Pati Debajyoti, Harvey Thomas E, Pati Sipra
Department of Design, College of Human Sciences, Texas Tech University, Lubbock (Dr Pati) and Center for Advanced Design Research & Evaluation, Dallas, Texas (Mr Harvey and Ms Pati).
Crit Care Nurs Q. 2014 Jul-Sep;37(3):299-316. doi: 10.1097/CNQ.0000000000000032.
The objective of this study was to explore and identify physical design correlates of safety and efficiency in emergency department (ED) operations. This study adopted an exploratory, multimeasure approach to (1) examine the interactions between ED operations and physical design at 4 sites and (2) identify domains of physical design decision-making that potentially influence efficiency and safety. Multidisciplinary gaming and semistructured interviews were conducted with stakeholders at each site. Study data suggest that 16 domains of physical design decisions influence safety, efficiency, or both. These include (1) entrance and patient waiting, (2) traffic management, (3) subwaiting or internal waiting areas, (4) triage, (5) examination/treatment area configuration, (6) examination/treatment area centralization versus decentralization, (7) examination/treatment room standardization, (8) adequate space, (9) nurse work space, (10) physician work space, (11) adjacencies and access, (12) equipment room, (13) psych room, (14) staff de-stressing room, (15) hallway width, and (16) results waiting area. Safety and efficiency from a physical environment perspective in ED design are mutually reinforcing concepts--enhancing efficiency bears positive implications for safety. Furthermore, safety and security emerged as correlated concepts, with security issues bearing implications for safety, thereby suggesting important associations between safety, security, and efficiency.
本研究的目的是探索和确定急诊科（ED）运营中与安全和效率相关的物理设计因素。本研究采用了一种探索性的多维度方法，以（1）检查4个地点的急诊科运营与物理设计之间的相互作用，以及（2）确定可能影响效率和安全的物理设计决策领域。在每个地点与利益相关者进行了多学科博弈和半结构化访谈。研究数据表明，16个物理设计决策领域会影响安全、效率或两者。这些领域包括：（1）入口与患者候诊区，（2）交通管理，（3）次候诊区或内部候诊区，（4）分诊，（5）检查/治疗区域配置，（6）检查/治疗区域的集中与分散，（7）检查/治疗室标准化，（8）充足空间，（9）护士工作空间，（10）医生工作空间，（11）相邻关系与通道，（12）设备室，（13）心理治疗室，（14）员工减压室，（15）走廊宽度，以及（16）结果等候区。从物理环境角度来看，急诊科设计中的安全和效率是相互促进的概念——提高效率对安全有积极影响。此外，安全与安保是相关概念，安保问题对安全有影响，从而表明安全、安保和效率之间存在重要关联。
