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Health Services Research & Development

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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

3021 — Inpatient Room Modeling

Farahmand KKarim R, and Srinivasan R, NDSU; Floyd K, VA Medical center, Fargo, ND;

Objectives:
In an inpatient unit where patients, nurses, and providers move and interact, the efficiency of the flow/movement can be dramatically decreased when the inpatient unit configuration has not been ideally designed. In order to meet the VHA mission of optimizing space use, a comprehensive solution to include layout redesign, nurse flow consideration, and operational logistics solution must be implemented. The optimized solution is multifaceted and will include a common solution or model to be adapted by all if not most VA clinics.

Methods:
Discrete event simulation, which is a well-documented method for analyzing and improving any type of flow in a medical facility, was used to conduct the study. A simulation model is developed to analyze the nurse movements as well as room configurations in inpatient care unit. Five medical inpatient configurations including Fargo VA, Minneapolis VA and three benchmark configurations obtained from the VA Draft Inpatient Design Guide were compared.

Results:
The simulation analysis indicates that the optimal configuration is the linear design where staff access to rooms is optimized and the layout allows for the maximum usage of space. Questionnaire response analysis obtained from stakeholders verified that staffs are more comfortable working in the rectangular or linear configurations. Lack of standardized room design forces everyone to spend more time looking for equipment or other non-standard items. Results from the simulation analysis and stakeholders indicated that the H shaped configuration is the weakest configuration among all layouts considered.

Implications:
The staff has to walk more in the H shaped configuration than that of other configurations. Understanding flow throughout a facility based on need would provide insight into optimization of space and the movements, while taking into consideration clinical space capacity. Aside from the high interaction with patients, the clinical team also plays an important role in the quality of care given to the patient. The linear configuration is the optimal design as far as travel distances shown by the simulation results.

Impacts:
The simulation model indicated that using decentralized utility room can save staff travel time. Standardization of inpatient rooms has proven to be more efficient and more popular with the end users or stakeholders. A standard inpatient room layout along with a standard linear configuration of the ward layout with access to nurses’ stations, utility closets, equipment, medication, nutrition, and other non-standard items would impact both resource utilization and time efficiency. A checklist was also developed to consider light, ventilation, space, furniture and equipment, design for flexibility, design for mobility, indoor air and moisture control, and security and safety in the facility for reconfiguration of the inpatient ward/unit.


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