Curbside to Bedside
Although pulling up to a curb and getting “healthcare-to-go” isn't in the foreseeable future, healthcare design that starts at the curb, is. Whether you're a patient or a visitor, a trip to the hospital is very rarely under ideal circumstances. Cognitive functions are not at the most heightened state and minds are overwhelmed with thoughts of concern and sometimes panic. We don't want to ask questions. We don't want to be confused. What we want is to reach our destination as quickly as possible and get quality service, if at all possible, with a smile.
To accomplish this, the healthcare process must start from the moment an individual pulls up to the curb. Among other things, this is done by choreographing the patient experience through planning, as well as designing a hospital that is patient-friendly, easily accessible, and concise in its design. More so, small touches and considerations should be taken to bring the healthcare process to the next level. Directions should be easy to understand, staff should be readily available to assist, and patient needs and well-being must be at the forefront of the hospital's mission.
The following is a walk-through of how to apply the “curbside to bedside” train of thought to healthcare projects:
Emergency Room/Unplanned visits
For the guest who is coming to the hospital for the most traumatic experiences, the emergency department is, of course, the front door. Whether the patient is arriving by ambulance or walk-in, the pathway to the entrance needs to be clear and manageable. Wayfinding and intuitive design play a dominant role in this-wayfinding in the form of landmarks, signage, or building elements, and intuitive design making things easy to understand.
Once a clearly located emergency entrance has been created, special attention needs to be given to separating walk-in patients from trauma cases. Close attention needs to be paid to screening the walk-in patient from an ambulance or trauma entry.
For the conscious patient and family member using the emergency department, parking and covered drop-offs are not seen as luxury items-they are a must. Once entering into the facility, guests should be met by clinical staff who can do a visual triage, asses the immediate need and place the patient in the appropriate exam room. If an exam room is not available, a relaxing environment with natural light, comfortable seating, and guest amenities should be offered.
Once in the exam room the patient is at “home base.” From this location, clinical assessment, registration, treatment, and discharge can happen. If the patient must leave to go to additional diagnostics, they should return to the exam room or be admitted. The patient must at all times know that he or she has a place and is not just being shuffled around from room to room.
For the patient who has a planned procedure, the front door should offer transparency and ease of navigation to the final destination. Once entering through the front door, a guest should experience more of a hospitality feel than one of a clinical institution. Having a host or concierge on hand who can easily direct patients to their destination is useful. If such a person is not available, easy wayfinding should be incorporated to aid in the journey. Special attention should also be given to recognizing that every visit is not necessarily the patient's first. Possibly helpful details might include check-in kiosks or patient access cards that allow them to move quickly through many of the initially cumbersome processes.
The environment should be easily navigated so that patients and families can find each other. Aiding in ease of navigation is providing a clear distinction between public and private areas. Support carts, inpatient gurneys and wheelchairs, and dietary service should not co-mingle with the public procession. With a clear separation established, access to the public functions and service portals should be as close to the public right of way as possible. Taking cues from retail and hospitality, place-making zones such as lobbies, promenades, and atriums are good ways to mark destinations, organize elements of circulation, and provide access to points of service. Each portal acts as the gateway to the healing process whether it is surgery, radiology, or another diagnostic procedure. From a staff point of view, separation is not only good to reduce traffic, but it provides a safer and more deliberate caregiving zone.
Let's say the patient has gone through entrance processes and has moved into the inpatient zone. The idea of public and private separation is still important. Many refer to this as “onstage” and “offstage.” This furthers the implication of a choreographed experience. A reduction in physical and visual clutter, as well as a decrease in noise and physical activity, all play a role in creating a more healing inpatient environment. Additionally, decentralized workstations provide medical staff with line-of-sight and convenient access to support and information services to provide immediate care to the patient.
For many patients and family members, the hospital stay can move from highly acute to less intensive with a stay of 4-7 days. The idea of a universal room of activity or adaptable room is used to describe a process that allows a patient to stay for intensive care to discharge in the same room. Many schools of thought vary on whether it is a good practice or even practical for a patient to stay in the same room for the continuum of their care. Nursing care may not work well as the patient transitions, and in some cases the patient may need to feel a sense that they are moving forward in their recovery by transitioning into another room. Whatever the case, universal and same-handed rooms are options that should be looked at. These rooms allow for flexibility, error reduction, and helpful familiarity for the family, patient, and staff. Finally, providing large enough rooms for families to join in the healing process is essential. This includes access to a bathroom and shower facilities and areas for overnight stays if they are required.
So the walk-through comes to an end. The physician has discharged the patient at an appropriate time and the personal touch of a bellhop or escort to the covered carport rounds out the experience.
With most people, having a choice in their healthcare, safety, and aptitude are not the issue. Patients expect to get good care wherever they go; it's the finer details that separate one institution from another. If healthcare providers pay attention to the finer points, patients will find comfort in realizing that the small things received the same attention as major items such as diagnosis and procedures. Good design, an integrated process, and a choreographed experience send this message to the patients, staff, and communities who are touched by the buildings we create. HD
Jim Henry, AIA, is the lead designer of the HDR Dallas Design Center.
For more information, visit http://www.HDRInc.com.
Healthcare Design 2010 May;10(5):68-69