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Healthcare Facility Planning Tools and Guidelines

Volume 3, Number 2

Spring 2010

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Redefining Patient-Centered Care

More Hospitals Are  Renovating to Accommodate the Obese

Fusion Imaging is Growing Fast 

Wearable Wireless Monitoring Sensor Now Available in Japan

Sizing Imaging Procedure Rooms

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Redefining Patient-Centered Care                                                       

BACKGROUND

A lot has changed since the concept of patient-centered care was first introduced several decades ago. The old definition of patient-centered care used to be bringing care of the patient to the bedside. That model ― which included decentralizing diagnostic equipment, pharmacies, and supply rooms to each inpatient floor ― proved too costly both from a facility and labor perspective. Today, the patient-centered care concept has moved to a relationship-based care model focused on orienting a health care organization around the preferences and needs of patients with the intention of improving the patient’s satisfaction with care and improving his or her clinical outcome. Today, the definition has also been expanded to include family members and is often referred to as the patient- and family-centered care (PFCC) model.

PATIENT- AND FAMILY-CENTERED CARE

The Institute for Family-Centered Care defines the following four core concepts of patient-and family-centered care:

• Dignity and respect. Healthcare providers listen to and honor the perspectives and choices of patients and their families ― however they are defined.

• Information sharing. Healthcare providers communicate and share information with patients and families ― timely, complete, and unbiased ― in order for them to effectively participate in care and decision-making.

• Participation. Patients and families are encouraged and supported in participating in care and decision-making at any level they chose.

• Collaboration. Patients, families, healthcare providers, and associated personnel collaborate in policy and program development, healthcare facility design, and professional education, as well as in the delivery of care.

IMPACT OF FACILITY RENOVATION AND RECONFIGURATION

Although there is a renewed effort by healthcare organizations to put the patients and their families at the center of everything ― from moving more patient care to the bedside, better coordinating care delivery among disparate providers through re-engineered work processes and technology, and implementing new web-based and social media communication tools ― facility renovation and reconfiguration is often necessary to fully realize the potential of moving to this model of care. In some cases, the existing facilities may impede achievement of the expected benefits. For example, it is difficult for care providers to provide patient- and family-centered care in an undersized semiprivate or multiple-bed patient room. Nurses who must walk extended distances to retrieve supplies, medications, and equipment on inpatient nursing units, or rely on paper-based health information and outdated communication systems, have limited time to spend with their patients and families. At the same time, outpatients and their families may not perceive that they are the focus of the organization if diagnostic and treatment services are physically dispersed throughout the healthcare facility ― hampering wayfinding and requiring them to walk significant distances.

NEW OPERATIONAL AND FACILITY RECONFIGURATION MODELS THAT ARE FOCUSED ON PATIENTS AND THEIR FAMILIES

Based on the early attempts at implementing the patient-centered care concept, it was assumed ― until recently ― that this concept was more expensive from both a capital and operational cost perspective. New organizational models are emerging that are not only patient and family friendly but also provide more efficient utilization of staff, equipment, and space. For example, the physical reorganization and consolidation of similar patient care or support functions around the patient and his or her family can create opportunities for cross-training of staff and reduce the number of managers and supervisors. This may result in a reduction in space need because smaller staffs require fewer offices and workstations; quicker throughput lessens the need for expensive procedure rooms and large patient and family waiting areas. Moreover, future flexibility is achieved by co-locating similar types of space ― patient reception and waiting areas, procedure rooms, prep and recovery spaces, and clinical and staff support space ― that can be redeployed over time for different types of patients or procedures with minimal renovation.

Some examples where facility reconfiguration promotes patient-and family-centered care ― as well as the efficient use of resources ― are described below. The concept of patient-centered care is no longer focused solely on the inpatient. The reorganization of clinical and support services to provide “one-stop shopping” for outpatients also improves patient and family satisfaction.

• Providing private patient rooms that are organized into smaller clusters. A private patient room ― with space for family members ― provides dignity and respect for the patient and allows family members to participate in care delivery. When charting areas and supplies are decentralized to a small cluster of patient rooms, the care providers will spend more time with the patients and families. Space and equipment may be provided on the nursing unit for the family to assist in food preparation or help the patient with mobility or physical therapy. All of this provides optimal use of the caregiver’s time and improves the quality of patient care delivered.

• Co-locating outpatient imaging and other diagnostics services. Many healthcare organizations are co-locating and consolidating traditional diagnostic and therapeutic departments ― creating a single diagnostic center ― to optimize the short-term sharing of resources and long-term flexibility. By the way, this also simplifies wayfinding for outpatients and their family members and facilitates coordinated scheduling. The reality is that regardless of the specific imaging modality, all of these services use essentially the same types of spaces ― patient reception and family waiting area, several sizes of rooms for procedures depending on whether the equipment is small and portable or large and fixed, optional recovery space, and the associated clinical and administrative support space. Rapidly advancing technologies require more flexible, generic procedure rooms that can easily be re-equipped over time with minimal renovation. The converging of many imaging technologies is also necessitating the cross-training of staff and elimination of the traditional department boundaries.

• Consolidating express testing services. Routine, quick turnaround diagnostic services may be further consolidated into an express testing center that is conveniently located near a major entrance with adjacent parking. These services may include routine blood and urine collection, electrocardiograms (EKGs), simple bone x-rays, and preadmission or pre-surgery consultation. In this model, the staff all work together as a team to provide quality care in an expedient manner. Patient satisfaction generally improves as access becomes more convenient, waiting time is minimized, and the continuity of care is improved.

• Creating a customer service center. In the traditional healthcare facility, multiple departments and staff are involved in customer intake, access, and processing activities ― reception, admitting and registration, coordination of multiple appointments, cashiering, insurance verification, and physician referrals. This typically results in fragmented customer service and complicated wayfinding. Although many of these departments are located on the first floor of the facility, only a few staff in each department actually have face-to-face interaction with patients and their families. With the continuing focus on patient-centered care, information technology, and reengineering techniques, the trend is to consolidate these services into a single operational unit. The customer service center serves as the primary patient and visitor intake, processing, and communica­tion area for a health­care facility or campus and also includes centralized patient and family amenities. The customer service center is located directly inside the primary entrance to the healthcare complex to serve as the initial access point for visitors and most scheduled outpatients. This area can also function as a “home base” for family members and visitors who are spending increased time at the facility as more treatments and procedures are performed on a same-day basis.

Conclusion

Many of the concepts of patient- and family-centered care can be achieved through re-engineered processes and improved technology. However, often the physical reorganization of services and spaces is required as well and the patient’s and family’s perception of the organizations mission and values is impacted by the physical environment. back to top

Cynthia Hayward, AIA, ACHA, FAAHC

Principal

Hayward & Associates LLC

chayward@hayward-assoc.com

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In the News

More Hospitals Are Renovating to Accommodate the Obese

Novation, a medical supply contracting company, has released its
2010 Bariatric Report, a nationwide survey of about 300 VHA Inc. and University HealthSystem Consortium member hospitals, confirming that the obesity epidemic poses new and significant challenges to U.S. hospitals.

According to this survey, over 48 percent of the respondents saw an increase in admissions of morbidly obese patients since 2008 while 13 percent saw a significant increase. Moreover, 28 percent of the respondent hospitals reported having invested in physical renovations of their facilities last year to accommodate the morbidly obese with another 8 percent saying that they planned to do so.

Novation reports that hospitals have been buying specialized medical equipment such as bariatric blood pressure cuffs, bariatric beds and mattresses, stretchers, operating room tables, and non-clinical furniture. While the industry has seen an overall decrease in spending on renovations and building improvements due to the still recovering economy, physical renovations to accommodate bariatric patients have increased ― such as widening door openings, installing higher-load steel toilets, providing open showers, and purchasing new seating for patients and family members. back to top

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Trendline                                                                                       Print (PDF)

Fusion Imaging is Growing Fast

BACKGROUND

Imaging is one of the fastest changing technologies ― from advances in
x-ray film and cassettes to the introduction of computers and digital images ― and it continues to reinvent its technology to improve patient care. Today, explosive growth is occurring in the area known as fusion imaging. This technology combines two independent imaging modalities ― typically a procedure that demonstrates an organ’s function with one that depicts the organ’s anatomy to produce a diagnostically and clinically superior image.

Nuclear medicine procedures such as positron emission tomography (PET) and single photon emission computerized tomography (SPECT) are unparalleled in their ability to assess information about metabolic function. Computerized axial tomography (CT) and magnetic resonance (MR) imaging are superior at depicting anatomy. Historically, clinicians had to obtain physiological and anatomical information on separate machines and use special software to digitally superimpose the two images. Today, new hybrid equipment is capable of performing both types of examinations simultaneously by automatically merging the data to form a composite image. By uniting metabolic function with anatomic form, fusion imaging depicts the human body with a level of precision that was not achievable in the past.

TREND IN FUSION IMAGING BY THE NUMBERS

Fusion imaging is diffusing very rapidly. As shown in the graph below, fusion imaging (PET/CT) was virtually unknown at the beginning of 2005 and conventional PET scans were the dominant technology. Within four years, PET scans had decreased from 80,000 to 20,000 procedures per quarter while fusion procedures had increased to nearly 180,000 procedures per quarter.

Trend in Fusion Imaging (PET/CT) Versus Conventional PET Scans

Source: Thomson Reuters.

IMPACT ON FACILITY PLANNING

With the evolution of fusion imaging and other merging technologies, healthcare facilities must be planned with optimal flexibility in mind. Imaging facilities should be designed with a variety of small and large procedure rooms that can accommodate different pieces of diagnostic and therapeutic equipment over time. Furthermore, various modalities should be centralized in a single, flexible diagnostic center or imaging center that can accommodate changing workloads and equipment as some modalities grow and other become obsolete.

A PET/CT unit requires a large procedure room with an adjacent control room. For example, the Philips GEMINI TF Big Bore PET/CT system requires a procedure room of about 330 net square feet (NSF) with an adjacent control room at 100 NSF. back to top

Cynthia Hayward, AIA, ACHA, FAAHC

Principal

Hayward & Associates LLC

chayward@hayward-assoc.com

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Technology

Wearable Wireless Monitoring Sensor Now Available in Japan

WIN Human Recorder Co Ltd, a Japan-based firm, has introduced a new health monitoring service to keep an eye on a person’s health by capturing data like electrocardiographic signals and body surface temperature, and then wirelessly transmitting that data to a mobile phone or computer where a professional or family member can access it remotely. The company commercialized the health monitoring system, which is called the "human recorder system," based on the research results of the Advanced Institute of Wearable Information Networks (WIN), a nonprofit organization established by researchers at the University of Tokyo. WIN is a group led by Kiyoshi Itao, professor emeritus at the university.

how it works

A small, lightweight sensor ― weighing only about seven grams ― attaches to the patient’s chest to measure electrocardiograph signals, heart rate, brain waves, body surface temperature, and respiration among other vital signs. It can also detect stress levels and heartbeat fluctuations. Human movements are detected by a three-axis acceleration sensor. A single CR2032 battery is able to keep it going for up to four days while using 2.4GHz wireless connectivity to transmit its data ― making it a whole lot more convenient to remotely monitor the health condition of an elderly person who lives alone or who cannot easily travel to a healthcare facility.

CURRENT STATUS

The service is only available in Japan at this point and is expected to cost the equivalent of about $100 monthly for software rental while the sensor itself will retail for around $300.

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Rule-of-Thumb                                                                          Print (PDF)

Sizing Imaging Procedure Rooms

The size of an imaging procedure room depends on whether the equipment is portable or fixed and whether the equipment requires a separate operator control room and space to accommodate ancillary equipment components. Most imaging equipment can be accommodated in one of three types of procedure rooms.

NSF = Net square feet which represents the inside wall-to-wall dimensions of the individual procedure room.                                                    

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