Healthcare Design - October 2016 - 48

he search for the right inpatient unit
design shouldn't just take into account size, footprint, and type of care being
provided-it's also about looking at an organization's philosophy on patient engagement,
care delivery, and technology in order to
plan and build the best environment. "There's
no right or wrong way," says Sheila Cahnman, president of JumpGarden Consulting
LLC (Wilmette, Ill.). "Each facility has its own
operational ideal." ¶ As those ideas evolve in
response to changing care models, patient expectations, and the latest research, design teams must
continue looking for new ideas to find that perfect fit.
¶ In the past, inpatient units have adapted to the shift
from paper-based charts to electronic medical records
(EMRs), from semiprivate to private patient rooms, and
from large waiting rooms to in-room family zones with
overnight accommodations. The evolution continues
as hospitals now rethink the location and layout of
staff workstations, accommodate the shift to multidisciplinary care, and plan for future technologies.

LEFT AND OPPOSITE:

On the inpatient unit,
traditional enclosed
nurses' stations with
casework around the
perimeter are being
replaced with open,
team-based work spaces
that foster collaboration
and keep staff visible to
patients. MetroHealth
System's new critical
care inpatient floors
incorporate open
workstations, nurses'
alcoves between pairs
of patient rooms,
and glass-walled
multidisciplinary rooms
to support a variety of
staff needs.

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OCTOBER 2016

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Following the first electronic charting, there
was a push in healthcare to move away from
the large, centralized nurses' station and "jump
whole hog into a decentralized model," Cahnman says. The thinking was that putting small
workstations around the corridor in proximity
to patient rooms would increase the amount of
time staff spend with patients. The reality was
that while the set-up helped improve visibility of
patients, it didn't account for employees' social
needs and made them feel disconnected. "They
don't just want to talk about what they did over
the weekend; they talk about patients, get help
from each other, and ask for advice," says Alan
Black, market sector leader and principal at FKP
(Houston).
Medicine has also evolved to become more
team-based, which is bringing more clinicians
and staff members to the inpatient unit or bedside to deliver care, including pharmacists, social workers, lab techs, and nurse practitioners,
driving the need for a higher volume and variety
of staff spaces. "They all need a place to work-
maybe not all eight hours in a shift, but they need
a place to sit down, do some work, and then move
on and see the next patient," Black says.
As a result, the pendulum is swinging back toward the middle, where new hybrid approaches
are emerging that incorporate decentralized
nurses' stations, such as alcoves or perches, with
one or more centralized command centers or
collaboration stations.
The MetroHealth System in Cleveland took
this approach when it built a two-story addition
atop its critical care pavilion to replace existing ICU units with 85 private patient rooms for
intensive care and critical patients. The new
floors, which opened in July, house nurses' alcoves between each pair of rooms along with a
variety of collaborative spaces, including a central workstation, glass-walled workrooms, and
dedicated offices for some staff members. "It's
very different," says Walter Jones, senior vice
president of campus transformation at MetroHealth. "Most of the spaces are shared and
distributed around the unit to allow for the caregivers to work wherever they need."
Going a step further, architecture firm NBBJ
looked outside the industry to corporate office
design to reimagine the inpatient floor and staff
work set-up, creating an open core nursing unit.
After successfully implementing the layout in
2012 with Miami Valley Hospital Heart and Orthopedic Center in Dayton, Ohio, the firm designs double-sided unit corridors with an 8-foot

CRAIG DUGAN PHOTOGRAPHY

FINDING A MIDDLE GROUND
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Healthcare Design - October 2016

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