Patient Room Design: Engaging Clinical Teams Through Iterative Simulation-Based Evaluation

Abstract

Objectives

This study evaluated a standardized patient room designed for multiple acuity levels in a quaternary care academic medical center by actively engaging clinical teams through an iterative simulation-based evaluation process using physical mock-ups.

Background

Patient rooms are replicated multiple times in hospitals, and their design impacts patient and staff outcomes. Balancing often-conflicting needs and designing for future flexibility can be challenging. Simulation-based mock-up evaluations can help engage clinicians to obtain feedback about healthcare facility design in the context of clinical work.

Methods

Focus groups, surveys, and observations collected input on a patient room design in three phases. The first phase assessed the bathroom location (inboard versus outboard) and room layout. The second phase evaluated five critical areas of the patient room: the bathroom, family zone, handwashing sink, dry work surface, and headwall. The third phase evaluated whether an outboard bathroom on the headwall or footwall supported patient care delivery better.

Results

The study found that an outboard bathroom provided a better connection to the corridor, more functional space in the room, better equipment flow, and dedicated family space. Through the simulations, the team identified spatial challenges in the context of clinical scenarios and provided recommendations for refining design features. Clinicians preferred the footwall bathroom configuration due to better workflow support during the enacted patient care scenarios.

Conclusion

Overall, an outboard footwall bathroom supported staff workflows and care activities. The iterative simulation-based evaluation process was highly effective for obtaining clinicians’ design feedback within the context of their everyday work.

Keywords

evidence-based design patient room design patient bathroom mock-up evaluation academic medical center

Get full access to this article

View all access options for this article.

References

Abareshi

Hekmatshoar

Rastaghi

Sharifi

(2019). Appropriateness of hospital equipment ergonomic indices to nurse's anthropometric dimensions. Journal of Occupational Hygiene Engineering, 5(4), 33–40. https://doi.org/10.29252/johe.5.4.33

Bayramzadeh

Joseph

Allison

Shultz

Abernathy

(2018). Using an integrative mock-up simulation approach for evidence-based evaluation of operating room design prototypes. Applied Ergonomics, 70, 288–299. https://doi.org/10.1016/j.apergo.2018.03.011

Bosch

S. J.

Apple

Hiltonen

Worden

Nanda

Kim

(2016). To see or not to see: Investigating the links between patient visibility and potential moderators affecting the patient experience. Journal of Environmental Psychology, 47, 33–43. https://doi.org/10.1016/j.jenvp.2016.04.013

Brandis

(1999). A collaborative occupational therapy and nursing approach to falls prevention in hospital inpatients. Journal of Quality in Clinical Practice, 19(4), 215–220. https://doi.org/10.1046/j.1440-1762.1999.00337.x

Calkins

Biddle

Biesan

(2012). Contribution of the designed environment to fall risk in hospitals. Ideas Institute.

Calkins

Cassella

(2007). Exploring the cost and value of private versus shared bedrooms in nursing homes. The Gerontologist, 47(2), 169–183. https://doi.org/10.1093/geront/47.2.169

Chisholm

Shultz

Caird

Lord

Boiteau

Davies

(2008). Identification of intensive care unit (ICU) system integration conflicts: Evaluation of two mock-up rooms using patient simulation. Proceedings of the Human Factors and Ergonomics Society Annual Meeting, 52(12), 798–802. https://doi.org/10.1177/154193120805201207

Choi

Y.-S.

Bosch

S. J.

(2013). Environmental affordances: Designing for family presence and involvement in patient care. HERD: Health Environments Research & Design Journal, 6(4), 53–75. https://doi.org/10.1177/193758671300600404

Copeland

Chambers

(2017). Effects of unit design on acute care nurses’ walking distances, energy expenditure, and job satisfaction: A pre–post relocation study. HERD: Health Environments Research & Design Journal, 10(4), 22–36. https://doi.org/10.1177/1937586716673831

10.

Decalf

Bower

Rose

Petrovic

Pieters

Eeckloo

Everaert

(2021). Prevalence and characteristics of incident falls related to nocturnal toileting in hospitalized patients. Acta Clinica Belgica, 76(2), 85–90. https://doi.org/10.1080/17843286.2019.1660022

11.

Elsadek

Liu

Xie

(2020). Window view and relaxation: Viewing green space from a high-rise estate improves urban dwellers’ wellbeing. Urban Forestry & Urban Greening, 55, 126846. https://doi.org/10.1016/j.ufug.2020.126846

12.

Health Quality Council of Alberta (HQCA). (2016). Simulation-based mock-up evaluation framework. https://hqca.ca/wp-content/uploads/2021/11/HQCA_SME_Framework_062217S.pdf

13.

Hetland

Hickman

McAndrew

Daly

(2017). Factors influencing active family engagement in care among critical care nurses. AACN Advanced Critical Care, 28(2), 160–170. https://doi.org/10.4037/aacnacc2017118

14.

Hignett

(2010). Space to care and treat safely in acute hospitals: Recommendations from 1866 to 2008. Applied Ergonomics, 41(5), 666–673. https://doi.org/10.1016/j.apergo.2009.12.010

15.

Hitcho

E. B.

Krauss

M. J.

Birge

Claiborne Dunagan

Fischer

Johnson

Nast

P. A.

Costantinou

Fraser

V. J.

(2004). Characteristics and circumstances of falls in a hospital setting. Journal of General Internal Medicine, 19(7), 732–739. https://doi.org/10.1111/j.1525-1497.2004.30387.x

16.

Joseph

Joshi

Mihandoust

Goel

Hebbar

Colman

(2022). Pediatric intensive care unit (PICU) patient room design: Identifying safety risks in mirrored rooms through a graphical systems analysis. HERD: Health Environments Research & Design Journal, 15(1), 189–206. https://doi.org/10.1177/19375867211032921

17.

Joseph

Reid

Kearney

J. J.

(2021). Planning patient care areas using simulation. In Deutsch

E. S.

Perry

S. J.

Gurnaney

H. G.

(Eds.), Comprehensive healthcare simulation: Improving healthcare systems (pp. 97–105). Springer International Publishing. https://doi.org/10.1007/978-3-030-72973-8_14

18.

Keep

James

Inman

(1980). Windows in the intensive therapy unit. Anaesthesia, 35(3), 257–262. https://doi.org/10.1111/j.1365-2044.1980.tb05093.x

19.

Kelly

Pingel

M. J.

(2022). Space use and the physical attributes of acute care units: A quantitative study. HERD: Health Environments Research & Design Journal, 15(1), 222–238. https://doi.org/10.1177/19375867211043848

20.

Lavender

S. A.

Sommerich

C. M.

Sanders

E. B.-N.

Evans

K. D.

Radin Umar

R. Z.

Patterson

E. S.

(2020). Developing evidence-based design guidelines for medical/surgical hospital patient rooms that meet the needs of staff, patients, and visitors. HERD: Health Environments Research & Design Journal, 13(1), 145–178. https://doi.org/10.1177/1937586719856009

21.

Lee

S. J.

Sanford

Calkins

Melgen

Endicott

Phillips

(2018). Beyond ADA accessibility requirements: Meeting seniors’ needs for toilet transfers. HERD: Health Environments Research & Design Journal, 11(2), 32–44. https://doi.org/10.1177/1937586717730338

22.

Lindblom

Flink

Elf

Laska

A. C.

von Koch

Ytterberg

(2021). The manifestation of participation within a co-design process involving patients, significant others and healthcare professionals. Health Expectations, 24(3), 905–916. https://doi.org/10.1111/hex.13233

23.

Ossmann

M. M.

Leaf

D. E.

Factor

P. H.

(2014). Patient visibility and ICU mortality: A conceptual replication. HERD: Health Environments Research & Design Journal, 7(2), 92–103. https://doi.org/10.1177/193758671400700206

24.

Machry

Joseph

White

Allison

(2023). Designing for family engagement in neonatal ICUs: How is the interior design of single-family rooms supporting family behaviors, from passive to active? HERD: Health Environments Research & Design Journal, 16(3), 238–260. https://doi.org/10.1177/19375867231168651

25.

Mihandoust

Joseph

Kennedy

MacNaughton

Woo

(2021). Exploring the relationship between window view quantity, quality, and ratings of care in the hospital. International Journal of Environmental Research and Public Health, 18(20), 10677. https://doi.org/10.3390/ijerph182010677

26.

Pati

Harvey

T. E.

Evans

Cason

(2010). Room handedness: Patient room layout in acute inpatient care. World Health Design, 3(3), 74–81.

27.

Pati

Harvey

T. E.

Reyers

Evans

Waggener

Serrano

Saucier

Nagle

(2009). A multidimensional framework for assessing patient room configurations. HERD: Health Environments Research & Design Journal, 2(2), 88–111. https://doi.org/10.1177/193758670900200208

28.

Pati

Lee

Mihandoust

Kazem-Zadeh

(2018). Top five physical design factors contributing to fall initiation. HERD: Health Environments Research & Design Journal, 11(4), 50–64. https://doi.org/10.1177/1937586718763798

29.

Pati

Valipoor

Cloutier

Yang

Freier

Harvey

T. E.

Lee

(2021). Physical design factors contributing to patient falls. Journal of Patient Safety, 17(3), e135–e142. https://doi.org/10.1097/pts.0000000000000339

30.

Peavey

E. K.

Zoss

Watkins

(2012). Simulation and mock-up research methods to enhance design decision making. HERD: Health Environments Research & Design Journal, 5(3), 133–144. https://doi.org/10.1177/193758671200500313

31.

Piatkowski

Taylor

Wong

Taylor

Foreman

K. B.

Merryweather

(2021). Designing a patient room as a fall protection strategy: The perspectives of healthcare design experts. International Journal of Environmental Research and Public Health, 18(16), 8769. https://doi.org/10.3390/ijerph18168769

32.

Qualtrics. (2022). Qualtrics XM. https://www.qualtrics.com

33.

Quan

Joseph

Nanda

(2017). Developing evidence-based tools for designing and evaluating hospital inpatient rooms. Journal of Interior Design, 42(1), 19–38. https://doi.org/10.1111/joid.12091

34.

Raanaas

R. K.

Patil

G. G.

Hartig

(2012). Health benefits of a view of nature through the window: A Quasi-experimental study of patients in a residential rehabilitation center. Clinical Rehabilitation, 26(1), 21–32. https://doi.org/10.1177/0269215511412800

35.

Sanford

Bosch

S. J.

(2013). An investigation of noncompliant toilet room designs for assisted toileting. HERD: Health Environments Research & Design Journal, 6(2), 43–57. https://doi.org/10.1177/193758671300600205

36.

Taylor

Hignett

(2016). The SCOPE of hospital falls: A systematic mixed studies review. HERD: Health Environments Research & Design Journal, 9(4), 86–109. https://doi.org/10.1177/1937586716645918

37.

Twibell

R. S.

Craig

Siela

Simmonds

Thomas

(2015). Being there: Inpatients’ perceptions of family presence during resuscitation and invasive cardiac procedures. American Journal of Critical Care, 24(6), e108–e115. https://doi.org/10.4037/ajcc2015470

38.

Tzeng

H.-M.

Yin

C.-Y.

(2010). Adding additional grab bars as a possible strategy for safer hospital stays. Applied Nursing Research, 23(1), 45–51. https://doi.org/10.1016/j.apnr.2008.05.003

39.

Ulrich

R. S.

Berry

L. L.

Quan

Parish

J. T.

(2010). A conceptual framework for the domain of evidence-based design. HERD: Health Environments Research & Design Journal, 4(1), 95–114. https://doi.org/10.1177/193758671000400107

40.

Verderber

Reuman

(1987). Windows, views, and health status in hospital therapeutic environments. Journal of Architectural and Planning Research, 4(2), 120–133. http://www.jstor.org/stable/43029487

41.

Zamani

Joy

Worley

(2024). Optimizing nurse workflow efficiency: An examination of nurse walking behavior and space accessibility in medical surgical units. HERD: Health Environments Research & Design Journal, 17(3), 269–289. https://doi.org/10.1177/19375867241237509