Key Thought:
Building a hospital based on Evidenced-Based Design, integrated IT solutions and Patient Safety. How to do it?
Summary:
Case of OhioHealth building Dublin (Ohio) Methodist.
OhioHealth believed that a guiding principle in the construction effort was basing building design on the best available research to positively impact balanced scorecard measures of quality and safety; patient, family and staff satisfaction; operational efficiency; and financial performance.
Another guiding principle was an investment in cutting-edge IT that assist in improving patient safety, at the same time allowing the hospital to be digital, wireless and paperless to the maximum extent possible.
Dublin (Ohio) Methodist was build by paying attention to stress-reducing design and creating a patient/family-centered environment that improves safety while respecting privacy and dignity.
Evidence-based design features:-
- Rooms are acuity adaptable, allowing patients to remain in the same room regardless of level of illness eliminating intra-hospital transfer
- rooms are like-handed (what is on the left in one room is on the left in the next room); diminish the need for care providers to search for what they need for patient care
- rooms has access to natural light to reach nearly 90 percent of all occupied spaces
- windows in patient rooms partially open to let in fresh air
- a waterfall and trees in the lobby help to reduce stress among patients, families and hospital staff
- decentralized work station bring caregivers closer to their patients
- sound-absorbing ceiling tiles and a noiseless paging system create a quieter environment
Weaving IT into evidence-based design:
- patient's medical information is accessible via networked PC, wireless tablet PCs, and handheld devices
- no admitting department but has a group of people who perform the admitting function in the patient's room upon arrival
- single sign-on with biometrics reader
- integration of patient call lights, cardiac monitor alarms and bed exit alarms with wireless communication badge and earpiece worn by each caregiver
- use of computerized physician order entry (CPOE)
- digital ED and surgery management systems
- bed management system allows proper placement of patients quickly and sends messages to environmental services when beds need to be cleaned
- only hire employees who were willing to use IT
- physicians applying for privileges at Dublin Methodist agreed to be trained in and use the available technology
- employees are required to attend 8 weeks of training before hospital opened
Evidence-based design was led by The Center for Health Design, a leading research and advocacy organization. Before design and construction started, a design company Big Red Rooster completed a cultural report by conducting research about patients and staff perceptions of hospitals and the environment. The research was centered around traditional hospital cultures to help identify areas for improvement such as healthcare quality, patient satisfaction, staff retention, operational efficiency and productivity, and attracting more patients.
My Comments:
Many of these principles can and should be incorporated into our new hospital tower.
Reference: Creating the Ultimate Healing Environment: integrating Evidence-Based Design, IT and Patient Safety by Cheryl L. Herbert RN and Lamont M. Yoder RN FACHE, Healthcare Executive, SEPT/OCT 2008, p17-23.
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4 comments:
All the Evidence-based design and how we can weave IT in sound very interesting. Some of the design features have to do with floor plan and layout but some of the points on weaving IT in have to do with procedures.
Some of the points listed could be easily implemented.
1. Admission in the room
When the pt comes for admission for next day surgery, we can straight send them to the room. Have the admission clerk go to the room to do the admission process.
Currently, the admission process has no privacy at all. Personal informations given in one cubical can be heard in the next cubical. I am not sure if it is the case here, if there is no signature, there is no room provided.
2. Bed Management
If Sakei Suzi has a software to taking food orders, there should be a way to manage the housekeeping of rooms. Pt doesn't like it when the housekeeping collect rubbish, sweep or mop the floor or change bedsheet while they are eating.
3. Patient Call light
One of the complain in the hospital is slow response to call button. Pt says the bell is too noisy and have to be called several times before the nurse come.
4. Noise Level
I used to know a time that it is a no horn zone near a hospital. However, now-a-day pts are complaining of noisy trolleys even at night. HKPG/LINN should be able to move the linen or rubbish without making a lot of noise, especially at night.
Sometimes, it is the small, small things that annoy our patients and it is the thing we can do something about.
A friend of mine shared your post with me due to my being one of the original directors that envisioned and opened Dublin Methodist. It is exciting to see that the vision for a therapeutic patient environment is a vision that is truly international and that we could be a part of that!
One of the IT pieces that made perhaps the single biggest impact - in terms of intergrating bed alarms, call lights, monitors, and room cleaning requests - were two products: Emergin and Vocera. Vocera devices are "badges" that all of the associates wear. These "badges" allow them to communicate with each other and be communicated to by another person or information system. We built a very novel approach to the manner in which we assigned roles and functions to our devices at Dublin Methodist - a model that Vocera is now rolling out to other groups. The Emergin package allowed us to route different information systems - such as our bed alarms and monitors - to the Vocera badges. All of this allows our staff to be accessible to patients, families, medical staff, and one another continuously and respond to changing acuities and requests in seconds or minutes.
Good luck in your efforts to implement some of these technologies in your facility.
Respectfully,
Corey D. Perry, M.Div., J.D.
Corporate Director, Clinical Ethics & Faith Group Relations
OhioHealth
Thanks Ben for your observation.
1. I'm not aware that you can hear the conversation from the next cubicle. I will have to personally test it. Admission in the room is been done for VIP patients, we will have to increase manpower to extend it to more patients.
2. It's a good point. Having a protected time to eat is a good idea. Perhaps an indicator light controlled by timer (a period of 30 minutes for uninterrupted eating) might be worth trying out.
3. I think we fixed this problem. The new call bell system we installed has the ability to log response time. A competition is now running where each wards that can achieve zero calls responds of more than 3 minutes are rewarded with a RM10 shopping voucher. The response has been dramatic!
4. Another good point. Our service pillar should really take it up as a project. Ben, you are a member, perhpas you can sound this up in the next meeting.
Thanks for your thoughts on this.
Michael
Thanks Corey for taking an interest in our dream.
We did looked at Vocera product during last year's HIMSS conference at Orlando. In fact it was recommended by our sister hospital, Florida Hospital of Adventist Heath System. Unfortunately, the economics did not work in our favour. So it have to be deferred as a priority.
The bulk of our IT budget in 2009 is for EMR implementation. You would certainly have stories to share on this I'm sure :)
Cheers
Michael
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