Freihoefer Kara, Kaiser Len, Vonasek Dennis, Bayramzadeh Sara
1 HGA Architects and Engineers, Milwaukee, WI, USA.
2 HealthEast Care System, Saint Paul, MN, USA.
HERD. 2018 Apr;11(2):89-103. doi: 10.1177/1937586717729348. Epub 2017 Sep 27.
The purpose of this study was to understand how two different ambulatory design modules-traditional and onstage/offstage-impact operational efficiency, patient throughput, staff collaboration, and patient privacy.
Delivery of healthcare is greatly shifting to ambulatory settings because of rapid advancement of medicine and technology, resulting in more day procedures and follow-up care occurring outside of hospitals. It is anticipated that outpatient services will grow roughly 15-23% within the next 10 years (Sg2, 2014). Nonetheless, there is limited research that evaluates how the built environment impacts care delivery and patient outcomes.
This is a cross-sectional, comparative study consisted of a mixed-method approach that included shadowing clinic staff and observing and surveying patients. The linear module had shared corridors and publicly exposed workstations, whereas the onstage/offstage module separates patient/visitors from staff with dedicated patient corridors leading to exam rooms (onstage) and enclosed staff work cores (offstage). Roughly 35 hr of clinic staff shadowing and 55 hr of patient observations occurred. A total of 269 questionnaires were completed by patients/visitors.
The results demonstrate that the onstage/offstage module significantly improved staff workflow, reduced travel distances, increased communication in private areas, and significantly reduced patient throughput and wait times. However, patients' perception of privacy did not change among the two modules.
Compared to the linear module, this study provides evidence that the onstage/offstage module could have helped to optimize operational efficiencies, staff workflow, and patient throughput.
本研究旨在了解两种不同的门诊设计模式——传统模式和前台/后台模式——如何影响运营效率、患者流量、员工协作和患者隐私。
由于医学和技术的快速发展，医疗服务正大幅转向门诊环境，导致更多的日间手术和后续护理在医院外进行。预计在未来10年内，门诊服务将增长约15%-23%（Sg2，2014）。尽管如此，评估建筑环境如何影响护理服务和患者结局的研究有限。
这是一项横断面比较研究，采用混合方法，包括跟踪门诊工作人员以及观察和调查患者。线性模式有共享走廊和公开暴露的工作站，而前台/后台模式通过通往检查室（前台）的专用患者走廊和封闭的员工工作区（后台）将患者/访客与工作人员分开。对门诊工作人员进行了约35小时的跟踪，对患者进行了55小时的观察。患者/访客共完成了269份问卷。
结果表明，前台/后台模式显著改善了员工工作流程，缩短了行程距离，增加了私密区域的沟通，并显著降低了患者流量和等待时间。然而，患者对隐私的认知在两种模式之间没有变化。
与线性模式相比，本研究提供的证据表明，前台/后台模式有助于优化运营效率、员工工作流程和患者流量。
