Patient room mock-up leads to effective design
Bugs are worked out before construction begins
That patient room in the cafeteria at Deborah Heart and Lung Center in Browns Mills, NJ, may have looked like a bizarre solution to a severe bed shortage. But it wasn’t. That room was a mock-up for the redesign of the medical intensive care unit (MICU).
The staff could work in the simulated setting, offering suggestions for changes before the real room was built. The architects at Ewing Cole Cherry Brott in Philadelphia then incorporated the changes into the new design.
"It was really a great way to see how it would work," says Diane Vile, RN, head nurse in the MICU. "The staff marked locations for electrical outlets and light switches, where and how high to place the ventilator, and where to install their custom designed cabinet. We have nurses who are 4 feet 11 inches tall and others who are 6 feet. They could all give their input so we could build something that’s serviceable to all nurses."
$30 million hospitalwide expansion
The MICU project was part of a hospitalwide $30 million five-year renovation and expansion that was completed last fall. Vile credits the mock up for the success of the new MICU. The MICU boasts three clusters of six to seven rooms grouped around nursing stations. The design provides nurses with better visual contact, and the clusters enable the unit to expand or contract based on patient census.
The unit now has satellite pharmacies at nursing stations, minimizing the need for someone to come from a central pharmacy with medication. Equipment sterilization is also done on the unit, another timesaver.
A key patient and family satisfier was the elimination of double rooms. The MICU now houses 24 private patient rooms and two isolation rooms.
"Before we had to ask families to leave if the other patient was having a problem," Vile says.
The single rooms have enabled the unit to enact a more flexible visiting policy. In fact, family can now spend the night on the unit either in the patient’s room, which has a recliner, or in the waiting room where all the furniture opens into sleeping accommodations.
"They can go in the waiting room and turn out the light, and if something happens, we can wake them," Vile says.
Innovative designs
The other innovations the redesign team came up with include:
• Adjoining doors.
Adjacent rooms have an adjoining glass door which can be opened to allow patients and their families to chat or to enable nurses to watch two patients at once if needed. The nurse can draw a curtain over the door for privacy. "It reassures the families that someone is watching the patient even if they’re not in the same room, and the nurses don’t have to keep running back and forth to check on the patient, so it’s less stressful for them. We’ve seen the two families talk a little to each other, which gives them some support." She adds that at least one patient came back to visit another patient he had met while hospitalized in an adjoining room.
• Showers.
Showers are a luxury in the ICU where patients normally receive bed baths, even those who are hospitalized for months. The showers accommodate wheel chairs and sport heat lamps. "It’s so much more refreshing," Vile says. "The nurse can wash their hair and clean them off. It makes the patients feel normal again."
• Toilets.
For patients who can walk, each room contains a toilet concealed under a pedestal near the sink. Patients have often complained about the humiliating experience of using a bedpan, Vile says. She says the toilets also have sprayers so clinicians can clean bedpans in the room, minimizing any chance of contamination that may occur when a nurse carries soiled materials outside the room to a disposal site.
• Custom cabinets.
The nurses designed a cabinet that contains a patient’s medical and pharmaceutical supplies. The nurses no longer have to leave the patient to retrieve those supplies from distant storage areas.
• Refrigerators.
The rooms contain a refrigerator for any supplies that need to be stored at cool temperatures. "This eliminates any mistakes that could happen when they’re stored in one central refrigerator," Vile says. "You won’t accidentally pick up another patient’s medication."
• Windows.
All but four of the rooms have windows to the outside so patients can see the passage of time. The patients scheduled for more than a 24-hour stay are assigned to the rooms with windows. "It’s easy to lose track of the days and nights when you’re here, and that can be very disturbing to the patient," Vile says. "It’s helpful for them to be able to experience daytime and nighttime."
[For more information, contact Diane Vile, Deborah Heart and Lung Clinic, 200 Trenton Road, Browns Mills, NJ 08015. Telephone: (609) 893-6611. Or Ted Newell; Ewing Cole Cherry Brott, 100 N. 6th St., Philadelphia, PA, 19106. Telephone: (215) 923-2020.]
Jennings K, Miller K, Materna S. Changing Health Care: Creating Tomorrow’s Winning Health Enterprise Today, Santa Monica, CA : Knowledge Exchange, LLC; 1997.
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