Zadeh

On a typical shift, an acute care nurse must juggle a dozen or more critical tasks in caring for numerous patients: dispensing medication, replenishing IVs, replacing bandages and more. The job carries an intense cognitive load, and the risk of distractions from unwanted noise, clutter, fatigue, co-workers and visitors is high.

Believing that better design can mitigate such problems, Rana Zadeh, assistant professor of design and environmental analysis in Cornell’s College of Human Ecology, has created a new evidence-based spatial analysis tool to help medical facilities reorganize nursing units to more closely match caregivers’ routines. If applied effectively, the tool can help lessen disruptions, reduce fatigue, cut costs, limit employee burnout and increase time spent with patients, Zadeh said.

The new approach is described in a paper in the fall 2012 issue of Health Environments Research and Design Journal (6:1).

Zadeh and her co-authors analyzed the floor plans of five medical-surgical units at U.S. hospitals – which experience the highest nursing staff turnover of all hospital units – as case studies. They applied established design guidelines and reviewed literature to assess the layouts’ congruity to caregiver work patterns.

The researchers defined the 10 most important clinical spaces based on nurses’ activities and movements, with about half of traffic occurring in patient-care corridors, followed by the nurses’ station and medication area. Using a “space syntax” method, they analyzed the linkages of all the spaces on the units and the paths nurses take to access resources and treat patients.

They found numerous opportunities to boost nurses’ efficiency through better design. In some 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 rooms, leading nurses to “hunt and gather” to find materials.

Zadeh’s observations and studies have found that some nurses walk up to five miles during a typical shift. Therefore, she said, even seemingly minor changes to better align a facility layout with caregiver workflow can have significant benefits. In acute units, where a patient’s life could be at stake, nurses can focus more on sensitive tasks when distractions are minimized.

“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,” Zadeh said. “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.”

Zadeh noted that the tool could be adapted to the workflow of physicians and other health care workers, not just nurses.

“Studies show that the average hospital has an infrastructure that is roughly 30 to 40 years old,” Zadeh said. “They can be designed innovatively and smartly for today’s fast pace of care. We hope this tool will offer 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.”

The paper’s co-authors are Mardelle Shepley, professor of architecture at Texas A&M University, and Laurie Waggener, research director at WHR Architects in Houston.

Ted Boscia is assistant director of communications for the College of Human Ecology.