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Gharaveis A, Hamilton DK, Pati D, Shepley MM, Rodiek S, McCall D. How Visibility May Reduce Security Issues in Community Hospitals' Emergency Departments. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024; 17:135-147. [PMID: 37522704 DOI: 10.1177/19375867231188985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
This research explored the relationship between visibility and the level of security risks as perceived by nurses and physicians in emergency departments (EDs). Security in EDs has been reported as a major global concern, and visibility has been identified as a design factor impacting behavior. However, few previous studies have rigorously investigated the role of visibility in reduction of ED security risks with evidence-based design approach. There is a lot of significant questions about how visibility impacts the reduction of security issues in EDs. METHODS How visibility may influence ED security was explored via qualitative methods in five EDs using semi-structured one-on-one interviews with 17 clinical staff and 48 hr of field observations. The coding process for both interviews and observational notes followed the principles of naturalistic inquiry. RESULTS The findings suggest security risks can be decreased by improving visibility. Medical staff (registered nurses and physicians) felt more secure in the EDs with higher visibility. DISCUSSION This study provides a framework to identify preferable levels of visibility in EDs and proposes design strategies to minimize security issues. Registered nurses and physicians can improve their team's sense of security by considering visibility throughout their daily practices.
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Affiliation(s)
| | | | | | | | | | - Denise McCall
- Emergency Department, Houston Methodist West Hospital, TX, USA
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Analysis of Functional Layout in Emergency Departments (ED). Shedding Light on the Free Standing Emergency Department (FSED) Model. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12105099] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The ever-increasing number of hospital Emergency Department (ED) visits pose a challenge to the effective running of health systems in many countries globally and multiple strategies have been adopted over the years to tackle the plight. According to a systematic review of the available literature, of the numerous models of healthcare systems used to address the issue in western countries, the FSED Model has the greatest potential for reducing hospital ED overcrowding as it can reduce the additional load by diverting minor cases, freeing up space for more urgent cases. The aim of the study is to shed light on the Free Standing Emergency Department (FSED) model and compare it with the traditional Hospital Based Emergency Department (HBED) in international contexts. In this study, 23 papers have been collected in a literature review and the main features have been highlighted; 12 case studies have been analyzed from a layout point of view and data have been collected in terms of surfaces, functions, and flow patterns. The percentages of floor areas devoted to each function have been compared to define evolution strategies in the development of emergency healthcare models and analyses. The use of FSED models is an interesting way to face the overcrowding problem and a specific range for functional area layout has been identified. Further studies on its application in different contexts are encouraged.
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Lim L, Zimring CM, DuBose JR, Fischer GM, Stroebel R. Clinic Design for Safety During the Pandemic: Safety or Teamwork, Can We Only Pick One? HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2022; 15:28-41. [PMID: 35380047 DOI: 10.1177/19375867221091310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This article aims to illustrate the design considerations of team-based primary care clinics in response to the pandemic. BACKGROUND Due to COVID-19, physical distancing became a critical practice in our daily life, especially in healthcare settings where healthcare professionals must continue providing care to patients despite the manifold risks. Many healthcare facilities are implementing physical distancing in their clinic layouts, and healthcare professionals are adjusting their behaviors, so they can stay away from each other. METHODS A total of four team-based primary care clinics were studied to identify their lessons learned regarding safety measures and space usage during the pandemic. RESULTS The four team-based primary care clinics made changes to the clinic design (e.g., waiting areas, exam rooms, team workspaces), operational protocols (e.g., in-person huddles, social gatherings, staff work locations), and usage of spaces (e.g., outdoor spaces, utility rooms). Such changes enabled the implementation of safety measures during the pandemic. However, healthcare professionals also reported challenges regarding their team communication and coordination due to physical distancing and separation. CONCLUSIONS Our findings suggest that the physical distancing may in fact contribute to less effective teamwork and patient care and negatively affect staff well-being. In this article, we ask healthcare system leaders and designers to continue supporting both safety and teamwork by paying attention to the flexibility and spatial relationships among healthcare professionals rather than fully sacrificing teamwork for safety. Also, now is the time when multidisciplinary collaborations are needed to establish and validate guidelines that can improve both factors.
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Affiliation(s)
- Lisa Lim
- Department of Civil and Environmental Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, South Korea
| | - Craig M Zimring
- School of Architecture, College of Design, Georgia Institute of Technology, Atlanta, GA, USA
| | - Jennifer R DuBose
- SimTigrate Design Lab, College of Design, Georgia Institute of Technology, Atlanta, GA, USA
| | - Gary M Fischer
- Office of Facilities Standards Service/Office of Facilities Planning, Office of Construction and Facilities Management, Department of Veterans Affairs, Washington, DC, USA
| | - Robert Stroebel
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Lipson-Smith R, McLaughlan R. Mapping Healthcare Spaces: A Systematic Scoping Review of Spatial and Behavioral Observation Methods. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2022; 15:351-374. [PMID: 35356828 DOI: 10.1177/19375867221089702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To provide a taxonomy of spatial observation methods that are commonly used in healthcare environments research and to describe their relative success. BACKGROUND Spatial observation is a valuable but resource intensive research method that is often used in healthcare environments research, but which frequently fails to deliver conclusive results. There is no existing catalog of the different spatial and behavioral observation methods that are used in healthcare design research and their benefits or limitations. METHODS The review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Ten key databases were searched, and articles were screened by both authors. RESULTS Across 67 included studies, 79 observation methods were reported. We categorized those into four, distinct methodological approaches, outlining the benefits, limitations, and suitability of each for obtaining different types of results. Common limitations included difficulty generalizing to other contexts and a lack of detailed description during data collection which led to key environment variables not being recorded. More concrete conclusions were drawn when observation methods were combined with complimentary methods such as interview. CONCLUSIONS The relative success of spatial observation studies is dependent on the fit of the method selected relative to the research question, approach, and healthcare setting; any complimentary methods delivered alongside it; and the analysis model employed. This article provides researchers with practical advice to guide the appropriate selection of spatial observation methods.
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Affiliation(s)
- Ruby Lipson-Smith
- School of Architecture and the Built Environment, University of Newcastle, Australia
| | - Rebecca McLaughlan
- School of Architecture and the Built Environment, University of Newcastle, Australia.,Sydney School of Architecture, Design & Planning, The University of Sydney, Australia
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Pilosof NP, Barrett M, Oborn E, Barkai G, Pessach IM, Zimlichman E. Telemedicine Implementation in COVID-19 ICU: Balancing Physical and Virtual Forms of Visibility. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2021; 14:34-48. [PMID: 34075789 PMCID: PMC8212392 DOI: 10.1177/19375867211009225] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: This case study examines the implementation of inpatient
telemedicine in COVID-19 intensive care units (ICUs) and
explores the impact of shifting forms of visibility on the
management of the unit, staff collaboration, and patient
care. Background: The COVID-19 crisis drove healthcare institutions to rapidly
develop new models of care based on integrating digital
technologies for remote care with transformations in the
hospital-built environment. The Sheba Medical Center in Israel
created COVID-19 ICUs in an underground structure with an
open-ward layout and telemedicine control rooms to remotely
supervise, communicate, and support the operations in the
contaminated zones. One unit had a physical visual connection
between the control room and the contaminated zone through a
window, while the other had only a virtual connection with
digital technologies. Methods: The findings are based on semistructured interviews with Sheba
medical staff, telemedicine companies, and the architectural
design team and observations at the COVID-19 units during
March–August 2020. Results: The case study illustrates the implications of virtual and physical
visibility on the management of the unit, staff collaboration,
and patient care. It demonstrates the correlations between
patterns of visibility and the users’ sense of control,
orientation in space, teamwork, safety, quality of care, and
well-being. Conclusions: The case study demonstrates the limitations of current telemedicine
technologies that were not designed for inpatient care to
account for the spatial perception of the unit and the dynamic
use of the space. It presents the potential of a hybrid model
that balances virtual and physical forms of visibility and
suggests directions for future research and development of
inpatient telemedicine.
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Affiliation(s)
- Nirit Putievsky Pilosof
- Cambridge Digital Innovation-CJBS & Hughes Hall, 2152University of Cambridge, United Kingdom
| | - Michael Barrett
- Cambridge Judge Business School (CJBS), 2152University of Cambridge, United Kingdom
| | - Eivor Oborn
- Warwick Business School, University of Warwick, United Kingdom
| | - Galia Barkai
- Sheba BEYOND, 26744Sheba Medical Center, Tel Hashomer, Israel.,26744Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Itai M Pessach
- 26744Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Israel.,Sheba's Talpiot Medical Leadership Program, Israel
| | - Eyal Zimlichman
- 26744Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Israel.,Sheba's Talpiot Medical Leadership Program, Israel
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Joshi R, Joseph A, Ossmann M, Taaffe K, Pirrallo R, Allison D, Perino LC. Emergency Physicians' Workstation Design: An Observational Study of Interruptions and Perception of Collaboration During Shift-End Handoffs. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2021; 14:174-193. [PMID: 33745345 DOI: 10.1177/19375867211001379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Frequent external interruptions and lack of collaboration among team members are known to be common barriers in end-of-shift handoffs between physicians in the emergency department. In spite of being the primary location for this crucial and cognitively demanding task, workstations are not designed to limit barriers and support handoffs. OBJECTIVE The purpose of this study is to examine handoff characteristics, actual and perceived interruptions, and perceived collaboration among emergency physicians performing end-of-shift handoffs in physician workstations with varying levels of enclosures-(a) open-plan workstation, (b) enclosed workstation, and (c) semi-open workstation. METHOD Handoff and interruption characteristics were captured through in-person observations of 60 handoffs using an iPad-based tool. Additionally, physicians participating in the handoffs responded to a survey pertaining to their perception of interruptions and collaboration with clinicians during each phase. Other organizational and demographic data were obtained from the hospital database, surveys, and observations. RESULTS Physicians working in the open workstation experienced a significantly higher number of interruptions/hour (18.08 int/hr) as compared to the semi-open (13.62 int/hr) and enclosed workstations (11.41 int/hr). Most physicians perceived that they were interrupted in the semi-open and open workstations. In addition, majority of physicians in the enclosed pod perceived high collaboration with clinicians involved in and present in the workstation during handoff. CONCLUSION This correlational study showed positive outcomes experienced by physician working in the enclosed workstation as compared to the open and semi-open workstations.
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Affiliation(s)
- Rutali Joshi
- Center for Health Facilities Design and Testing, School of Architecture, 2545Clemson University, SC, USA
| | - Anjali Joseph
- Center for Health Facilities Design and Testing, School of Architecture, 2545Clemson University, SC, USA
| | - Michelle Ossmann
- Knowledge and Insights, Healthcare, 51405Herman Miller, Holland, MI, USA
| | - Kevin Taaffe
- Department of Industrial Engineering, 170373College of Engineering, Computing and Applied Sciences, Clemson University, SC, USA
| | - Ronald Pirrallo
- Department of Emergency Medicine, 3626Prisma Health, University of South Carolina School of Medicine Greenville, SC, USA
| | - David Allison
- School of Architecture, Graduate Program in Architecture + Health, 191204Clemson University, SC, USA
| | - Larissa Coldebella Perino
- Department of Emergency Medicine, 3626Prisma Health, University of South Carolina School of Medicine Greenville, SC, USA
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