square Feet (DGSF)	Comments

Labor and Delivery Area:			The space ranges shown below assume one to three delivery/operating rooms for C-sections, a normal newborn nursery/holding area, and a modest admission/triage area for higher volume services.
LDRP Concept (Exclusively)	100 to 200 annual births per LDRP room	800 to 1,000 DGSF per LDRP room	Assumes single-room maternity care with exclusive use of combined labor/delivery/recovery/postpartum (LDRP) rooms with the patient discharged from the LDRP room.
LDR Concept (Primarily)	300 to 400 annual births per LDR/LDRP room	800 to 1,000 DGSF per LDR/LDRP room	Lower capacity range assumes that selected patients will be discharged from the LDR/LDRP room; higher capacity range assumes that the LDR concept is used exclusively with discharge from a separate postpartum room.
Antepartum/ Postpartum Unit		450 to 700 DGSF per bed	Lower space range for a mix of private and semiprivate patient rooms; higher range assumes all private patient rooms and enhanced amenities; excludes shared public lobbies, stairs/ elevators, and other common areas not within the nursing unit.
Neonatal Intensive Care Unit		250 to 500 DGSF per bassinet	Lower space range assumes traditional open-bay configuration; higher range assumes a single-room concept and should also be used for a small unit with only a few bassinets.

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).