Central Washington Hospital, Wenatchee, Washington

 

To increase caregiver efficiency through the implementation of evidence-based design strategies in the design of a new patient bed tower at Central Washington Hospital.

 

To achieve this goal, HDR was challenged to integrate the latest research findings, EMR technologies, evidence-based design strategies and Lean operational efficiencies into the patient tower design. Specifically, the design team hypothesized that building a standardized and same-handed patient room would decrease errors and increase caregiver efficiency.

 

Lean studies were performed during programming through construction as staff transitioned into the new facility. A workflow analysis was completed as part of a comprehensive process improvement study of travel patterns for nurses and doctors using handheld PDA devices that track staff travel times. This same study was repeated one year post-occupancy in the new bedtower. Data collection for the PDA study was done with “Time Study RN”, a PDA handheld used by the nursing staff. The PDA alerts them at random intervals to indicate their location, what task they just completed, and what task they are currently completing. This was used to track clinical behaviors and to identify opportunities for improvement for the newly designed space.

Three units were analyzed including Critical Care, Medical Oncology and Obstetrics. The care delivery time results were then compared against “Time Study RN” benchmarking data and were stratified into value-added, value-enabling, and non-value-added time categories. Travel densities were also vetted indicating over 49% of nursing travel was spent between patient room and nurse station or document server. This provided clear direction for designers that decentralized workstations could decrease travel distances for clinicians. Layout optimization was then used to map processes in the new design layout. Travel distances were calculated and new workflow processes were identified. The travel study indicated for all units measured, that the time spent on value added care, the time spent on direct care, and the aisle effectiveness all increased from current to future state workflow and generally outperformed the national benchmarks for their corresponding unit types.

Additionally, HDR conducted a post-occupancy evaluation, (POE), one year after occupancy. User focus groups were held to gather feedback from the staff on how well the design of the building supports their work processes. A survey was also distributed to supplement the findings of the focus groups. The POE revealed that overall the staff is very satisfied with the design of the new facility. The surveys also revealed areas in communication and technology that were not functioning properly and have since been addressed.