Transforming the Hospital Stay
Dramatic changes in the design of future patient rooms in DoD inpatient facilities are becoming a reality. Legacy characteristics are giving way to patient rooms with single occupancy and other attributes that emphasize patient and family safety, comfort and privacy, and an improved working environment
By Marty Kauchak
Dramatic changes in the design of future patient rooms in U.S. Department of Defense inpatient facilities are becoming a reality. Multiple occupancy and other characteristics of Cold War and earlier-era built hospital rooms are giving way to patient rooms with single occupancy and other attributes that emphasize patient and family safety, comfort and privacy, and an improved working environment for facility staff. For the department’s vision of a next-generation patient room to succeed, challenges must be addressed in technology, and the culture and processes of providing inpatient health care.
Joint Solutions
A discussion of future patient rooms is timely given DoD’s pace for building and renovating its inpatient hospitals. The Air Force’s Keesler Hospital is in design with an estimated start of construction in June 2009 and completion in September 2011. The service’s Langley Hospital is under construction and is expected to be completed in spring 2009. Ground has been broken for the Army’s new Fort Belvoir community hospital, which is scheduled to open in spring 2011. The nation’s first joint Veteran’s Affairs-Navy hospital (Captain James A. Lovell Federal Health Care Center) is also being built and is expected to open in 2010 at Great Lakes, Ill.
The department’s Military Health System is working to develop joint, best practices supported by medical evidence for its next generation of patient rooms. The Air Force Medical Service “collaborates with HA/TMA [Office of the Assistant Secretary of Defense (Health Affairs)/(TRICARE Management Activity)] and our sister services in a joint effort to distill best practices in patient room design,” pointed out Colonel Ronald Steele, chief, Headquarters, Air Force Surgeon General, Health Facilities Division.
While the services and their representatives on the Tri-Service Evidence Based Design Working Group, the Health Facilities Steering Committee and other DoD collaborative bodies work within a department construct to field future patient rooms, these trail blazers are also seeking community-wide best practices from centers of excellence in the private sector and academia. During one recent outreach effort the working group visited Kaiser Permanente Garfield Innovation Center in San Leandro, Calif. to see mock-up bedrooms and entire patient units. The center’s Website noted “From prototyping to technology testing, the center brings blueprints to life so nurses, physicians, pharmacists and other hospital or clinic staff can collaborate with designers to perfect the plans for the environments they will work in every day. With 37,000 square feet to work with, the potential to experiment at the San Leandro center is virtually endless.”
The collaborative groups have also “sponsored evidence based design conferences with leading researchers in the field and conducted surveys of the design literature as part of a Quadrennial Defense Review objective to transform the infrastructure,” added Steele.
For its part, the Navy gains additional information on best practices through participation in the Epidaurus Project on Patient/Family Centered Design and the Georgia Tech College of Architecture/Military Health System Evidence Based Design 2.0 Collaborative Research Workshop, pointed out Captain Stephen S. Bell, facilities director, Navy Bureau of Medicine and Surgery.
Single Occupancy
“The patient room of the future will be a single-patient, private room,” the Air Force’s Steele told MMT. The single room is also forecast to have “family sleep-over space of 300-square feet or more with patient staff and family zones,” elaborated the Navy’s Bell.
Single patient rooms will be built in the department’s new generation of health care facilities. “All patient rooms in the new hospital at Fort Belvoir will be designed for single occupancy,” said Clay Boenecke, chief, Capital Planning Branch, Office of the Chief Financial Officer, HA/TMA. “Additional single patient rooms will be provided at the new Walter Reed National Military Medical Center and at the San Antonio Military Medical Center,” he added. For its part, the Air Force’s Keesler patient bedroom project is projected to be finished in June 2009 and mock-up rooms will be done in the near future.
Many of these single-patient room designs are funded in new construction projects in the department’s future years defense program and the Base Realignment and Closure 2005 Report.
There are significant benefits to constructing single occupancy rooms, noted a service expert. Evidence to date indicates the features of these future rooms “should shorten hospital stays; result in fewer airborne and contact infections, falls and medication errors; lower stress levels for both patients and staffs; improve communication between patients, families and care givers; increase privacy, satisfaction and social interaction,” said Bell.
These single patient rooms are being designed to provide unprecedented levels of safety, comfort and privacy for the patient, their visiting loved ones and the supporting health care staff.
Improvements Throughout
Safety for all members of a patient’s healing process will be improved through a combination of design characteristics and technology. Enhancements that promote safety include apparent and more subtle design changes.
The prominent and convenient location of sinks and alcohol gel dispensing stations will promote and improve staff hand washing and reduce hospital acquired infections. Patient falls and other mishaps are expected to be reduced through the wider-use of grab bars along the wall between the bed and bathroom, and the installation of dual-assist toilets and showers and other hardware.
Hospital staff members will find comfort knowing an end is in sight for manually lifting and moving patients to and from their beds. “Ceiling mounted lifts will be used in those areas where patients require the greatest staff assistance for movement. These lifts will reduce the potential for injury to both patients and staff,” pointed out Boenecke. Low-impact flooring, room-side storage units for high-usage, daily consumables and other improvements will also improve the staff’s working environment.
Other pronounced and more subtle changes are on the horizon for health care providers in new facilities. Workspaces are being designed to eliminate noisy and chaotic environments and support improved team communication and effectiveness. And “decentralized nurse stations will place providers closer to the patient room will increase visual contact and reduce staff walking distance and decrease fatigue,” pointed out Boenecke.
Other architectural and construction standards will further enhance the patient’s comfort. Patient rooms will be built to maximize the availability of natural light and, where possible, provide views of trees, ponds, mountains, gardens and other natural features. “Operable windows will also enhance the patient’s ability to connect with nature and allow for patient and family control of the environment. Building materials and furnishing will be more like home and less like an institution,” predicted Boenecke.
Patients are expected to have local controls to self-regulate natural day lighting in the room, heating and air conditioning, and artificial lighting from ceiling-mounted fixtures.
A broad cultural shift in the services’ attitude toward sick and wounded service men and service women has increased the presence of family members in the healing process. In one case, Army transition units have been established and geographically dispersed so that no matter where soldiers live, they can be assigned to a unit within a reasonable distance from their families. By extension, future patient rooms are being designed to provide for more family involvement in the healing process. “The rooms will have more space to allow family members to stay with the patient and more family group space will be on inpatient nursing units,” said Steele. “Family involvement in the care of the patient can also expedite recovery,” emphasized Boenecke.
An array of technology will be an important part of the future room’s infrastructure and is expected to benefit both patient and care giver. The patient is envisioned to have Internet connectivity and an in-room, flat-screen TV. Wireless technology, hands-free communications and other technology enhancements are expected to support the health care providers and allow them to make entries into the patient’s AHLTA (military’s electronic health record) and complete other electronic transactions. This capability will further allow DoD to implement department-wide electronic health records by 2011.
Help Needed
As conceptual designs of future patient rooms are quickly moving from design to implementation, there are an array of unresolved topics that require answers and solutions from industry and academic teams.
At the top of the Navy’s list of opportunities for resolution are issues regarding advanced information technology access and design. Evidence is lacking on a wide range of topics, “wall and bedside access to the patient’s record and its effects on communication and patient self management; patient control of room art, music, lighting level and temperature and their impact on satisfaction, length of stay and stress levels; patient access to the Internet and email; use of virtual reality to facilitate consults, therapy evaluations and interventions and their impact on length of stay, treatment and communications,” said Bell. He also highlighted the Navy’s interest in resolving how advanced infection controls, “such as ‘ultra clean air’ (high-efficiency particulate air-filtered, ultraviolet-irradiated), strategic placement of sinks, enhanced terminal disinfection of room between patients and metal ion-impregnated coated surfaces that oxidize microorganisms affect hospital acquired infections.” The service suggests further study is needed on how the nature of the patient bed, with respect to size, comfort and technology attributes, impacts the patient experience. As there will be a yet-to-be determined impact of patient room designs on health care providers, the Navy is interested in addressing how acuity adaptable rooms affect medical error rates, efficiency and staffing.
The Air Force has two additional challenges to help it more efficiently migrate to its future patient rooms. These include “providing more economical and efficient ways to deliver highly filtered (more than 90-percent) air and safe ways to provide operable windows in an inpatient room,” concluded Steele.
At the end of the day, building next-generation patient rooms alone will not produce the maximum potential benefits to the patient, family and health care provider. “Strong leadership, reengineered business and clinical processes and a commitment to focusing on the needs of the patient and family must accompany improvements to the built environment to ensure maximum improvement,” concluded Boenecke. ♦