WHERE RESEARCH MEETS DESIGN. Using Parametric Modeling to Optimize Walking Distances and Enhance Workflow

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1 WHERE RESEARCH MEETS DESIGN Using Parametric Modeling to Optimize Walking Distances and Enhance Workflow

2 Adeleh Nejati, MArch, EDAC Tom Harvey, FAIA, MPH, FACHA, LEED AP Upali Nanda, PhD, Assoc. AIA, EDAC Heath May, AIA Ryan Gathmann, AIA

3 WHY RESEARCH IS IN

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5 3 INITIATIVES

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9 PARAMETRIC MODELING

10 PARAMETRIC MODELING Designing a process rather than a form Designing a reusable and configurable process Creating a nearly infinite number of variations from one rule set of inputs, decisions and actions IMAGE Optimizing by quickly creating, testing and comparing multiple options

11 THEORETICAL FRAMEWORK

12 THEORETICAL FRAMEWORK DRIVER (MANIPULATED FEATURE) Distance from a Patient Room to: Medication Room Clean Supply room Soiled Utility Room Equipment Holding room Crash Cart Alcoves Documentation Station(s) CONSTRAINT (CONTROL/CONFOUND) Room Size Unit Size Minimum Clearances (patient bed, toilet) Maximum Distance DRIVEN LEVEL 1 ENVIRONMENTAL QUALITY Walking Distance - PR to Support Area - Support to Support - Support to PR DRIVEN LEVEL 2 HUMAN OUTCOME Time in Bed-side Care Time in Non-Value Added Activities Nurse Fatigue DRIVEN LEVEL 3 HUMAN/ ORGANIZATIONAL OUTCOME Med Errors Falls HCAHPS Nurse Retention

13 CASE STUDY Centralized vs. Decentralized Nurse Stations

14 METHODIST CHARLTON HOSPITAL DALLAS, TX Each nursing unit in this hospital has: 36 PATIENT ROOMS 3 CENTRALIZED NURSE STATIONS 18 DECENTRALIZED NURSE STATIONS

15 METHODIST CHARLTON HOSPITAL DALLAS, TX Scenario 1 Scenario 3 IMAGE Scenario 2 36 Bed Unit

16 METHODIST CHARLTON HOSPITAL DALLAS, TX Scenario 1

17 METHODIST CHARLTON HOSPITAL DALLAS, TX Round Trip and Distance Parameters for Nurse Travel from Patient Rooms Location Activity Minimum Roundtrips per Primary Shift 1 Documentation Station(s) Documentation 10.0 Consultation/Collaboration Socialization Medication Room Meds Management/Admin 5.0 Med Prep Med Supply Acquisition Clean Utility Room Supply Use Management/Admin 3.0 Medical Supply Acquisition Clean Linen Acquisition Soiled Utility Room Waste Disposal 2.0 Dirty Equipment Holding Soiled Linen Holding Equipment Holding Room Equipment Storage 1.0 Broken Equipment Holding Nourishment Room - Meals Food Tray Hold/Retrieval 3.0 Used Tray Holding Nourishment Room - Ice/Snacks Snack/Drink Acquisition 4.0 Ice Pack Acquisition Break Room Personal Effects Access/Toilet 3.0 Education Respite Patient Transport (Service Link to Surgery, Imaging, Other 0.2 Elevators) D&T Link to other Bed Units 1 These figures are theoretical assumptions for purposes of this Link study. to Actual Discharge trip counts (Lobby) measured through shadowing in the field often show higher

18 METHODIST CHARLTON HOSPITAL DALLAS, TX Walking Distance for Centralized vs. Decentralized Nurse Stations Patient Room 1 Patient Room 2 Patient Room 3 Patient Room 4 TOTAL Centralized Scenario 1 Decentralized % reduced %27.0 %22.5 %19.2 %18.2 %21.6 Centralized Scenario 2 Decentralized % reduced %18.0 %23.6 %30.4 %36.0 %26.8 Centralized Scenario 3 Decentralized

19 METHODIST CHARLTON HOSPITAL DALLAS, TX Walking Distance for Centralized vs. Decentralized Nurse Stations 5,000 4,500 4,000 3,500 3,000 2,500 2,000 1,500 1,000 0,500 0, % 26.8% 21.6% Scenario 1 Scenario 2 Scenario 3 Centralized Nurse Station Decentralized Nurse Station Scenario 1 Scenario 2 Scenario 3 1,000 1,000 1,500 0,800 0,600 0,800 0,600 1,000 0,400 0,200 0,400 0,200 0,500 0,000 PR1 PR2 PR3 PR4 0,000 PR1 PR2 PR3 PR4 0,000 PR1 PR2 PR3 PR4

20 IMPLEMENTATION IN PRACTICE

21 PROMEDICA TOLEDO HOSPITAL TOLEDO, OH Each nursing unit in this hospital has: 2WINGS 4 NURSE STATIONS 40 PATIENT ROOMS

22 20 Beds 20 Beds

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24 AVERAGE DISTANCE FROM PR TO SUPPORT SPACES Wow Stations Linen Meds Main Nurse Station Ice Equipment Soiled Work Conference Nourishment Break Room 24,125 50,8 59,325 59,875 68,25 79,725 81, ,

25 PATIENT ROOMS NURSE WALKING DISTANCES Excessive Distance Reasonabl e Distance UNIT AREAS

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27 IMPLICATIONS FUTURE RESEARCH

28 IMPLICATIONS Increased value of care giver time by optimizing time with the patient rather than time wasted in hunting and gathering activities. Enhanced understanding of design implications informed by quality data relative to spatial configurations on the workflow, unit organization and human behavior Enabled purposeful scenario planning of workflow, space allocation and spatial configurations that then inform operational planning and space programming that drive design goals.

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31 FUTURE RESEARCH Building a tool providing the planner/designer with the ability to set a specific criteria of maximum threshold for walking distances, and input parameters related to the specific site and program to generate geometry within a parametric model. IMAGE Building a generic solver to automate the process of iteration and allow for numerous alternates to be tested against user-defined criteria and sorted for

32 Thank you for your attention