E42 RIGHT SIZED PATIENT SMART ROOMS · 1866 . 32918 . Recommend Hospital: Definitely Yes . 1864 ....
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+ E42 RIGHT SIZED PATIENT SMART ROOMS SOLVE THE COST VS PERFORMANCE EQUATION
Transcript of E42 RIGHT SIZED PATIENT SMART ROOMS · 1866 . 32918 . Recommend Hospital: Definitely Yes . 1864 ....
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E42 RIGHT SIZED PATIENT SMART ROOMS SOLVE THE COST VS PERFORMANCE EQUATION
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OUR TEAM COLLABORATION
TAMRA MINNIER UPMC
CHIEF QUALITY OFFICER RN, MSN, FACHE
ESPERANZA HARPER BBH DESIGN ASSOCIATE HEALTHCARE PLANNER
EDAC, NOMA
TIM SPENCE BBH DESIGN PRINCIPAL
HEALTHCARE MARKET LEAD AIA, LEED AP BD+C
NICK WATKINS BBH DESIGN PRINCIPAL
RESEARCH LEAD PH.D.
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EQUATION COST VS. PERFORMANCE
EXPLORATION FINDING THE RIGHT SIZE
SOLUTIONS COMFORT, COST, AND FUNCTIONALITY
VALIDATIONS THE RESEARCH
CONCLUSION BEING SMART; SOLVING THE EQUATION
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UPMC EAST
The Palace Inn, Monroeville, PA
“UPMC East will house a hospital and ambulatory care center in a 430,00 SF state-of-the-art facility.”
“UPMC East will serve the healthcare needs of East Pittsburgh, increase vitality of Monroeville and restore the natural environment through sustainable building practices.”
RESTORE
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250 SF min. clear
15 FT min. clear dimension
Additional 30 SF / family member
FGI GUIDELINES Patient/Family Centered Care
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11 UPMC facilities
7 non-UPMC facilities
183 NSF average
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RIGHT-SIZE CRITERIA A C D
IMPORTANCE FACTOR
Nurse Charting/Nurse Server
2 3 3 RANK
16 24 24 8 Weight
Reduce Room Clutter 1 2 3 RANK 6 12 18 6 Weight
Flexibility / Convertibility 1 3 3 RANK 10 30 30 10 Weight
Sink in Work Path 1 3 3 RANK 4 12 12 4 Weight
Plumbing Efficiency 2 2 2 RANK 10 10 10 5 Weight
Patient Privacy 3 2 1 RANK 3 2 1 1 Weight
Exterior Façade Consistency
2 3 3 RANK
6 9 9 3 Weight
Point of Care Testing / Treatment
3 2 3 RANK
6 4 6 2 Weight
Total 266 359 318
* Rank = 1; Indicates 50% of patient rooms have capability for specialty patients
A C D
IMPORTANCE FACTOR
Square Footage Closest to Target
3 1 1 RANK
48 16 16 16 Weight
Flexibility around Patient Bed
2 3 1 RANK
22 33 11 11 Weight
Visibility of Patient from Corridor
2 3 1 RANK
28 42 14 14 Weight
Maximize Natural Light 2 3 3 RANK 24 36 36 12 Weight
Toilet Access along Headwall
3 1 2 RANK
45 15 30 15 Weight
Family Zone / Caregiver Zone
1 3 2 RANK
13 39 26 13 Weight
Patient Recliner and Visitor Seating
1 3 3 RANK
9 27 27 9 Weight
Bariatric* 1 3 3 RANK 9 27 27 9 Weight
ADA Toilet Rooms with Shower*
1 3 3 RANK
7 21 21 7 Weight
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CRITERIA
“SQUARE FOOTAGE CLOSET TO TARGET.”
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MOCK-UP TESTING SQUARE FOOTAGE VS. FUNCTION
SOLUTIONS WHAT IS THE BEST OPTION?
CONSENSUS INFORMED BUY-IN
FULL SCALE REFINEMENT
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SMART ROOM 3 KEY COMPONENTS
CERNER SMART ROOM NCH HEATHCARE SYSTEM NORTH NAPELS HOSPITAL
UPMC SMART ROOM
UPMC EAST PATIENT ROOM
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SMART ROOM PLANNING
Cords and outlets Ergonomics
Low Tech and High Tech eSignage
UPMC EAST PATIENT ROOM CERNER SMART ROOM, NORTH NAPELS HOSPITAL
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SMART ROOM THE FUTURE
NXT Health, Clemson University Birdtree Design, Patient Room 2020
Premier Inn, HUB Hotel
PLANNING FOR TOMORROW’S TECHNOLOGY
NXT Health, Clemson University Birdtree Design, Patient Room 2020
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SMART ROOM THE FUTURE PLANNING FOR TOMORROW’S TECHNOLOGY
“Google Glass will be like the Segway. It’s really cool, but will only have a few practical uses and won’t be a paradigm shifter.” How doctors will use Google Glass – Chris Rangel, MD www.KevinMD.com, June 2013
GOOGLE GLASS
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NO
RTH
Temperature
Energy
Cost
Time 6PM 12PM 6AM
SOLAR STUDIES
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1 Lobby
Patient/Food Service/Supplies
Nurse Station
Conference Room
Lounge
LEGEND
2 3 4
1 2 3
4
3
5
2 5
UNIT LAYOUT
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1 Nurse Station
Medication
Equipment
Clean Hold
Soil Utility
LEGEND
2
3
4
5
1 2
3 4 5
+19%
NURSING LAYOUT
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4%
Typical Patient Room = 300 NSF
UPMC Right-sized Room = 220 NSF
Difference = 80 NSF
156 Rms x 80SF = 12,480 SF
12,480 SF x $400/SF
$4,992,000.00
CAPITAL COST SAVINGS
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7%
Typical Patient Room = 300 NSF
UPMC Room = 220 NSF
Difference = 80 NSF
156 Rms x 80SF = 12,480 SF
12,480 SF x $700/SF
$8,736,000.00
OPERATIONAL SAVINGS
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UPMC East and UPMC System
Sources:
• Billing
• Infection Control
• Incident Reporting
• Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS)
Approximate Time Period: July 2012-August 2013
RESEARCH PHASE I Cross Comparison of Multiple Facilities
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Patient Safety Outcomes – Average length of stay – Catheter-associated urinary tract infection
rate (CAUTI) – Clostridium difficile (C. diff) infection rate – Deep vein thrombosis (DVT) rate – Fall rate (total) – Readmission rate – Surgical site infection rate (SSI)
Patient Satisfaction Outcomes Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) top box scores
RESEARCH PHASE I Cross Comparison of Multiple Facilities
12 hospitals including UPMC East
15 hospitals including UPMC East
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RESEARCH PHASE I Patient Safety Sample Size
Outcome Unit of Measurement East System - East
C-diff Infection Patient Days 21551 966911
CAUTI Device Days 6995 236922
Deep Vein Thrombosis Total IP Discharges 5911 170039
Falls (Total) Patient Days (including Obs.) 36924 11740558
Readmission Discharges 6205 144972
Surgical Site Infection Surgery Count 5940 196632
Average Length of Stay Total IP Discharges 6653 198854
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RESEARCH PHASE I Patient Safety Outcomes
Outcome UPMC East UPMC System1 UPMC East to UPMC System
Fisher’s Exact p-value C-diff Infection (per 10,000) 2.78 5.20 .168
CAUTI (per 1,000) 0.86 2.22 .013* Deep Vein Thrombosis 0.12% 0.13% 1.000 Falls ( Total per 1,000) 3.14 3.85 .030*
Readmission 12.49% 14.17% .000* Surgical Site Infection 0.12% 0.69% .000*
mean (sd) t-statistic (degrees of freedom) t-statistic p-value
Average Length of Stay 4.90 (0.37) 5.34 (0.13) -4.215 (16.26) 0.001*
(Unequal variances assumed)
1 UPMC System = system-wide data with UPMC East extracted. * p-value ≤ 0.05 denotes statistical significance.
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RESEARCH PHASE I Patient Satisfaction Sample Size
Question East System - East
Call button help as soon as wanted it 1644 28795 Room and bathroom kept clean 1870 32893
Doctors treat with courtesy/respect 1871 33075 Doctors listen carefully to you 1871 33016
Help toileting as soon as you wanted 895 16151 Nurses treat with courtesy/respect 1877 33197
Nurses listen carefully to you 1877 33149 Pain well controlled 1049 22518
Area around room quiet at night 1861 32939 Rate Hospital: 9-10 1866 32918
Recommend Hospital: Definitely Yes 1864 32906
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HCAHPS1 Outcome (Top Box Score) UPMC East UPMC System1 p-value: UPMC East to
UPMC System
Call button help as soon as wanted it 61.86% 56.42% .000*
Room and bathroom kept clean 70.59% 63.22% .000*
Doctors treat with courtesy/respect 81.83% 85.53% .000*
Doctors listen carefully to you 73.17% 76.61% .001*
Help toileting as soon as you wanted 66.26% 63.04% .055**
Nurses treat with courtesy/respect 85.51% 82.72% .002*
Nurses listen carefully to you 74.53% 71.70% .008*
Pain well controlled 59.29% 59.34% .975
Area around room quiet at night 58.25% 48.07% .000*
Rate Hospital: 9-10 71.76% 66.84% .000*
Recommend Hospital: Definitely Yes 73.55% 69.73% .000* 1 HCAHPS=Hospital Consumer Assessment of Healthcare Providers and Systems 2 UPMC System = systemwide data with UPMC East extracted.
RESEARCH PHASE I Patient Satisfaction Outcomes
* p-value ≤ 0.05 denotes statistical significance. ** p-value very close to significance.
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VALIDATION THE RESEARCH UPMC EAST VS. SAINT MARGARET
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RESEARCH PHASE I Cross Comparison of UPMC East and UPMC St. Margaret
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RESEARCH PHASE I Patient Safety Outcomes
Outcome UPMC East UPMC St. Margaret UPMC East to UPMC St. Margaret
Fisher’s Exact p-value Surgical Site Infection 0.12% 0.37% .003*
mean (sd) t-statistic (degrees of freedom) t-statistic p-value
Average Length of Stay 4.90 (0.37) 5.00 (0.30) -0.78 (26) 0.442 (Equal variances assumed)
* p-value ≤ 0.05 denotes statistical significance.
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RESEARCH PHASE I Patient Satisfaction Outcomes
HCAHPS1 Outcome (Top Box Score) UPMC East UPMC St. Margaret p-value: UPMC East to UPMC
St. Margaret
Call button help as soon as wanted it 61.86% 48.60% .000* Room and bathroom kept clean 70.59% 60.59% .000*
Help toileting as soon as you wanted 66.26% 58.52% .000* Nurses treat with courtesy/respect 85.51% 83.33% .057**
Nurses listen carefully to you 74.53% 70.35% .003* Area around room quiet at night 58.25% 38.90% .000*
Rate Hospital: 9-10 71.76% 67.06% .001* Recommend Hospital: Definitely Yes 73.55% 70.28% .023*
1 HCAHPS=Hospital Consumer Assessment of Healthcare Providers and Systems * p-value ≤ 0.05 denotes statistical significance. ** p-value very close to significance.
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RESEARCH PHASE I Space Syntax Analysis: Integration
Integration How easy or difficult it is to access the floor plan from various locations UPMC East vs.UPMC St. Margaret’s • Easier to reach various parts of the plan
2 turns 5 turns
UPMC East 4th Floor
UPMC St. Margaret’s 4th Floor
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RESEARCH PHASE I Space Syntax Analysis: Visibility
Visibility Indication of the size of the area visible from every occupiable square foot of the floor plan UPMC East vs.UPMC St. Margaret’s • Both have highest visibility near the
nurses’ station • Visibility at UPMC East higher overall
2200 sf visible 200 sf visible
UPMC East 4th Floor
UPMC St. Margaret’s 4th Floor
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RESEARCH PHASE I Space Syntax Analysis: Path Lengths
Path Lengths Measured travel distance to the rest of the unit from a point UPMC East vs.UPMC St. Margaret’s • Both have shortest travel distances from
the nurses’ station • UPMC East has shorter travel distances
overall
50 ft 120 ft
UPMC East 4th Floor
UPMC St. Margaret’s 4th Floor
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RESEARCH PHASE I Space Syntax Analysis: Spatial Center of Gravity
Spatial Center of Gravity Measured travel distance to the rest of the unit from a point UPMC East vs.UPMC St. Margaret’s • UPMC East has zones of highly
integrated space that fronts all of the patient rooms
2 turns, avg. 5 turns, avg.
UPMC East 4th Floor
UPMC St. Margaret’s 4th Floor
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Design and Operational Intervention
Time with Patient
Adverse Events
Communi-cation
LOS Patient Satisfaction
Patient Control and Competence
Crowding and Clutter
Workflow Efficiency
Smart Room capabilities
Decentralized capabilities
Zoning and unit layout
Bathroom location
PHASE I PHASE II PHASE III
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RESEARCH NEXT STEPS
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RESEARCH NEXT STEPS Implications
• Supplement the “Big Data”
• Smart room, zoning, layout or all of the above?
• Acuity-adaptability without added square footage?
• Smart room as a viable retrofit strategy
• HIT locations and additional capabilities
• Room configuration as a way to optimize function and reduce cost
• Process to fit space to organization so every square foot is accountable
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ACKNOWLEDGEMENTS Julie Zook
Researcher, BBH Design [email protected] Tzu Chen, AIA Graphics, BBH Design [email protected] Linda Higgins, PhD, RN Jeffery McKibben Susan Martin, RN, MSN Jeffery Borrebach, MS Kevin Quinn Erik Tomain
Donald D. Wolff Jr. Center for Quality, Safety and Innovation at UPMC Ed Massery, Alexander Denmarsh
Photography
Timothy Spence AIA, NCARB, LEED AP BD +C Principal, HC Market Lead, BBH Design [email protected]
Esperanza Harper, EDAC Associate, BBH Design
Nicholas Watkins, Ph.D. Principal, Research Lead, BBH Design [email protected]
Tamra Minnier, RN, MSN, FACHE Chief Quality Officer, University of Pittsburgh Medical Center [email protected]
For more from BBH Design, see Smart Healthcare Infrastructure: How Stand-Alone Emergency Departments Improve Patient Accessibility and Care
