Designing for Safety

Designing and detailing the next generation of patient rooms to decrease falls and hospital-acquired infections (HAIs) is extremely significant for our healthcare systems. Since Medicare/Medicaid reimbursements to hospitals are continuing to decrease, it is more important than ever for the healthcare industry to address unreimbursed “never events.”

In addition, the Center for Medicare/Medicaid (CMS) has taken a nonreimbursable stance to hospitals on “never events,” or its 28 serious reportable events. Hospitals cannot pass these costs along to patients. This causes unreimbursed losses to hospitals and healthcare systems to the tune of millions of dollars.

Of these 28 “never events,” 70% occur because of two major causes: pressure ulcers and patient falls. According to the American Hospital Association, in 2009, pressure ulcers cost $43,180 and injuries due to falls cost $33,894 per occurrence, on average. In the same year, pressure ulcers cost healthcare systems overall $11.1 billion, and falls with injuries cost $6.5 billion. These events force longer patient stays and make patients vulnerable to HAIs. The CMS is now considering decreasing reimbursement to hospitals for certain HAIs, in addition to already cutting funding for “never events.”

Charting a course toward a safer patient room

Francis Cauffman assembled an expert advisory committee, with members from across the spectrum of the healthcare industry, to work with the architecture firm’s healthcare team and take a look at the design of patient rooms. The goal was to solve the problem of patient falls, prevent HAIs, and, in the process, save hospitals money. The committee included patients, a patient safety expert, a legal advisor, a finance/risk assessment expert, an infection control risk assessment specialist, nurses, physicians, vendors for beds/headwalls/lifts, and MEP engineers.

Research and evaluation

The team evaluated the designs of existing patient rooms and investigated the reasons why patients fall. The committee determined that most falls could be attributed to either the design of the patient room or incidents of patients getting out of bed unassisted and unobserved. The attributing causes were:

• Limited views into patients’ rooms. Some room designs restrict visibility of patients from corridors and nurses’ stations.
• Limited family space. This causes fewer family members to be present in rooms and less able to observe patients.
• Poor access to toilet rooms. Most patient toilet rooms are located across the room from the beds, which creates unassisted travel paths from beds to toilet rooms. Often as patients are recovering, they think they are well enough to leave their beds unassisted when they are not yet ambulatory.
• Small toilet rooms. Historically, bathrooms are designed for only one person and often have no grab bars.
• Poor lighting. Most patient rooms are lit for daytime use with only one supplemental light used for nighttime. This leaves the travel paths to the patient toilet rooms poorly illuminated, which causes falls.
• Slippery materials. Flooring materials and other finishes can cause patients to become unsteady as they are toileting or showering.
• Lack of patient control of the room environment. Patients often try to exit their beds to adjust lighting levels, close window shades, or retrieve items from across their rooms.
• Lowered bed rails. These cause patient falls, especially during sleeping hours.

Creating safe solutions

To solve these design deficiencies, the committee applied evidence-based design (EBD) principles to create a room with several important design solutions focused on patient safety. The principles of a truly safe patient room include: