Trends & State of the art design

Technology has taken humans a long way toward achieving efficiency as manual labor has been replaced by machines. However, healthcare remains a very labor-intense business with greater ranges of quality outcomes because of the human elements involved. Only small work segments in healthcare have been mechanized or automated, and quality initiatives have just begun to have an impact on the healthcare environment. Organizations need to examine how technology solutions can enhance the efficiencies gained with process improvement initiatives. In some cases, the use of technology can have a large impact on space. Communication, staff and materials tracking, and robotic systems play a major role in the design of efficient healthcare facilities.

Wireless communication systems, such as Voice over Internet Protocol (VoIP), allow increasingly mobile caregivers to communicate promptly and efficiently. A single wireless hands-free device replaces multiple communication devices such as phones and pagers. Nurses can communicate with team members without having to travel to a central station to find a phone. Users report an increase in direct patient care time and process efficiencies, resulting in improved patient and staff satisfaction while reducing staff stress levels. These wireless systems can also be integrated with clinical applications, sensors, patient monitoring equipment, and nurse call systems.

Patient tracking systems or workflow management systems such as NaviCare and Awarix collect information from a variety of sources and display key highlights to caregivers. Using “real-time whiteboards,” these systems display information for caregivers to alert them about care needs, pending test results, patient location, outstanding orders, and other metrics. Having this information readily available reduces staff time spent calling and/or searching for it and expedites patient care. The patient tracking system is also an invaluable tool for the “Bed Czar” (the person responsible for assigning patient rooms for a healthcare facility). Efficient and effective bed placement results in optimal bed utilization and eliminates bottlenecks that result in delayed placement or bypass situations.

Bar coding is used to identify and track assets, patients, and medications. Many hospitals primarily use it for medication administration to reduce errors and to improve documentation accuracy. According to Kohn, medication errors nationally cost an additional $2 billion each year (2000). Inventory control and patient tracking can be accomplished using the same technology. Bar code scanners are being incorporated into laptops, handhelds, or other portable devices that can be taken to the patient bedside, making their use more practical and making staff more efficient.

Radio-frequency identification devices (RFID) use wireless technology to transmit product serial numbers from tags to scanners without human intervention. Scanners are placed intermittently throughout the facility similar to using an antenna for telemetry. Caregivers then can view a central scanner to locate personnel and supplies. This technology has the potential to replace bar code inventory tracking systems because it has immediate and automatic data capture resulting in fewer potential medication errors, reduced travel time for caregivers, and improved inventory control.

Telemedicine robots, surgical assist robots, telerobots, and service robots are becoming more popular in healthcare facilities. (Cohen, 2008). Telemedicine robots collect and transmit patient information to remotely located physicians for diagnosis and treatment. One growing use of the telemedicine robot is for stroke teleconsultations in rural Emergency Departments (EDs). Surgical assist robots such as the da Vinci Surgical System are guided by surgeons using 3-D visualization to perform minimally invasive surgery (Tsui & Yanco, 2007). Telerobotic surgery is being tested for surgeons to operate on patients in other locations. Service robots are primarily used to pull supplies, including medications and equipment, or to haul soiled linens and waste through healthcare facilities. The use of robots to do delivery types of services frees staff to perform other patient-centric activities. Buildings, however, need to be designs to accommodate the technology that supports the increased use of robots.

Nurses reportedly spend an estimated 2-to-3 hours per shift manually completing forms and documenting patient care (Poissant, Pereira, Tamblyn, & Kawasumi, 2005). Beyond the inefficiency of handwriting information, these statistics often raise concerns about legibility and completeness of records. However, though the benefits of an electronic medical record are numerous, to improve staff utilization and efficiency, the technology needs to be mobile and easy to use. Handheld wireless devices and tablets with docking stations can be taken to the bedside for nurses to document care at the time it is completed. Real-time data input from equipment further saves the nurse time transferring that information. Improved efficiency and accuracy result. As other software applications are developed, building layout and design must support decentralized documentation.

Building on the interest and ability of patients to use technology in their personal lives, healthcare facilities are integrating interactive patient technologies into their designs. The multimedia and communication systems being offered include customized patient education programs; entertainment options of cable, Internet access, movies on demand, and video games; and hospital service options such as food service orders, housekeeping requests, and satisfaction surveys. Other interactive patient technologies include registration and information kiosks. Registration kiosks function similar to those used in airports and hotels for check-in, check-out, and appointment scheduling. Interactive maps of the building and campus are provided in facility lobbies. Besides being a customer convenience, these interactive technologies free hospital staff to provide other services. They impact design by reducing the amount of needed space.

When designing healthcare facilities, plan for the technology infrastructure needed to support future innovations. The ultimate design goal is the full integration of clinical and building systems (Koch, 2007). Use additional planning to convert vacated space after the new technology is implemented. One good example of how technology significantly reduces the need for space is the impact of an electronic medical record on the amount of space needed in the medical records department.