Affiliated with the Detroit Medical Center, Karmanos is one of the nation's leading cancer research, treatment, and education centers.
Its Pebble Project involved two renovated inpatient nursing units. Measurements for these inpatient units include employee turnover, length of stay, patient satisfaction, daily variable costs, pain medication, and medication variances. The architect for the units was Hobbs and Black
Data collected on two inpatient units that opened in 1999 and 2000 includes:
- Patient satisfaction rose 18%.
- Nurse attrition rate fell from 23% to 3.8%.
- Lower daily variable costs per case.
- Reduced pain medication requirements.
- Decrease in medication variances.
- 30% reduction in medical errors, a result of increased space in medication room, location of medication room, organization of medical supplies, standardized visual cues, and acoustical panels to decrease noise levels.
- 6% reduction in patient falls, a result of better visualization of patients due to angle of doorway, improved lighting, and room layout.
Quantitative research on patient outcomes:
For the first assessment, Karmanos compared 11 matched pairs of patients with sickle cell anemia with vaso-occlusive pain crisis (with no secondary diagnoses such as pneumonia) in which clinical pathways were available. Eleven patients were observed at the old unit and 11 at a new unit on a different floor. Since their symptoms generally are driven by seasonality, the patients all were observed from November 2000 to March 2001. They all had patient-controlled analgesia (PCA) pumps that they could regulate to alleviate their pain.
- When they were admitted, the average pain score at both units was 8.4 on a scale of 1 to 10. The patients all averaged a 5.5 pain score at discharge. However, those who had been in the renovated unit used 45% less PCA to control their pain than the patients in the old unit. Also, narcotic use to supplement their PCA declined 16%.
The next step was to observe responses in another group receiving medical/nursing-type care for a condition with the same clinical pathway and the same surgeon. This time, hospital officials looked at 417 men who had received radical prostatectomies. Of these patients, 202 were observed on the old unit in the 12 months before the move, and 215 were observed in the 12 months after the move.
- In reviewing their records, officials found that the variable costs per case were 23.5% less on the renovated unit than on the old unit.
- Institute officials looked at 312 craniotomy patients (specified by diagnosis-related group) in the renovated unit compared with 291 other craniotomy patients. A 20% reduction in variable costs was noted in the renovated unit for the same type of patients
Publications
- Goodman, M., & Marberry, S. (2010). Happy Anniversary Pebble Project. Healthcare Design, 10(6), 26–26,28.
“It is hard to believe, but this year marks the 10th anniversary of The Center for Health Design's (CHD) Pebble Project. Launched in 2000 as a research collaboration between CHD and a few like-minded healthcare providers, the idea for the Pebble Project came during a joint meeting of CHD's Board of Directors and Research Council in 1999.”
- Gulwadi, G. B., & Keller, A. B. (2009). Falls in healthcare settings. Healthcare Design, 9(7), 28–28,30,32,34.
“There are complexities inherent in falls research because of multiple co-acting physiological and environmental factors. While interventions for reducing and preventing falls have included physiological measures, recent efforts explore risk factors and support factors in physical settings.”