Let's start at the very beginning” may apply as much to designing an acute care patient room as to learning to sing. Much is written about patient room configuration and the importance of understanding the implications of choices in layout (same-handed or mirrored rooms?) and the location of room zones and components such as the patient toilet. Yet successful patient room design often hinges on a series of critical choices that are rarely discussed: those made in the first 15 feet-the width of the patient room and its interface with the corridor.

The patient room grows up

Planners didn'talways have 15 feet to work with. As recently as 10 years ago, patient rooms were doubles, designed with a width of just 13 feet. The single-patient room width has increased in response to a variety of needs, including longer beds, larger patient bathrooms, and family space.

While patient rooms still come in all shapes and sizes, the majority of new rooms have a nominal width of 15 feet, defined by the common structural bay size of 30 feet. After excluding partitions between patient rooms, there is a clear width of approximately 14′6″, a relatively limited amount of space in which to handle all of the movement, visibility, and support functions that jockey for position along this transitional edge.

Establishing priorities

Planning a bed tower is rich with the seductive sense of limitless space, and it is easy to be lured into a false sense that everything can fit. Failing to develop priorities for the corridor interface early in the planning process can mean a harsh reality check later, when you discover that you've given away space you didn'thave. Decisions about what should or should not be included along the corridor/room interface cannot be made without thorough consideration of all potential elements.

Priority is given to a wide door (with wing), supply closet, and a documentation station that can accommodate two medical staff.

Doors

The need to plan for a door may be apparent, but in terms of space, even doors are not what they once were. Managing the movement of people and equipment between the corridor of the nursing unit and the patient room is a primary function that must be accommodated. As patients and support equipment have gotten larger, so too have the doors into patient rooms. For the past several years, we have typically added a second smaller door leaf to the four-foot-wide patient door so that the door opening is closer to five or five-and-a-half feet in the acute care setting. In an ICU, where the ability to move a critically ill patient and/or a large amount of equipment and staff, as well as provide enhanced visibility from the corridor is important, doors and door openings may be almost twice as large. For an acuity-adaptable patient room, the issue of door width and door type requires careful consideration (see sidebar, pg. 35).

Need: Required

Space requirement: 5′6″ minimum

Options for the corridor-room interface

Documentation stations

Three factors are driving the placement of documentation stations just outside every patient room: the move to single-patient room nursing units, which have resulted in much larger nursing units (on a square-foot-per-bed basis), the desire to keep nurses closer to patients, and the expanded use of computers for documentation and other work.

When nursing unit design began to include documentation stations, they were often seen as a transitional element until the installation of bedside or in-room computing. However, nurses at in-room workstations face a balancing act, trying not to disturb a sleeping patient, and avoiding disrupting (or being disrupted by) visiting family. We have found that many hospitals that incorporated workstations within the patient room without an external documentation station are now planning for external stations in their new nursing units, while retaining workstations within the room. In most instances, documentation stations enhance visibility to the patient from the corridor; while this is ideal in an ICU, patient privacy must be accommodated in an acute care environment. A documentation station is likely to require a minimum of two feet along the corridor/patient room edge if one station is shared between two rooms. The inclusion of documentation stations is more challenging for institutions interested in same-handed rooms: if patient rooms are to be truly identical and consistent, each room will require a dedicated documentation station, with a likely minimum width of four feet. If it is a priority, documentation stations can be made large enough to accommodate more than one person, and may also provide storage for supplies.

Need: Optional

Space requirement: 2′ (when accommodating two rooms); 4′ (for even-handed room units)

Six-foot patient door, supply closet, two-person documentation station.

Six-foot door with added sidelight for patient visibility, supply closet with pass-through to in-room nurse server; and two-person documentation station.

Supplies and nurse servers

The same decentralization pressures behind the demand for documentation stations have resulted in a resurgence of nurse servers and the provision of supplies available to staff at every patient room. Improved infection control and provision of caregiver precautions without littering corridors with carts also contribute to the need to locate these materials outside of the patient room. The question of what supplies should be kept within the patient room is an ongoing discussion at many hospitals, where issues of cost and inventory control, as well as security concerns mean a reduced in-room complement. Whether a true nurse server (a throughwall system that allows access to supplies from both outside and inside the patient room) or a single-sided cabinet or closet accessible only from the corridor, a supply area is likely to require at least two feet in width.

Need: Optional

Space requirement: 2′ minimum

Decentralized medications

The location of medication supply at each patient room may reduce the risk of medical error and assist medical staff, allowing nurses to review and prepare medications without distraction. Medication supplies may be incorporated as part of a documentation station as drawers or a cabinet, either of which may be part of a throughwall system. If included as part of the documentation station, an additional one-and-a-half feet is likely to be required; if part of a nurse server or cabinet, no additional width is likely to be needed.

Need: Optional

Space requirement: 0′ if part of supply/nurse server unit; 1′6″ (if part of documentation station)

Building support

Although still relatively rare, increased concern for sustainability and energy efficiency may directly impact the area available between the corridor and patient room. Such is the case at Sherman Hospital in Elgin, Illinois. At Sherman, a geothermal space conditioning system will minimize the need for major mechanical spaces within the new hospital but does require a heat pump for every patient room. To minimize downtime during filter exchanges, heat pumps are located just outside of each room, adding another competing element for the 15 feet between the corridor and patient room. In the case of Sherman, heat pumps are raised and take up 2′ x 2′; an enclosure for a soiled linen hamper accessible from the patient bedroom is located below the heat pump.

Need: Variable (depending on building requirements)

Space requirement: 2′

Patient toilet

Locating the patient toilet remains one of the most important factors in patient room design. The benefits of an inboard toilet (along the corridor wall) have been well documented, and include a larger window wall, which is optimal for siting the room's family zone. However, by choosing to site a toilet inboard, the toilet room's seven-foot width means at least one, and more likely two, elements detailed earlier will not be accommodated along the corridor/patient room wall. For acuity-adaptable rooms the location of the toilet may be a given (see sidebar).

Need: Optional (may be located outboard, along window wall)

Space requirement: 7′

Placing the toilet on the corridor wall and fitting in a small documentation station means a four-foot door.

Building support requirements (heat pump locations in this case) are central to the design of this room-corridor interface.

Now what?

Clearly not all of the elements that might be important to the design and function of a patient bedroom and might best be located along the wall between the nursing unit corridor and the bedroom will fit in the available 15 feet of space. Although widening patient rooms might allow for the inclusion of one more element, it would likely do so only by increasing the total square footage of the bedroom and the nursing unit (with a significant impact on project cost), as well as the distances nursing staff must cover.

The real answer to designing a successful patient bedroom lies in understanding all of the required and desired elements within and just outside of the room and the implications of their location. Realizing the limits to accommodating all of the desirable elements along the first 15 feet between the corridor and the patient room is the first step. After that, it is an issue of assessing priorities and options, and sticking with them.

When you know the notes to sing, you can sing most anything. HD

Jennifer Aliber, AIA, ACHA, LEED AP, is a leader in healthcare design at Shepley Bulfinch, where she specializes in master planning and healthcare programming and planning. Jennifer was a contributing author to ICU 2010: A Critical Care Design, published by the Center for Innovation in Health Facilities. For more information, visit

http://www.sbra.com.

Sidebar

Acuity adaptability

Acuity-adaptable (or universal) patient rooms1

A distinction should be made between acuity-adaptable rooms (a single room type that supports patients of all acuities but may be used in distinct acute and critical care nursing units with patients transferred as required) and acuity-adaptable operations (the patient stays in the acuity-adaptable room throughout their stay). Many hospitals have chosen to build acuity-adaptable rooms so that they may easily adjust the balance between acute and critical care beds and nursing units, even if they never intend to utilize an acuity-adaptable nursing model, or in anticipation of a future cadre of nurses who are willing and able to make adjustments in patient acuity.

-rooms that can support both acute and critical care patients with little or no architectural modifications-may be more straightforward or more complicated than regular acute care rooms when it comes to designing the first 15 feet. As acuity rises, so does the need for visibility and patient access. Most ICU rooms are still designed with sliding glass breakaway doors, with an average width of nine feet (though widths may range from 7 to 12 feet, depending on the type of door system and desired opening dimension). Documentation stations are almost ubiquitous in contemporary ICU rooms, further reducing the available space along the corridor/patient room interface and limiting supply storage opportunities. Requirements for extended door width and documentation stations mean that the toilet/shower is almost always outboard in an acuity-adaptable room. Healthcare Design 2009 June;9(6):28-35