Department of Planning, Policy and Design, School of Ecology, University of California, Irvine, USA.
HERD. 2009 Fall;3(1):41-78. doi: 10.1177/193758670900300106.
The design of the consultation room remains largely unaltered despite major changes in clinical practice, such as the electronic medical record and patient-centered care. The value of redesigning the consultation room to accommodate these changes and the effect of a redesign on patient-clinician interaction are unclear.
The authors randomly allocated 65 patient-physician dyads to consultations in a standard room (n = 30) or in an experimental room designed with a semicircular table around which the clinician and the patient sat, with equal access to the computer screen (n = 35). Participant responses to post-visit surveys, assessing patient experiences in these rooms, were compared in an intention-to-treat fashion.
The authors found no differences between the rooms in terms of patient satisfaction with the consultation, mutual respect, or communication quality. Compared to the standard room, patients in the experimental room were better able to interact with the computer monitor (24 [75%] vs. 17 [59%], P = 0.07) and had a greater ability to look at the screen at any time (22 [73%] vs. 8 [28%], P < 0.001); and they reported that clinicians allowed them to review the medical record on the screen (22 [71%] vs. 13 [45%], P = 0.012), shared information on the computer screen (24 [80%] vs. 18 [60%], P = 0.037), and reviewed information on the Internet with the patient (13 [43%] vs. 7 [26%], P = 0.010) more than those in the standard room.
The design of the consultation room affects the clinical encounter. In particular, ready access to a computer screen using the electronic medical record and the Internet may enhance information sharing.
尽管临床实践发生了重大变化，如电子病历和以患者为中心的护理，但咨询室的设计基本保持不变。重新设计咨询室以适应这些变化的价值以及重新设计对医患互动的影响尚不清楚。
作者将 65 对医患组合随机分配到标准房间（n=30）或设计为半圆形桌子的实验房间中进行咨询，医生和患者坐在桌子周围，可平等访问计算机屏幕（n=35）。以意向治疗的方式比较参与者在这些房间就诊后的调查中对患者体验的回答。
在咨询满意度、相互尊重或沟通质量方面，两个房间之间没有差异。与标准房间相比，实验房间的患者更能与计算机监视器互动（24 [75%] 对 17 [59%]，P=0.07），并且随时查看屏幕的能力更强（22 [73%] 对 8 [28%]，P<0.001）；他们报告说，临床医生允许他们查看屏幕上的病历（22 [71%] 对 13 [45%]，P=0.012），在计算机屏幕上共享信息（24 [80%] 对 18 [60%]，P=0.037），并与患者一起查看互联网上的信息（13 [43%] 对 7 [26%]，P=0.010）比标准房间的患者更多。
咨询室的设计会影响临床就诊。特别是，使用电子病历和互联网随时访问计算机屏幕可能会增强信息共享。
