When considering the implementation of policies for risk reduction in acute care, the optimal approach takes a multidirectional course of action. This involves tackling risk reduction in a multifaceted way – leveraging education, forming operational policies, instituting reporting and tracking methods, as well as intervening through the built environment. In the US, as many as 22,000 preventable deaths occur in hospitals every year. This statistic highlights the importance of mitigating risk to patients wherever possible, and it is also important to bear in mind risk factors in the workplace that contribute to staff injury, fatigue, and burnout. Auditing risk incidence and trends related to incidents when designing or updating acute care facilities allows the built environment to be leveraged to play a role in risk reduction.
Design Features for Risk Reduction to Acute Care Patients
A number of risk factors pertain to patients in acute care units, with one of the primary concerns for facility managers being the mitigation of fall risk. In up to 39% of patient falls, the physical environment is a contributing factor in the incident – highlighting the importance of acknowledging safety risks in the built environment, and making patient-centricity a core focus in designing acute care spaces. Furthermore, falls in which patients were injured cost facilities on average $13,316 in operational value, and prolonged patient stays by 6.3 days. Risk reduction through design is not a one-size-fits-all process, however, as different treatment units will need to implement different measures to cater to the specific needs of the patients they house. Many fall incidents occur due to patients miscalculating their own capabilities – for instance, after a hip surgery or undergoing treatment for a stroke. Additionally, falls are more prevalent in neuroscience and geriatric units, as well as in the transfer of patients between ICU and other treatment units. These units will need to implement specific and targeted systems and procedures to reduce the risk to vulnerable patients.
There are several simple design features that can be built into acute care treatment spaces to promote the reduction of fall risk. Lighting, flooring, signage, and unit layout can all be utilized to create a safer environment for patients. Firstly, flooring and subflooring are often highlighted in studies as the most important factor in mitigating fall risk. The selection of non-slip materials and procedural protection from spills is likely to help reduce injuries from falls, and the incidence of falls. Creating even and smooth walking surfaces that are free from obstructions is important, as well as designating clear and unambiguous travel paths which are non-patterned and unaffected by glare. As well as selecting highly visible and non-slip materials, colors and contrast should be utilized to aid patient and staff visual perception during transit.
Standardizing the layout of patient rooms is another useful technique in acute care risk reduction. By standardizing the design of rooms and the location of supplies and medical equipment, staff familiarity with treatment environments is improved while also reducing time spent locating supplies or equipment. This in turn improves staff efficiency and allows caregivers to familiarize patients more effectively with the environment. Studies have revealed that the efficiency of treatment units is determined by layout rather than by their size or level of occupancy, suggesting that standardizing room layout for efficiency can have a significant impact on workflows and patient safety.
When designing patient bathrooms, it is important to ensure that sufficient space is allocated to accommodate a variety of patient types and any equipment they might need, as well as allowing room for caregiver assistance. Building in grab bars for patient support helps to reduce fall risk in transit – as well as ensuring bathrooms are located in proximity to patient beds and paths are clearly visible, even in low light conditions. Low level lighting must be present even in dark conditions to aid patient transit. Additionally, ensuring call bells are within reach of patient bed areas reduces the need for patients to overreach and expose themselves to harm. Adjustable furniture seating heights within rooms is also important to accommodate a variety of patient types and aid ingress and egress to and from seating and beds. The elimination of clutter via adequate storage space also works to reduce tripping hazards.
Design Features for Risk Reduction to Acute Care Staff
Separately, clinical staff face several areas of risk in the workplace from repetitive strain and excessive workloads without properly administered rest breaks. Extended work hours, working consecutive shifts, and insufficient sleep or rest all compound to diminish staff wellbeing. Studies have revealed that in 10% of shifts, nurses have no opportunity to rest – and even when able to rest, in 43% of shifts nurses are not free from care responsibilities during their breaks. In part, this is due to inadequate staff rest break areas. Insufficient rest increases risks in several areas for clinical staff – such as an increase in the frequency of needlestick injuries. These injuries are estimated to cost hospitals around $200,000 per year to treat and could be mitigated with the implementation of proper resting protocols and the creation of suitable rest areas. Inadequate rest and overworking also increase the incidence of musculoskeletal injuries among clinical staff. As well as physical injuries, staff suffer an increased risk of depressive and behavioral disorders from a lack of rest. This in turn contributes to a downturn in alertness and motivation, as well as increasing the frequency of attention lapses. More lapses in attention lead to errors, as well as a reduced ability to identify errors made by others. Tired staff may be perceived as less attentive to patients, meaning overall care quality suffers.
Rest Areas and Unit Layout
Consequently, it is prudent for facility managers to consider how risk reduction can be implemented through design of the built acute care environment. Nurses report that the size, aesthetics, and location of break rooms are often unsatisfactory – features that can easily be improved through a careful design approach. Firstly, it is important to note that workspaces without adequate windows or ventilation are commonly associated with poor staff health and negative attitudes towards work. Conversely, spaces that provide views of nature mitigate the negative effects of job-related stress. Exposure to daylight and access to outdoor recreational spaces similarly works to enhance well-being. Building proper ventilation and natural lighting features into staff spaces is a simple way of reducing stress and promoting relaxation. Furthermore, providing lush outdoor spaces or gardens for staff to explore during rest breaks helps to remove caregivers from stressful work environments – impactful rest breaks require a change of mindset, rather than simply pausing work activities.
On a similar note, the allocation of dedicated sleep and rest areas for nurses and caregivers can also help to reduce the ill-effects of long and stressful shifts. Restorative breaks work to improve staff health and attitudes about work. Effective rest areas must function as a sanctuary, giving staff much-needed personal space, privacy and quiet. Additionally, treatment units can be designed to promote efficiency and reduce care interruptions. Instead of designating a single centralized nursing station, designers may consider allocating space for several decentralized stations placed at strategic points throughout the unit. This works to reduce staff transit time in looking for equipment or materials, and in filing and administration. The reduction in time spent traveling to and from a central nursing area gives staff more time to spend with patients and thereby improves patient monitoring. Consulting nursing staff on unit design and improvements such as this can help build efficiencies into the working environment.
When considering the reduction of risks to patients and staff in acute care facilities, it is important to take a multidirectional approach that incorporates patient and staff education, the forming of stringent procedures, and building risk reduction features into the physical environment. Taking a considered approach in the design of treatment facilities can help meet the needs of patients and caregivers, while mitigating the impacts of risks in the environment.
Champion Chair’s Human-Centric Furniture Solutions
Here at Champion Chair, patient and staff safety and comfort are at the core of everything we do. We design our products to look after your people across the full treatment journey. Contact us today to find out how Champion Chair can help your facility provide an outstanding care experience. Take a look at our most recent article on trends in furniture design for acute care for more information on how we are keeping up with best practices in designing furniture for acute care.