Healthcare Design - January/February 2016 - 50
R | 02.16
lifting a person up in response to a certain level
of acceleration in the body. Analysis identified
a total of 730 potential fall events. The exact fall
moments were subsequently extracted from
digital videos, which were used to capture all
activities in the mock-up simultaneously with the
motion capture system. The fall video clips were
subsequently examined and coded by experts of
the Covenant falls committee and experienced
healthcare designers. A variety of statistical
analyses were conducted on the coded data.
Among the key findings, the research team
determined that when the relationship between
number of falls and intrinsic, environmental, and
postural factors were examined separately, the
following demonstrated statistical significance:
age and gender (intrinsic); bathroom location (environmental); and turning, grabbing, pushing, and
pulling (postural). However, when all factors were
examined together, age, gender, and bathroom
location lost significance, while postural factors
remained significant-meaning, from a physical
design perspective, designing for the appropriate postures and motions constitutes the most
The top offending postures in the bathroom
were turning, grabbing, pulling, and pushing (in
that order), with pushing and pulling demonstrating significance in the clinician zone. These were
associated with, among others: configurational
factors forcing turns; managing the IV pole when
walking or conducting tasks; interacting with
the door and moving through the entry; a lack
of adequate space; and attributes of specific
elements such as toilets (seat height, flush valve
location), grab bars (number, location, and orientation), patient chairs (absence of armrest, seat
height, and as obstruction in travel path), and
over-bed tables (as obstruction in travel path).
Following are some testable strategies developed
from the findings. It's important to note that these
are not tested ideas yet and should be treated as
* Design bathrooms to reduce turning as much
as possible. The number and degree of turns
will be affected by the relative locations of the
bathroom door, toilet, and sink.
* Don't require motions that involve two or
more of the offending postures, such as turning and grabbing or grabbing and pulling, etc.
Avoid swinging doors in patient bathrooms
and use sliding doors instead.
Use wider door openings to accommodate
the patient and an IV pole.
Testable findings include designing bathrooms to
reduce turning as much as possible and increasing
the width of door openings.
Explore different heights for the toilet seat
(e.g., increasing the height).
* Provide folding grab bars on both sides of
the toilet, along with space to accommodate
* Provide automatic flushing or place the flush
handle/button at a location that enables
operation from a standing position.
* Explore operational or design interventions to
keep the toilet seat at a lowered position.
* Examine adjacencies of/distances between
bathroom fixtures to reduce sideways shuffling.
* Assess patient room configurations that may
allow the bathroom door to be left open while
maintaining privacy from the hallway.
* Design patient room configurations and operations that eliminate unnecessary obstructions in the clinician zone and the path from
the bed to the bathroom.
* Use over-bed table designs that allow proximal location but quick, effortless removal by
the patient (e.g., integrated with the bed).
* Find IV pole designs with smaller bases or
robotics solutions where the pole can independently track and follow a patient but stay
clear of the patient's movement path.
With baby boomers aging across countries
and continents, falls will become an immediate
problem to millions-in hospitals, long-term care
facilities, and homes. This study shows a few vital
areas for design thinking and innovation for design, equipment manufacturing, and care delivery.
The following individuals made substantial contributions to the study: James Yang, Shabboo
Valipoor, and Aimee Cloutier (Texas Tech University), Thomas E. Harvey Jr. (HKS Architects), and
Patricia Freier (Covenant Health System). HCD
Debajyoti Pati, PhD, FIIA, IDEC, LEED AP, is
professor and Rockwell Endowment Chair in the
Department of Design at Texas Tech University
(Lubbock, Texas). He can be reached at d.pati@