Canadian hospital raises the bar on acute care inpatient design

Embracing the patient perspective

There's little doubt that evidence-based design played a critical role in obtaining the necessary approvals to move forward with these precedent-setting concepts. In 2000, Trillium Health Centre's interdisciplinary inpatient design team established the vision for future inpatient care by applying four key principles:

• Patients will be older and more complex

• Staff will be older and ergonomic considerations will be critical for staff satisfaction

• A quiet, soothing, homelike environment is desired

• Technology will be evident at the bedside

The team wanted to bring staff closer to the patients and to enable patients to have more control within their own environment. Patient and staff safety was a critical factor. The design also had to be flexible enough to accommodate changing community health needs over the next five decades.

Susan Black, principal architect of Perkins Eastman Black Architects and designer (in joint venture with Parkin Architects) translated the team's vision to paper, incorporating basic principles of sustainable design with patients', doctors', and nurses' input.

Designed to promote healing, improve patient outcomes, and reduce patient stress and anxiety, each of the new wing's 36-bed units features three 12-bed clusters housing six private rooms, one semiprivate room, and one ward room (four beds). With flexibility built in, the ward room can quickly be converted to a semiprivate room with the pull of a movable wall (figure 1).

Central to the wing's design is a two-bed inpatient room configuration that allows for maximum privacy, confidentiality, and safety regardless of what type of room a patient is in. Each patient bed is visible from the corridor and can be accessed through its own door, has its own handwashing sink, offers a separate entrance to the shared barrier-free washroom and has its own picture window offering expansive views of the outdoors (figure 2).

The room design allows for ease of maneuverability when transferring patients onto stretchers or into wheelchairs, and provides ample space for visitors. Given the 45-degree angle of the patient beds, patients in semiprivate rooms can't see one another, and additional privacy can be achieved with the pull of a curtain (figure 3).

The use of abundant artwork, natural light, and vivid colors throughout the units attempts to relieve the sterile feel of traditional hospital spaces. Nine-foot-high corridor ceilings and designated alcoves for the storage of supplies and equipment keep the hallways free of clutter.

Quiet rooms for families, a nutrition station, a patient lounge, and a therapy/education room are available on every floor. Televisions are available at every bedside and internet access will soon be available.

Noisy overhead pagers have been replaced with wireless nurse call devices connecting patients directly with their attending nurse and improving responsiveness to patient requests.

Optimizing healthy workplaces

Poorly designed workspaces often lead to inefficient patient care, and several correlations link the work environment with nurse satisfaction. In hospitals, where nurses experience job satisfaction, the patient outcomes are often positive (Hendrich A. Hospital Work Environments: Implications for Nursing Practice and Patient Care Quality, 2006).