Previous to March 2020, UW Health, the well being system of the College of Wisconsin-Madison with seven hospitals and 156 clinics and different factors of care, confronted the problem of excessive occupancy and restricted mattress capability. Its Madison area was already full, with occupancy averaging 95 p.c. Most days it surpassed 100%.
When the pandemic started to take maintain, metropolitan areas like Madison with populations of 250,000 to 500,000 individuals have been anticipated to have 500 to 1,000 confirmed instances presenting directly. That was anticipated to end in 250 complete admissions, with surge anticipated to hit in late April and early Might.
The hospitals on this a part of UW Well being’s system had a complete of 671 beds, however availability fluctuated day by day, together with some days when no beds have been accessible. Already in want of extra intermediate care (IMC) and intensive care unit (ICU) beds to satisfy capability points, the COVID-19 surge additional influenced the system to analyze the way it may increase its accessible beds.
To start addressing the scenario, UW Well being stakeholders determined to switch present inpatient rooms at a number of of its hospitals to extend capability and advance some inpatient tasks to extend total mattress capability.
As well as, UW was already creating a common care mannequin and was implementing a kind of models at its College Hospital. This gave UW Well being Planning Design and Building and design agency EUA, UW’s associate on the mission, info to construct upon to information the design of a brand new common care inpatient unit at East Madison Hospital.
As building on the unit progresses, listed here are some insights on the mission’s planning and growth in addition to future expectations.
Design instruments to extend inpatient care
Utilizing an evidence-based design (EBD) strategy, the mission was already outlined with targets and aims from the continuing work with common care/acuity-adaptable inpatient rooms inside UW’s system of care.
Particularly, design of the brand new mission had to make sure enhancements in a wide range of organizational metrics, together with scientific outcomes, security indicators, affected person satisfaction, and monetary efficiency. The brand new query turned: Can a patient-centric, protected, common care/acuity-adaptable inpatient unit—that additionally enhances workers efficiencies and satisfaction—be applied?
Using a Lean technique, EUA workforce members analyzed affected person and caregiver motion by the unit and recognized methods to enhance the consumer expertise, together with addressing problems added by pandemic protocols similar to customer restrictions and the required use of non-public protecting tools.
EUA workforce members made web site visits to among the present hospitals to look at shift modifications amongst nurses’ workers and stayed all through their shifts to know how they utilized the unit, workplaces, and provide rooms, as nicely the gap workers walked throughout these shifts.
The on-site visits have been supplemented with conferences on-line, partaking a large swath of consumer teams. Equally, because of the excessive degree of demand on UW Well being workers, questionnaires and on-line surveys have been additionally used to incorporate them within the design course of. Apparently, vital info was gleaned from that technique, as workers members have been extra forthright with their considerations.
Mock-ups have been additionally utilized throughout assembly occasions to permit stakeholders to guage spatial relationships, particularly contemplating the medical tools and controls that might be housed within the acuity-adaptable rooms.
Design options of a common care inpatient unit
Creating flexibility in serving a high-acuity affected person surroundings meant a number of modifications needed to be created from the everyday medical/surgical affected person rooms. Because of this, these design enhancements have been recognized for the ultimate design of UW’s new common care inpatient unit:
- All inpatient rooms can swap to detrimental strain, and the rooms have been made extra strong with further medical gases, electrical shops, and low-voltage capabilities.
- Remark home windows and particular person charting stations have been added. Affected person remark home windows enable workers a direct view into the room, with displays and controls positioned outdoors the affected person room, as nicely. Within the face of the pandemic, this enables workers to proceed monitoring sufferers with out having to put on full private protecting tools (PPE) after they enter a affected person room.
- Every room has a decentralized charting space, which is able to add as much as 28 further laptop stations/seats. Sooner or later, these additions will even help the extra workers vital when the unit must function in a higher-acuity surroundings, whatever the medical incident.
- A bigger collaboration space was added within the middle of the unit to help higher communication amongst workers. The unit is accessible from all elements of the central collaboration space.
- To cut back strolling distances and provides workers extra flexibility for scientific help, twice as many dirty rooms, clear storage rooms, and medical tools storage areas have been added.
- A spotlight room was created, which provides workers day-to-day and long-term flexibility. At present, it might be used for dictation or for a convention amongst a nurse supervisor and nurses. Sooner or later, it may be transitioned into workplace area if vital. Digital ICU infrastructure was added to permit communication with specialists from distant areas, as nicely.
- Dialysis capabilities have been added to the rooms. All through the pandemic, transporting sufferers with COVID-19 by the hospital to dialysis remedy has been problematic. That is true for sufferers with out COVID-19, as nicely. Having dialysis entry will enable sufferers to remain inside one room for all care.
- Bogs have been designed to enhance security and performance similar to redesigning the bathe enclosure and including accessible options. Further area was added for employees help and bathe chair entry, too.
Whereas enhancements for the mission have been aimed toward scientific outcomes, UW Well being and EUA additionally targeted on the household, workers, and affected person expertise. Wayfinding to the nurses’ station was improved with lighting, whereas supplies have been additionally modified throughout the area to supply improved acoustics. An ample workers break room with giant home windows was added, as was household area for sufferers.
Measuring inpatient capability success
The acuity-adaptable unit will assist prepared UW Well being’s infrastructure for the following pandemic or medical occasion. For instance, rooms within the renovated space may be transformed rapidly to the next acuity degree for sufferers, which is able to assist workers to function inside areas they’re already acquainted with and, consequently, enhance consumer experiences.
And whereas it might be ultimate to make common care inpatient models a system-wide change, stakeholders perceive it will not be possible. The truth is that the area essential to convert an present room into an acuity-adaptable one requires the conversion of two inpatient rooms to renovate the area into one new acuity-adaptable room, leading to much less total mattress rely.
Success of the mission can be decided by comparability to metrics that UW Well being already tracks. Baseline ranges of affected person falls, hospital acquired infections, and so on., can be established and in contrast with the identical ranges from inpatient models on the fourth and fifth flooring at East Madison Hospital.
These efficiency measures are embedded throughout the mission’s design and are being tracked all through building and into post-occupancy analysis (POE).
When the mission is completed and the POE is accomplished, a clearer image can be revealed as as to whether dramatically rising the amount of acuity-adaptable rooms is medically vital and/or financially sound, and if workers and sufferers will profit from renovations made all through UW’s hospital system.
Michael McKay is director of UW Well being Planning Design and Building (Madison, Wis.). He may be reached at mailto:[email protected]. John Ford is a senior design architect with EUA (Madison). He may be reached at mailto:[email protected]. Ed Anderson is a healthcare market chief with EUA (Madison). He may be reached at [email protected].