Joint determination of nurse and patient bed positions in an inpatient unit considering equity in visibility

Abstract

Layout design is considered a crucial aspect of healthcare architecture and its goal is to allow easy access to essential hospital services and effective patient care. Literature suggests that modifying or redesigning the inpatient unit layout is one of the ways to maximize patient visibility in an inpatient layout. However, prior work has been descriptive in nature and limited in their ability to derive optimal layouts. To fill this gap, we propose a non-linear optimization model that optimizes both equity and effectiveness in visibility by jointly determining the optimal location of two nurses and patient bed positions in multiple rooms. The bi-objective model is then converted into a single objective model utilizing the ε-constrained method, with equity in the objective function and effectiveness as a constraint. Patient visibility is estimated using a ray-casting algorithm that also considers nurses’ line of sight, door positions, and obstruction levels. A progressive refinement algorithm embedded in the Particle Swarm Optimization framework is proposed to efficiently solve this model. Our results suggest that optimizing bed position in conjunction with nurse position can enhance equity by over 45.2% compared to just optimizing the nurse position. Similarly, angular layouts are superior to linear layout by up to 53% in patient equity. We also notice that increasing spatial distance between nurses in angular layouts can further increase equity. Our approach provides valuable insights and can serve as a benchmark tool for hospitals looking to improve the design of their inpatient units that promote patient safety and high-quality care.