Design becoming new focus for improving patient safety
Risk managers are accustomed to working with whatever physical surroundings they find in their facilities, making the best of work and patient areas that might not be optimal for safety, and reducing liability risk. But there's a new trend in which risk managers are getting involved early enough to influence the fundamental design of facilities to improve safety.
That was the case at Palomar Pomerado Health (PPH) in San Diego, which is designing and building the so-called "hospital of the future." Janie Frincke, RN, district director for risk management at PPH, was involved from the start and says the new facility will incorporate the latest ideas for improving safety for patients and staff, thereby reducing liability risks and associated costs. The plan calls for creating a new regional medical campus with 453 beds, doubling the size of PPH's campus in Poway, CA, from 107 beds to more than 200; it will transform the existing acute care facility in Escondido to a specialty campus offering physical rehab, behavioral health, corporate offices, and mixed-use with housing and retail.
PPH is incorporating "evidence-based design" into planning for safer facilities. Frincke explains that evidence-based design is a way to incorporate what we know about improving patient safety — the strategies that have been proven to work — into the basic design of a facility. For instance, how many times have you thought that you could reduce patient falls if the bathroom were located much closer to the bedside? That's a hard fix in an existing facility, but it's no problem to design it that way from scratch.
Frincke was directly involved in the design process from the early stages, as were many other key leaders at PPH. She conducted extensive research into the design of patient rooms and patient units by studying the literature and other hospitals to see how design could reduce errors and improve safety.
One immediate finding was that moving patients from one room to another as their conditions changed greatly increased the risk of errors. So Frincke supported the idea of designing "acuity adaptable" rooms that would accommodate patients in various conditions. "We also found that by moving the nurses closer to the patients, with work stations between the rooms, you can decrease the rate of falls and medication errors," Frincke says. "So we recommended that as a key design goal."
Frincke says risk managers can bring unique perspectives and skills to the design process. They could explain the organization's history of claims and losses, plus their own knowledge of how many hazards can be avoided. "It's very important for the risk manager to be involved," she says. "The risk manager brings something to the group that no one else brings."
Worth upfront expense
Frincke helped the design team understand what patient safety issues were important and how they might be addressed. From there, the design team came up with ways to incorporate those strategies.
Frincke emphasized that patient falls while trying to access the toilet were a big concern, so Michael Shanahan, AIA, director of facilities, planning, and development for PPH, worked with Tom Chessum, AIA, principal architect for PPH, to design extra wide bathroom doors that slide completely out of the way. The larger opening allows the patient easier entry and reduces staff injury as they try to help the patient.
"It's easier for both patient and staff to maneuver in the larger, more open space, so not only will we reduce patient falls, but we will reduce workers' compensation costs for our own caregivers," Shanahan explains.
Risk managers are key to the process, Shanahan says. Facilities management and architects may have to come up with the final method of implementation, but risk managers can define the problems and possible solutions. Risk managers also can make the case to upper management that such design solutions can be cost-effective.
"If you show that you're lowering your workers' compensation costs and the lawsuits from patients, or the infections in the hospital, there's a value to that," Shanahan says. "Yes, you may be paying more up front for this design effort, but it's going to more than pay for itself in savings over the near future."
Sources
For more information, contact:
- Tom Chessum, AIA, Principal Architect, Palomar Pomerado Health, 15255 Innovation Drive, San Diego, CA 92128. Telephone: (323) 525-0500. E-mail: [email protected].
- Janie Frincke, RN, District Director, Risk Management, Palomar Pomerado Health, 15255 Innovation Drive, San Diego, CA 92128. Telephone: (858) 675-5552. E-mail: [email protected].
- Michael Shanahan, AIA, Director of Facilities, Planning, and Development, Palomar Pomerado Health, Palomar Medical Center, 15255 Innovation Drive, San Diego, CA 92128. Telephone: (858) 675-5593. E-mail: [email protected].
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