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Department Focus: Quality--Designed to Succeed

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Using evidence-based design, an Atlanta hospital's ICU improves outcomes, staff satisfaction.

Sometimes improving quality at your hospital is as simple as giving your staff the supplies and space they need to properly care for patients.

"Over the years it has been clear that the physical environment that we work in often works against us instead of with us," says Owen Samuels, MD, director of neuroscience critical care at Emory University Hospital in Atlanta. When designing its ICU, Emory used evidence-based design to eliminate the obstacles to quality patient care, leading to better patient outcomes and higher staff satisfaction.

Each of Emory's 20 ICU suites is approximately 345 square feet—almost double the size of a typical hospital room, says Ray Quintero, RN, department director of the neuroscience critical care unit. Most of the equipment needed by ICU patients has been moved from the wall to a unit mounted on the ceiling, allowing staff members to have all equipment at arm's reach and opening up space around the patient's bed.

"When we have a crisis, we have no trouble reaching the patient," Quintero says. "A traditional room blocks you from moving freely around a patient's bed, but with the ceiling manager, that doesn't happen."

Each room is also equipped with a computer station that gives caregivers access to patient records in the room, so nurses aren't running back and forth between the nurses' station and patient's room to find medical information.

"We wanted our nurses to be able to access information and deliver care wherever they were. We wanted to provide everything they needed at the bedside or immediately outside the room," says Samuels.

In the 15 months since the ICU opened, early numbers show better patient outcomes and high rates of patient satisfaction. Nurses also report feeling more fulfilled with their work. Samuels says the two are related.

"Nurses form the bedrock of patient care," Samuels says. "They're the ones who are at the patients' bedside 24-7. You've heard the saying, ‘A happy wife is a happy life?' Well, a satisfied nurse makes for a happy patient and family."

Evidence-based design allows Emory's nurses to spend less time running from supply closet to supply closet looking for the equipment they need, Quintero says. This means they are less stressed and able to spend more time caring for patients. And the more time they spend with patients, the more likely they are to notice a change in a patient's condition or an early sign of infection.

Of course, not every hospital can afford to build a brand new ICU, but D. Kirk Hamilton, FAIA, FACHA, associate professor of architecture at Texas A&M University in College Station, says changes don't have to be dramatic to bring change.

"Little things can be tremendous," Hamilton says, adding that whether it's a well-stocked cart of supplies in each patient's room or supply closets moved to more centralized locations, reorganization can help make quality care more attainable.

"If there's a crisis and you can't find whatever it is you need, it's a safety issue," Hamilton says. "If things aren't consistently located where they belong, it's not good practice."

There's evidence to support that a "noninstitutional" hospital environment can also do wonders to relieve staff stress and put the patient in a more healing state of mind, he says. Several years ago, he walked into a unit of a hospital that had been recently renovated and included plants, wood trim, soothing paint colors, and non-institutional furniture.

"They were items that were relatively trivial in terms of cost changes to the physical facility, yet they were profound in terms of the message they sent to those who observed them," he says.

Maureen Larkin

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