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Floor Layout Analysis Can Boost Nursing Work Improvements

U.S. Army nurses in Honduras (Staff Sergeant Sean A. Foley, army.mil)Architects at Cornell and Texas A&M universities and in private practice developed an analytic technique to find ways of improving the work of nurses by improving the layout of medical and surgical facilities. The team led by Cornell’s Rana Zadeh published its findings in the current (December 2012) issue of the Health Environments Research and Design Journal; paid subscription required.

Zadeh, a professor of design and environmental analysis, and colleagues analyzed floor plans and work patterns at acute care units in five hospitals to identify the clinical spaces that support nursing care and the linkages to other hospital services and units. The researchers created what they call a syntactic anatomy of the most important work spaces, highlighting the distribution of movements and factors that can interrupt nurses’ attention, such as noise and interruptions.

The syntactic anatomy technique revealed 10 main clinical spaces where patients and clinical staff interact. The team found important spaces such as nourishment rooms are located far away from a nurse’s typical path. In addition, crowding patients in hospital corridors creates excessive noise, and the resulting high foot traffic raises the risk of interruptions.

The analysis shows stock rooms are scattered around their units or buildings, forcing the nurses to take valuable time to search for needed supplies. “Imagine if a pilot was flying an airplane and trusted with keeping passengers safe,” says Zadeh, “but instead of located in the cockpit, the necessary tools and controls were spread around the cabin of the plane.”

The results indicate rooms for reporting, nourishment, and physicians’ work are linked to the patient corridor and nurses’ stations, although the authors say standard health care facility design guidelines do not clearly discuss these spaces. The team found most care giver activity takes place in the patient corridor and nurses’ station, which are also the areas that pose the greatest possibility of interruptions.

The authors translated their findings into a visual design efficiency checklist to reduce nurse and medical staff fatigue, as well as distractions that can hurt patient care quality and result in higher medical costs. “New medical practices and technology have emerged during the past decade,” notes Zadeh, “and facility design should adapt to these changing practices so that care givers can perform better on their critical tasks.”

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Photo: U.S. Army/Flickr

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