Tom Ryan
June 14, 2019
Central Mass HEALTH - Summer Edition
Build better patient recovery rooms
By Tom Ryan
When someone suffers from a serious injury, ailment or life-threatening event where a trip to hospital is required, that patient may start in the intensive care unit, be moved to an intermediate care unit and then as recovery improves ultimately be transferred to a medical/surgical unit before being discharged. All of these transfers are rife with inefficiencies, missed or delayed treatments, medication errors, patient falls and contact with numerous caregivers.
On the horizon is a better way for hospitals to design their care: acuity-adaptable patient rooms. These are cutting-edge rooms allowing the care to come to where the patient is – via portable telemetry and diagnostics – rather than the patient moving.
As hospitals around the country struggle with overcrowding, the acuity-adaptable room is quickly becoming the answer. AA rooms would serve medical/surgical and intermediate care (also called step down) units and allow patients to stay in a centralized room from admission through discharge. Studies have shown these AA rooms lead to less wasted time and resources waiting on transfers and greater patient safety, so it’s easy to see why this model is enjoying a resurgence. A New Hampshire hospital put out an architectural request for qualifications asking for experience in the design of AA patient rooms, so you can see where some hospitals are headed.
The American College of Emergency Physicians says the lack of available patient rooms leads to the overcrowding of the emergency department as patients wait for admission. This condition is known as boarding. The extensive boarding time of patients leads to several problems: ambulance refusals, prolonged waiting times, and increased suffering for those waiting on gurneys in hallway corridors. When emergency departments are overwhelmed, the hospital’s response to community emergencies and disasters is compromised. By reducing the number of patient transfers, AA rooms have proven to reduce delays.
There’s another value-add to AA rooms – long-term survivability. Over the past decade, nearly 100 rural hospitals have closed. A CEO of a community hospital told me these rural hospitals maintain too many patient beds. Since the reduction of patient transfers directly affects the average length of stay in a hospital, the number of patient beds could be reduced, thereby saving the facility considerable financial resources to be redirected to more value-added services.
So, what can AA rooms mean to a hospital, and what’s the best way to go about implementing them?
For starters, cost needs to be considered. Big proponents of AA rooms would argue they should be able to handle all care, from ICU through discharge, but given hospitals would have to double the size of the patient room to account for the ICU requirements, that suggestion isn’t practical. A more realistic scenario calls for AA rooms to rotate between intermediate care and medical/surgical units, allowing the care to fluctuate. Instead of doubling a room’s size, the most significant of these requirements would be an increase in minimum clear floor area (20 square feet), and medical gas outlets.
Opinions vary about the practicality of AA units, with some arguing an acuity-changeable model is more appropriate. At a hospital I worked on in North Carolina, senior management opted for an acuity-changeable model where the rooms are constructed so it would take minor modifications to renovate to different patient acuity levels when future census of acuity demographics or organizational changes occur. This model allows for organizational flexibility, but since patients still must be moved based on the care they need, it does not address the delay in patient transfers and the resulting overcrowding, quality of care and patient satisfaction issues.
With no single, isolated solution, flexibility and adaptability will need to reflect the overall mission for the hospital of the future. AA rooms will benefit all stakeholders – patients, families, care providers and administrators - addressing major issues such as patient safety, decreased length of stay and a cost-effective care delivery model.
If you’re not yet considering acuity-adaptable rooms for your hospital, perhaps it’s time you should.
Tom Ryan is a senior project manager at Harvard firm Maugel Architects.
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