WHD_2014_Where Research Meets Design
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WHERE RESEARCH MEETS DESIGN Using Parametric Modeling to Optimize Walking Distances and Enhance Workflow
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Transcript of WHD_2014_Where Research Meets Design
WHERE RESEARCH MEETS DESIGNUsing Parametric Modeling to Optimize Walking Distances and Enhance Workflow
• Adeleh Nejati, MArch, EDAC
• Tom Harvey, FAIA, MPH, FACHA, LEED AP
• Upali Nanda, PhD, Assoc. AIA, EDAC
• Heath May, AIA
• Ryan Gathmann, AIA
WHY RESEARCH IS “IN”
3INITIATIVES
PARAMETRIC MODELING
• Designing a process rather than a form
• Designing a reusable and configurable process
• Creating a nearly infinite number of variations from one rule set of inputs, decisions and actions
• Optimizing by quickly creating,
testing and comparing multiple
options
IMAGE
PARAMETRIC MODELING
THEORETICAL FRAMEWORK
DRIVER(MANIPULATED FEATURE)
Distance from a Patient Room to: • Medication Room• Clean Supply room• Soiled Utility Room• Equipment Holding room• Crash Cart Alcoves• Documentation Station(s)
DRIVEN LEVEL 1ENVIRONMENTAL QUALITY
• Walking Distance- PR to Support Area- Support to Support- Support to PR
DRIVEN LEVEL 2HUMAN OUTCOME
• Time in Bed-side Care• Time in Non-Value
Added Activities• Nurse Fatigue
DRIVEN LEVEL 3HUMAN/ ORGANIZATIONAL OUTCOME
• Med Errors• Falls• HCAHPS• Nurse Retention
CONSTRAINT(CONTROL/CONFOUND)
• Room Size• Unit Size• Minimum Clearances
(patient bed, toilet)• Maximum Distance
THEORETICAL FRAMEWORK
CASE STUDYCentralized vs. Decentralized Nurse Stations
PATIENT ROOMS
CENTRALIZED NURSE STATIONS
36
3
METHODIST CHARLTON HOSPITAL
DALLAS, TX
DECENTRALIZED NURSE STATIONS
18
Each nursing unit in this hospital has:
IMAGE
METHODIST CHARLTON HOSPITAL
DALLAS, TX
Scenario 1
Scenario 2
Scenario 3
36 Bed Unit
METHODIST CHARLTON HOSPITAL
DALLAS, TX
Scenario 1
Location ActivityMinimum Roundtrips
per Primary Shift1
Documentation Station(s) Documentation 10.0
Consultation/Collaboration
Socialization
Medication Room Meds Management/Admin 5.0
Med Prep
Med Supply Acquisition
Clean Utility Room Supply Use Management/Admin 3.0
Medical Supply Acquisition
Clean Linen Acquisition
Soiled Utility Room Waste Disposal 2.0
Dirty Equipment Holding
Soiled Linen Holding
Equipment Holding Room Equipment Storage 1.0
Broken Equipment Holding
Nourishment Room - Meals Food Tray Hold/Retrieval 3.0
Used Tray Holding
Nourishment Room - Ice/Snacks Snack/Drink Acquisition 4.0
Ice Pack Acquisition
Break Room Personal Effects Access/Toilet 3.0
Education
Respite
Patient Transport (Service Elevators) Link to Surgery, Imaging, Other D&T 0.2
Link to other Bed Units
Link to Discharge (Lobby)1These figures are theoretical assumptions for purposes of this study. Actual trip counts measured through shadowing in the field often show higher frequencies.
Round Trip and Distance Parameters for Nurse Travel from Patient Rooms
METHODIST CHARLTON HOSPITAL
DALLAS, TX
Patient Room 1
Patient Room 2
Patient Room 3
Patient Room 4
TOTAL
Centralized 0.673 0.708 0.681 0.819 2.881
Scenario 1 Decentralized 0.491 0.549 0.55 0.67 2.26
% reduced %27.0 %22.5 %19.2 %18.2 %21.6
Centralized 0.857 0.831 0.805 0.796 3.289
Scenario 2 Decentralized 0.702 0.635 0.56 0.509 2.407
% reduced %18.0 %23.6 %30.4 %36.0 %26.8
Centralized 1.346 1.183 1.167 0.952 4.647
Scenario 3 Decentralized 1.063 0.942 0.929 0.795 3.729
% reduced %21.0 %20.3 %20.4 %16.5 %19.8
METHODIST CHARLTON HOSPITAL
DALLAS, TX
Walking Distance for Centralized vs. Decentralized Nurse Stations
METHODIST CHARLTON HOSPITAL
DALLAS, TX
0.000
0.200
0.400
0.600
0.800
1.000
PR1 PR2 PR3 PR4
Scenario 1
0.000
0.200
0.400
0.600
0.800
1.000
PR1 PR2 PR3 PR4
Scenario 2
0.000
0.500
1.000
1.500
PR1 PR2 PR3 PR4
Scenario 3
0.000
0.500
1.000
1.500
2.000
2.500
3.000
3.500
4.000
4.500
5.000
Scenario 1 Scenario 2 Scenario 3
Centralized Nurse Station
Decentralized Nurse Station
Walking Distance for Centralized vs. Decentralized Nurse Stations
21.6%26.8%
19.8%
IMPLEMENTATION IN PRACTICE
WINGS
NURSE STATIONS
2
4
PROMEDICA TOLEDO HOSPITAL
TOLEDO, OH
PATIENT ROOMS
40
Each nursing unit in this hospital has:
40 Bed Unit
20 Beds
20 Beds
200.075
115
83
81.55
79.725
68.25
59.875
59.325
50.8
24.125
0 50 100 150 200 250
Break Room
Nourishment
Conference
Soiled Work
Equipment
Ice
Main Nurse Station
Meds
Linen
Wow Stations
AVERAGE DISTANCE FROM PR TO SUPPORT SPACES
NURSE WALKING DISTANCES
Excessive Distance
Reasonable Distance
UNIT AREAS
PA
TIE
NT
RO
OM
S
IMPLICATIONSFUTURE RESEARCH
• Increased value of care giver time – by optimizing time with the patient rather than time wasted in hunting and gathering activities.
• Enhanced understanding of design implications – informed by quality data relative to spatial configurations on the workflow, unit organization and human behavior
• Enabled purposeful scenario planning of workflow, space allocation and spatial configurations that then inform operational planning and space programming that drive design goals.
IMPLICATIONS
• Building a tool providing the planner/designer with the ability to set a specific criteria of maximum threshold for walking distances, and input parameters related to the specific site and program to generate geometry within a parametric model.
• Building a generic solver to automate the process of iteration and allow for numerous alternates to be tested against user-defined criteria and sorted for fitness.
IMAGE
FUTURE RESEARCH
Thank you for your attention
