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Methodist Hospital/Clarian Health Partners

Indianapolis, IN

In February 1999, Clarian opened a new 56-bed demonstration Cardiovascular Comprehensive Critical Care Unit (CCCU) at Methodist Campus in Indianapolis, IN. The unit combines a former critical care unit and a step-down unit of medical care into a single nursing unit.

Each headwall is critical care ready and enables the patient to change levels of care within the same patient room, thereby eliminating the need for most patient transfers.


Extreme attention was given to designing the environment to promote healing and involvement of the family or significant other in the care process. The design firm for the project was BSA Design.


Because the existing units were moved into the new area of the hospital on a single day, there was a unique opportunity for true baseline comparison before and after the design intervention. Four key areas were measured:


  • Clinical outcomes
  • Satisfaction -- patient, payer, clinician
  • Education and personal growth for clinicians, and
  • Cost and efficiency


The following data have been collected:

  • Patient falls down 75% due to the unit’s decentralized design, which allows for better observation.
  • Patient room layout, equipment integration, and other design features have helped push patient transfers down 90%.
  • Overall patient dissatisfaction has dropped from 6% in 1998 to 3% in 2001.
  • Decrease in patient transfers and nurses' more consistent knowledge of each patient's condition have contributed to an improved medication error index.
  • Unit design has helped reduce the caregiver workload index, resulting in improvements in nursing efficiency.


  • 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”
  • Hendrich, Ann L, & Lee, N. (2005). Intra-unit patient transports: time, motion, and cost impact on hospital efficiency. Nursing Economic$, 23(4), 157.
    Abstract: The costly and inefficient movement of patients within the hospital challenges health systems across the country as they strive to simultaneously contain rising costs and provide high-quality patient care. Solid evidence to support the improvement of hospital and patient care efficiency through the identification and suggested elimination of waste patterns within the transport process is presented.
  • Hendrich, A. L, Fay, J., & Sorrells, A. K. (2004). Effects of acuity-adaptable rooms on flow of patients and delivery of care. American Journal of Critical Care, 13(1), 35–45.
    Background: Delayed transfers of patients between nursing units and lack of available beds are significant problems that increase costs and decrease quality of care and satisfaction among patients and staff.
    Objective: To test whether use of acuity-adaptable rooms helps solve problems with transfers of patients, satisfaction levels, and medical errors.
  • Hendrich, A. (2003). Case Study: The impact of Acuity Adaptable rooms on future designs, bottlenecks and hospital capacity. Impact Conference on optimizing the physical space for improved outcomes, satisfaction and the bottom line. Atlanta, GA: The Institute for Healthcare Improvement & The Center for Health Design.
  • Hendrich, A., Fay, J., & Sorrells, . A. (2002). Courage to heal: Comprehensive Cardiac Critical care. Healthcare Design, 11–13.
    "This is the story of what happened in one health system that dared to combine technology and humanism, ingenuity and accommodation, and to respond to pres-ent challenges and future care delivery needs. This is the story of what happened when one healthcare organization, determined to find solutions, sought to create a better environment for patients and caregivers. The result: the Comprehensive Cardiac Critical Care unit (CCCC) in Methodist Hospital of Clarian Health Partners in Indianapolis"