Purpose: This article describes a case study of a collaborative human factors (HF) and systems-focused simulation (SFS) project to evaluate potential patient and staff safety risks associated with a multimillion-dollar design and construction decision.
Background: The combined integration of HF and SFS methods in healthcare related to testing and informing the design of new environments and processes is underutilized. Few realize the effectiveness of this integration in healthcare to reduce risk and improve decision-making, safety, design, efficiency, patient experience, and outcomes. This project showcases how the combined use of HF and SFS methods can provide objective evidence to help inform decisions.
Methods: The project was initiated by a healthcare executive team looking for an objective, user informed analysis of a current connector passageway between two existing buildings. The goal was to understand the implications of keeping the current route for simultaneous use for public and patients service flow versus building and financing a new passageway for separate flow and transport. An interprofessional team of intensive care unit professionals participated in two simulations designed to test the current connector. A failure mode and effects analysis and qualitative debrief feedback was used to evaluate risks and potential failures.
Results: The evaluation resulted in data that enabled informed executive decision making for the most effective, efficient, and safest option for public, staff, and patient transport between two buildings. This evaluation resulted in the decision to go forward with building a multimillion-dollar new connector passageway to improve integrated care and transport.
Background: It is proposed that patients in single-occupancy patient rooms (SPRs) carry a risk of less surveillance by nursing and medical staff and that resuscitation teams need longer to arrive in case of in-hospital cardiac arrest (IHCA). Higher incidences of IHCA and worse outcomes after cardiopulmonary resuscitation (CPR) may be the result.
Objectives: Our study examines whether there is a difference in incidence and outcomes of IHCA before and after the transition from a hospital with multibedded rooms to solely SPRs.
Methods: In this prospective observational study in a Dutch university hospital, as a part of the Resuscitation Outcomes in the Netherlands study, we reviewed all cases of IHCA on general adult wards in a period of 16.5 months before to 16.5 months after the transition to SPRs.
Results: During the study period, 102 CPR attempts were performed: 51 in the former hospital and 51 in the new hospital. Median time between last-seen-well and start basic life support did not differ significantly, nor did median time to arrival of the CPR team. Survival rates to hospital discharge were 30.0% versus 29.4% of resuscitated patients (p = 1.00), with comparable neurological outcomes: 86.7% of discharged patients in the new hospital had Cerebral Performance Category 1 (good cerebral performance) versus 46.7% in the former hospital (p = .067). When corrected for telemetry monitoring, these differences were still nonsignificant.
Conclusions: The transition to a 100% SPR hospital had no negative impact on incidence, survival rates, and neurological outcomes of IHCAs on general adult wards.
Objectives, purpose, or aim: The study aimed to decrease noise levels in the ICU, anticipated to have adverse effects on both patients and staff, by implementing enhancements in acoustic design.
Background: Recognizing ICU noise as a significant disruptor of sleep and a potential hindrance to patient recovery, this study was conducted at a 40-bed ICU in Fiona Stanley Hospital in Perth, Australia.
Methods: A comprehensive mixed-methods approach was employed, encompassing surveys, site analysis, and acoustic measurements. Survey data highlighted the importance of patient sleep quality, emphasizing the negative impact of noise on work performance, patient connection, and job satisfaction. Room acoustics analysis revealed noise levels ranging from 60 to 90 dB(A) in the presence of patients, surpassing sleep disruption criteria.
Results: Utilizing an iterative 3D design modeling process, the study simulated significant acoustic treatment upgrades. The design integrated effective acoustic treatments within patient rooms, aiming to reduce noise levels and minimize transmission to adjacent areas. Rigorous evaluation using industry-standard acoustic software highlights the design's efficacy in reducing noise transmission in particular. Additionally, cost implications were examined, comparing standard ICU construction with acoustically treated options for new construction and refurbishment projects.
Conclusions: This study provides valuable insights into design-based solutions for addressing noise-related challenges in the ICU. While the focus is on improving the acoustic environment by reducing noise levels and minimizing transmission to adjacent areas. It is important to clarify that direct measurements of patient outcomes were not conducted. The potential impact of these solutions on health outcomes, particularly sleep quality, remains a crucial aspect for consideration.
Objective: This article describes the development of the rural community-based participatory design framework to guide healthcare design teams in their integration of rural community and clinical voice during the planning, design, and construction of a healthcare facility.
Background: Rural communities are facing an alarming rate of healthcare facility closures, provider shortages, and dwindling resources, which are negatively impacting population health outcomes. A prioritized focus on rural care access and delivery requires design teams to have a deeper understanding of the contextual considerations necessary for a successful healthcare facility project, made possible through engagement and partnership with rural dwelling community members and healthcare teams.
Method: The rural community participatory design framework is adapted from the rural participatory research model, selected due to its capture of key concepts and characteristics of rural communities. Underpinning theories included rural nursing theory and theory of the built environment.
Results: The framework encompasses healthcare facility project phases, key translational concepts, and common traits across rural communities and cultures. As a middle-range theoretical framework, it is being tested in a current healthcare project with a Critical Access Hospital in Montana to facilitate design team and stakeholder collaboration.
Conclusion: The rural community participatory design framework may be utilized by design teams as a means of familiarization with rural cultures, norms, values, and critical needs, which relate to meaningful design. The framework further enables design teams to critically appraise best practices of stakeholder engagement throughout the project lifecycle.
Objective: This study utilizes a design-led simulation-optimization process (DLSO) to refine a hybrid registration model for a free-standing outpatient clinic. The goal is to assess the viability of employing DLSO for innovation support and highlight key factors influencing resource requirements.
Background: Manual registration in healthcare causes delays, impacting patient services and resource allocation. This study addresses these challenges by optimizing a hybrid centralized registration and adopting technology for efficiency.
Method: An iterative methodology with simulation optimization was designed to test a proof of concept. Configurations of four and five registration options within a hybrid centralized system were explored under preregistration adoption rates of 30% and 50%. Three self-service kiosks served as a baseline during concept design and test fits.
Results: Centralized registration accommodated a daily throughput of 2,000 people with a 30% baseline preregistration rate. Assessing preregistration impact on seating capacity showed significant reductions in demand and floor census. For four check-in stations, a 30%-50% preregistration increase led to a 32% seating demand reduction and a 26% decrease in maximum floor census. With five stations, a 50% preregistration reduced seating demand by 23% and maximum floor census by 20%.
Conclusion: Innovating introduces complexity and uncertainties requiring buy-in from diverse stakeholders. DLSO experimentation proves beneficial for validating novel concepts during design.
Objectives: This narrative literature review aims to develop a framework that can be used to understand, study, and design maternal care environments that support the needs of women from diverse racial and ethnic groups.
Background: Childbirth and the beginning of life hold particular significance across many cultures. People's cultural orientation and experiences influence their preferences within healthcare settings. Research suggests that culturally sensitive care can help improve the experiences and outcomes and reduce maternal health disparities for women from diverse cultures. At the same time, the physical environment of the birth setting influences the birthing experience and maternal outcomes such as the progression of labor, the use of interventions, and the type of birth.
Methods: The review synthesizes articles from three categories: (a) physical environment of birthing facilities, (b) physical environment and culturally sensitive care, and (c) physical environment and culturally sensitive birthing facilities.
Results: Fifty-five articles were identified as relevant to this review. The critical environmental design features identified in these articles were categorized into different spatial scales: community, facility, and room levels.
Conclusions: Most studies focus on maternal or culturally sensitive care settings outside the United States. Since the maternal care environment is an important aspect of their culturally sensitive care experience, further studies exploring the needs and perspectives of racially and ethnically diverse women within maternal care settings in the United States are necessary. Such research can help future healthcare designers contribute toward addressing the ongoing maternal health crisis within the country.
Objectives: This research aims to propose a novel methodology for analyzing and optimizing wayfinding in complex environments by examining their spatial configurations.
Background: Wayfinding difficulties often lead to disorientation and hinder users' ability to locate destinations. Although architectural design can aid in simplifying user access, existing approaches lack a specific focus on wayfinding optimization despite its significant impact on users' navigational abilities.
Methods: In this study, an agent-based model was employed to assess the efficacy of wayfinding in a multistory hospital. Subsequently, the layouts were optimized, leading to the creation of a new space distribution diagram. The simulation was then repeated to examine the potential improvement in wayfinding. Data collection encompassed user types, workflow scenarios, population distribution, and user speed.
Results: Comparative analysis of the agent-based simulation findings before and after layout optimization revealed a decrease in total distance and time spent on the modified floor plans for all users when compared to the existing layout. This suggests that the optimized layout holds significant potential for enhancing wayfinding performance. Given the positive outcomes observed for users, this approach is particularly well suited for preliminary design stages of complex environments, where designations among user groups are less crucial or flexibility is desired. Additional advantages include the ability to generate a comprehensive simulation of users' daily workflow, which is integrated into the optimization process and considers specific requirements regarding spatial adjacency.
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