Fay Lindsey, Carll-White Allison, Schadler Aric, Isaacs Kathy B, Real Kevin
1 College of Design, University of Kentucky, Lexington, KY, USA.
2 College of Pharmacy, University of Kentucky, Lexington, KY, USA.
HERD. 2017 Oct;10(5):80-94. doi: 10.1177/1937586717698812. Epub 2017 Mar 31.
The focus of this research was to analyze the impact of decentralized and centralized hospital design layouts on the delivery of efficient care and the resultant level of caregiver satisfaction.
An interdisciplinary team conducted a multiphased pre- and postoccupancy evaluation of a cardiovascular service line in an academic hospital that moved from a centralized to decentralized model. This study examined the impact of walkability, room usage, allocation of time, and visibility to better understand efficiency in the care environment.
A mixed-methods data collection approach was utilized, which included pedometer measurements of staff walking distances, room usage data, time studies in patient rooms and nurses' stations, visibility counts, and staff questionnaires yielding qualitative and quantitative results.
Overall, the data comparing the centralized and decentralized models yielded mixed results. This study's centralized design was rated significantly higher in its ability to support teamwork and efficient patient care with decreased staff walking distances. The decentralized unit design was found to positively influence proximity to patients in a larger design footprint and contribute to increased visits to and time spent in patient rooms.
Among the factors contributing to caregiver efficiency and satisfaction are nursing station design, an integrated team approach, and the overall physical layout of the space on walkability, allocation of caregiver time, and visibility. However, unit design alone does not solely impact efficiency, suggesting that designers must consider the broader implications of a culture of care and processes.
本研究的重点是分析分散式和集中式医院设计布局对高效护理服务的提供以及护理人员满意度的影响。
一个跨学科团队对一家学术医院的心血管服务线进行了多阶段的入住前和入住后评估，该服务线从集中式模式转变为分散式模式。本研究考察了可步行性、病房使用情况、时间分配和可见性的影响，以更好地了解护理环境中的效率。
采用了混合方法数据收集方式，包括用计步器测量工作人员的步行距离、病房使用数据、在病房和护士站进行时间研究、可见性计数以及工作人员问卷调查，得出定性和定量结果。
总体而言，比较集中式和分散式模式的数据得出了混合结果。本研究的集中式设计在支持团队合作和高效患者护理方面的能力得分显著更高，工作人员的步行距离也有所减少。发现分散式病房设计在更大的设计占地面积内对靠近患者有积极影响，并有助于增加对病房的探访次数和在病房花费的时间。
有助于护理人员效率和满意度的因素包括护士站设计、综合团队方法以及空间的整体物理布局对可步行性、护理人员时间分配和可见性的影响。然而，仅病房设计本身并不能单独影响效率，这表明设计师必须考虑护理文化和流程的更广泛影响。
