Medical Units Revamped to Reduce Nursing Fatigue

A new study offers a range of spatial solutions to boost nurses' efficiency through better floor design and environmental analysis.

Researchers at Cornell University (Ithaca, NY, USA) analyzed the floor plans and work patterns within five medical-surgical units at US hospitals, using concepts recommended by Lean thinking. The researchers used a new design tool which facilitates matching spatial flow with caregivers' workflow to reduce waste and redundancies and increase efficiency in acute care settings, generating a space syntax—a diagrammatic analysis of relationships—that was used to decode spatial relationships among the clinical spaces.

To do so, they determined the main clinical spaces supporting nursing care, and their important linkages. The movement distributions were measured and possible conflicts with focus-demanding tasks, such as noise and interruptions, were identified. The results showed that the main clinical spaces were the patient corridor; nurses' station; medication area; clean room; soiled room; physicians' dictation area; report room; restricted nourishment area; equipment storage; and unrestricted nourishment area.

The researchers found that the report room, nourishment area, and physician workspace showed strong linkages to the patient corridor and nurses' station, although such spaces were not clearly discussed in the design guidelines. The most caregiver movement occurs in the patient corridor and nurses' station, areas that also posed the greatest possibility of interruptions by persons.

The information was summarized in a visual diagram providing the "syntactic anatomy" of the most important workspaces. By illustrating the spatial order of the support spaces, and comparing that to use patterns, designers will be able to reduce the movement sequences nurses undertake when accessing resources, and identify where the flow is disrupted by "displaced" functions. The study was published in the January 2013 issue of Health Environments Research and Design Journal.

“Imagine if a pilot was flying an airplane and trusted with keeping passengers safe, but instead of located in the cockpit, the necessary tools and controls were spread around the cabin of the plane,” said lead author Rana Zadeh, PhD, March, an assistant professor of design and environmental analysis. “New medical practices and technology have emerged during the past decade, and facility design should adapt to these changing practices so that caregivers can perform better on their critical tasks.”

The five principles of Lean Thinking, as devised by James Womack, are to identify customers and specify value; identify and map the value stream; create flow by eliminating waste; respond to customer pull; and pursue perfection. As this happens, more and more layers of waste become visible and the process continues towards the theoretical end point of perfection, where every asset and every action adds value for the end customer.

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