Study yields tool for optimizing nursing workflow in hospitals

A design efficiency checklist for medical facilities developed by researchers at Texas A&M provides spatial solutions for flawed floor plans that can contribute to medical staff fatigue, cause distractions that hinder quality patient care and potentially result in higher medical costs.

The study, led by Rana Zadeh, a spring 2012 architecture Ph.D. graduate from Texas A&M, analyzed the floor plans and work patterns within five medical-surgical units at U.S. hospitals and found numerous opportunities to boost nurses' efficiency through better design. The study, "Rethinking Efficiency in Acute Care Nursing Units: Analyzing Nursing Unit Layout for Improved Spatial Flow," appears in the current issue of Health Environments Research and Design Journal (6:1).

Mardelle Shepley, professor of architecture and director of the Center for Health Systems & Design at Texas A&M, and Laurie Waggener, research director at WHR Architects in Houston, contributed to the study.

In some hospital wards, important spaces such as nourishment rooms are located far away from a nurse's typical path. Jammed patient-care corridors create excessive noise, and high foot traffic raises the potential for interruptions. Supplies are stocked in various locations, leading nurses to "hunt and gather" to find materials.

Experts say some nurses walk up to five miles during a typical shift. Even seemingly minor changes to improve the alignment of a facility layout for better caregiver workflow can have significant benefits.

"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 Zadeh, now an assistant professor of design and environmental analysis at the College of Human Ecology at Cornell University. "New medical practices and technology have emerged during the past decade.  Facility design should adapt to these changing practices so that caregivers can perform better on critical tasks."

Data confirms the average hospital has an infrastructure that is roughly 30 to 40 years old, says Zadeh. "They can be designed innovatively and smartly for today's fast pace of care. We hope this tool offers planners, designers and managers doing a facility renovation or addition a way to spot the missing links in their floor plans and to make work processes more efficient through research-based design."

Researchers analyzed hospitals to identify the top ten clinical spaces supporting nursing care and developed a visual design efficiency checklist that prioritizes their linkages, movement distribution and noise interruption potential.

"By understanding the nurse movement patterns within inpatient unit spaces," Shepley said, "designers can reduce the distances nurses travel to access resources. When nurses are more efficient in the movement patterns, they will be less fatigued and spend more time in the direct care of patients."