EDRA Inaugural Symposium at NYSID

8/18/2015 1EDRA Inaugural Fall Symposium

Oct.11.2013

University Medical Center of

Princeton at Plainsboro


Oct.11.2013

Barry Rabner

Chief Executive Officer

Princeton Healthcare System

[email protected]

Dr. Susan Lorenz, DrNP RN NEC-BC

Chief Nursing Officer


[email protected]

Erin Peavey

Researcher Medical Planner

HOK Architects

[email protected]

Julie Somarriba

Associate

HOK Architects

[email protected]


Oct.11.2013

Acknowledgements

• Jaynelle Stichler, DNSc, RN, FACHE

• Kirk Hamilton, FAIA, FACHE, EDAC

• Joseph Szmerekovsky, PhD

• Inez Brandon, MSN, RN, CNL

• Geralyn Karpiscak, RN, MSN, NEA-BC

• Janice Allunario, BS Pharmacy, RPh,

RPIC

• Donna Covin, MSN, RN, CNL

• Louise Yorke, BS

• PHCS Research Advisors &

Contributors

• Nicholas Watkins, PhD

• Carolynn Bitzer, RN, MSN, FNP-BC

• Chris Korsh

• Anjali Joseph, PhD

• Jayanti Ingle, DPT, MPH, EDAC

• Roz Cama

• Jessica Vuocolo

• Ismini Naos

• HOK & RMJM Hiller

• Center for Health Design

• And many others…

This Study was made possible by a

Robert Wood Johnson Foundation

Grant

University Medical Center of

Princeton at Plainsboro


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Introduction & Guiding Principles

The Evidence Base

Integrating Original Research

Design Informed by Research

Research Results & Lessons Learned

Question & Answer

University Medical

Center of Princeton at

Plainsboro


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The Evidence Base




Question & Answer

University Medical


Plainsboro


Oct.11.2013


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Be a top 10% hospital in the country in clinical outcomes

Be a top 10% hospital in the country in patient satisfaction scores

Be a top 10% hospital in the country in profitability

Be the dominant provider of selected service lines in our primary service area

Incorporate technology and innovation into the delivery of healthcare

Be a responsible member of the community

Adopt design flexibility – site, buildings and system considerations

Design for 150% of projected need

Reserve site areas for expansion

Include horizontal and vertical growth zones

Guiding Principles


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Embrace and support patient-centered care concepts

Provide a supportive and friendly atmosphere for patient, family and

staff

Organize the facility to separate patients and operations

Provide an environment that enhances the quality of work life for staff

and physicians

Optimize operational efficiency and achieve cost reductions

Improve operating performance by 5%

Move technology to patient and caregiver

Improve patient flow and process

Provide a superior environment that supports the teaching mission

Develop an integrated campus

Guiding Principles (cont.)


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The Evidence Base




Question & Answer

University Medical


Plainsboro


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Pebble Project

• Investigate

• Hypothesize

• Continue to Prove or Innovate

• Measure

• Share

Using the Evidence Base


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1. Reduce Stress, Improve Quality of Life and

Healing for Patients and Families

• Noise Reduction

• Positive Distractions

• Provide Social Support

2. Reduce Staff Stress / Fatigue,

Increase Effectiveness in Delivering Care

• Noise Reduction

• Patient Care Time per Shift

• Improve Medication

Processing & Delivery Times

• Improve Satisfaction

EBD Checklist:

Areas Known to Impact Outcomes


Oct.11.2013

3. Improve Patient Safety and Quality of Care

• Reduce Nosocomial Infections

• Reduce Patient Falls

• Improve Confidentiality

• Improve Communications

4. Improve Overall Healthcare Quality

and Reduce Cost

• Reduce Patient Transfers

• Reduce Length of Stay

• Staff Work Effectiveness

• Patient Satisfaction with

Quality of Care

EBD Checklist:

Areas Known to Impact Outcomes


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The Evidence Base




Question & Answer

University Medical


Plainsboro


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A hospital unit

is identified for

study.

Measure existing

conditions.

Impact on

outcomes.

Use as baseline.

Occupants

move in.

Measure impact.

Compare to

baseline or

original intent.

Results help

inform, inspire

design solutions

for new facility.

InnovateExistingFacility

NewFacility

Assess

Use baseline to

inform innovative

design.

Validate

Infusing Research on Projects


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Phases of Physical Mock-Up

Phase 1: Simple Mock-up User discussions, testing headwall Gyp board, painters tape, foam core Internal Review Board (IRB) Exempt

Phase 2. Detailed mock-up Testing scenarios, equip placement Patient actors IRB Exempt

Phase 3: Live Mock-up Fully functioning Integrated with existing unit IRB Approved

Princeton (UPMC) Mock-UpsMock-Up & Simulation Process


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Phase 1& 2: Mock-Up & Simulations

• Research Design

– Mixed Methods

– Qualitative & Quantitative

– Non-experimental comparative

• IRB Exempt

– Does not involve real patients

– Comparison of rooms using current practice

– No videotaping of participants


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What needed to start Basic equipment

Design

Project Time

Who to engage Interdisciplinary staff

Interior Designers

Medical Planners

Project Management

What to measure Impact on care, experience, safety

Ease of use

Princeton (UPMC) Mock-Ups

Staff participants

Convenient space

Building materials

What need to create Questionnaires

Built spaces



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Discussion Examination Proposed Change

Phase 1: Learning Lab Mock-Up


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Materials • Foam core, gypsum board,

plastic laminate

Participants & Location• On existing nursing unit• Multidisciplinary Staff (N=175)

- Individual & Group

Purpose • Staff feedback• Test proposed changes• Validate design assumptions • Efficiency, Safety, Quality• Established design directives to

explored in later phases

Discussion Examination Proposed Change

Phase 1: Learning Lab Mock-Up


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Code Blue Simulation Prevent Medication Errors Preventing Falls

Phase 2: Simulations


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Materials• Trial finish materials

Participants & Location • On existing nursing unit• Interdisciplinary Staff• “Patient” Actors• Total Sim. N=39

Purpose• Test difference between rooms• Analyze steps for each scenario • Define important questions• Staff identify needed change

Code Blue Simulation Prevent Medication Errors Preventing Falls

Phase 2: Simulations


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• Support Nurse Concentration

• Support Care Delivery

• Family Involvement

• Patient Falls & Recovery

• Headwall Implications

• Lighting & Power

(Watkins, N., Kobelja, Peavey, Thomas, Lyon. 2011)



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The Evidence Base




Question & Answer

University Medical


Plainsboro


Oct.11.2013

ZONES: Patient I Family I Staff



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Hand railing to Bathroom

Night-light between patient bed and

bathroom

Soft bathroom light through sliding door

TV with education system, magnetic writing

surface, and wardrobe closet at footwall

Patient Zone


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Space for family, not in care zone

Sleeper Sofa with soft reading light

Work desk with multiple outlets and data

Closet room for luggage

Family Zone


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Visible hand washing

Easy access to gloves

Double- loaded server

Quiet loading of supplies

Face-to-Face View of Charting

Facilitate shared communication

Staff Zone


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The Evidence Base




Question & Answer

University Medical


Plainsboro


Oct.11.2013

• Compare impact of new vs. current hospital rooms on specific design elements

– care delivery

– caregiver satisfaction

– patient experience

– clinical outcomes

Phase 3: Purpose of the Study


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Participants:

• Patients & Care Staff (Orthopedic)

• Random Selection

Measures:

• Staff Surveys

– Periodic Surveys, Interdisciplinary

• Patient Survey

– During Hospital Stay

– Post Hospital Stay (Press Ganey)

• Clinical Outcomes

Phase 3 Process


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Current Room

Model Room

Orientation to Rooms


Oct.11.2013

Nurse Server I Room Size & Design I Lighting

Acoustics I Caregiver Presence I Hand washing

Topics Addressed


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Statistically Significant Differences

Nurse Server

• Height of Medication Preparation

• Medication Access

• Minimized walking

• Location of waste disposal

• Second RN Verification

Room Size and Design

• Location of the bed

• Space for patient’s valuables

• Color of the room

• Furniture functionality

Nurse Responses


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Acoustics

• Door Noise

• Professional Conversations

• Equipment Carts

Lighting

• Bed Tasks

• Bed Reading

Hand Washing

• No difference found

Caregiver Presence

• Prepare Medication

Nurse Responses


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0

1

2

3

4

5

Current

Model

Average Responses Nurse Server

(*=significant at 0.05 level; **=significant at 0.01 level)

Nurse Responses: Nurse Server


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0

1

2

3

4

5

Nurse Responses Room Size and Design


Nurse Responses:



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0

1

2

3

4

5

Current

Model

Nurse Responses Room Size and Design


Nurse Responses:



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Average Responses Room Size and Design(*=significant at 0.05 level; **=significant at 0.01 level

0

1

2

3

4

5

Current

Model

Average Responses:



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Room Size & Design

Lighting

Multidisciplinary Staff Responses


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0

1

2

3

4

5

Current

Model

Staff Responses(*=significant at 0.05 level; **=significant at 0.01 level

Multidisciplinary Staff Responses


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No significant difference observed between:

Pain Medication Utilization

–Model Room vs Current Patient Room

–Hip vs. knee patient

–Pain medication type

Medication Errors

Falls

Infection Rates

Clinical Data Comparison


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Patient Experience

Responses

Our goal-

“less clinical more hospitable”**Kim, S. Contract 2011. Vol. 52(8): 62

University Medical Center at Plainsboro


Oct.11.2013


Environment of Care

• Valuables

• Belongings

• Color /Soothing Appearance

• Wellbeing

• Room Temperature

Hand washing

• No significant difference

Noise

• Equipment Carts

• Outside Room

Patient Responses


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0

1

2

3

4

5

Current

Model

Average Responses Total and by Category(*=significant at 0.05 level; **=significant at 0.01 level)

Patient Responses:



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• National patient experience surveys

• Mailed to patient home 2 weeks after

• Benchmarks data: national, state and

similar bed size organizations

Patient Experience:

Press Ganey Surveys


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• Overall Experience*

• Registration and

Admission

• Room*

• Meals

• Nurses

• Tests and Treatments

• Visitors and Families

• Physician

• Other Services

• Discharge

• Personal Issues

• Overall Assessment

Elements of Measurements

Press Ganey Significant Results with Various Scales(*=significant at 0.05 level; **=significant at 0.01 level)

Patient Experience: Press Ganey


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0123456789

10

Current

Model

Press Ganey Significant Results with Various Scales(*=significant at 0.05 level; **=significant at 0.01 level)

Patient Rm Satisfaction: Press Ganey


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• Return Press Ganey Surveys

– Not all patients returned Press Ganey surveys

– Due to randomization some patients received Press

Ganey after the initial two weeks of discharge

• Patient population:

– Unequal numbers of hips/knees

– Not controlled for age/gender

Limitations of Study


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• Must train staff to use the space

• Ambiance of the room

• And much more…

Lessons Learned


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The Evidence Base




Question & Answer

University Medical


Plainsboro


Oct.11.2013

Thank you. Questions?

Contact information:

[email protected] [email protected] [email protected] [email protected]

Barry Rabner

Chief Executive Officer


[email protected]

Dr. Susan Lorenz, DrNP RN NEC-BC

Chief Nursing Officer


[email protected]

Erin Peavey

Researcher Medical Planner

HOK Architects

[email protected]

Julie Somarriba

Associate

HOK Architects

[email protected]

EDRA Inaugural Symposium at NYSID

Design

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