Design Researcher, EwingCole, Raleigh, NC, USA.
Six Sigma Green Belt, Healthcare Planner, EwingCole, Raleigh, NC, USA.
HERD. 2019 Oct;12(4):99-115. doi: 10.1177/1937586719826055. Epub 2019 Feb 5.
This article evaluates the effects of technology integration and design features in clinical exam rooms on examination experiences, communication, and satisfaction.
Exam room features can affect the delivery of patient-centered care and enhance the level of communication, which has been shown to directly impact clinical outcomes. Although there has been an increasing body of literature examining design and patient-centered care, little research has evaluated the extent to which information sharing and electronic health record (EHR) interaction are impacted.
The research randomly allocated 22 patients, 28 caregivers, and 59 clinicians to simulated clinical encounters in four exam room mock-ups with semi-inclusive, exclusive, and inclusive layouts (128 sessions in 32 scenarios). Video recordings of the simulations were coded for clinician gazing, talking, and EHR-interaction behaviors. Participants also completed surveys and answered open-ended questions after experiencing each scenario ( = 362).
Semi-inclusive rooms with a triangular arrangement of consultation table, sharable screens, exam table, and caregiver chair were highly preferred as they supported conversation, gazing, and information sharing. The layout had higher durations of EHR interactions and enhanced viewing and sharing of EHR information. However, this layout was criticized for the lack of clinician-shared information. The layouts impeded information sharing, eye contact, and constrained simultaneous data entry and eye contact for clinicians. The distance and orientation between chair, exam table, curtain, and door were important for protecting patient and family comfort and privacy.
Characteristics and configurations of design qualities and strategies have a key role on examination experiences, communication, and satisfaction.
本文评估临床检查室中的技术整合和设计特点对检查体验、沟通和满意度的影响。
检查室的特点会影响以患者为中心的护理的提供，并增强沟通水平，而沟通水平已被证明会直接影响临床结果。尽管已经有越来越多的文献研究设计和以患者为中心的护理，但很少有研究评估信息共享和电子健康记录（EHR）交互的程度。
研究随机分配了 22 名患者、28 名护理人员和 59 名临床医生在四个模拟检查室模型中进行模拟临床接触，这些模型具有半封闭、封闭和开放布局（32 种情况下的 128 个会话）。对模拟视频记录进行了编码，以记录临床医生的注视、交谈和 EHR 交互行为。参与者在体验完每个场景后还完成了调查和回答了开放式问题（=362）。
三角形布局的半封闭房间，咨询桌、可共享屏幕、检查台和护理人员椅子，非常适合支持对话、注视和信息共享。布局具有更高的 EHR 交互持续时间，并增强了 EHR 信息的查看和共享。然而，这种布局因缺乏临床医生共享的信息而受到批评。布局阻碍了信息共享、眼神交流，并且限制了临床医生同时进行数据输入和眼神交流。椅子、检查台、窗帘和门的距离和方向对于保护患者和家属的舒适和隐私至关重要。
设计质量和策略的特征和配置对检查体验、沟通和满意度起着关键作用。
