The Biomechanics of Patient Room Standardization

Th e contemporary focus in healthcare environment standardization has been on reducing the cognitive load of caregivers, and rightly so. The reduction of cognitive load has been addressed via the consistency of location and the design of elements in the patient care environment across all instances; for example, the concept of samehanded patient rooms, where all of the patient rooms in a unit, or across all units, in a hospital are designed to be identical in configuration and design (Cahnman, 2006; McCullough, 2006; Reiling, 2007).The term element in this paper refers to the smallest physical entity that has an independent identity in the care delivery process. Examples of elements include the patient bed, the headwall, the medication cabinet, the supply cabinet, the intravenous (IV) pole, the patient chair, the sink, and so forth. Design of elements means the way an individual element is designed. The design of an element affects numerous actions, for instance, bed height, angle, and other attributes that influence the work of caregivers. The design of a sink determines whether hand washing can be a hands-free task; the height of a sink determines the degree of bending required, and so forth.The distinction between design and location is crucial to the optimization of standardization. It is possible that an element (the hand-washing sink or the supply cabinet) is standardized in location (located in the exact same place in all rooms in a unit or hospital) but not in design. The reverse is also true. An element can be standardized in design but not in location. Furthermore, location has three dimensions, which can vary even though a design is standardized: the two axes representing the floor plane and vertical height from the floor.The term configuration or physical configuration in this paper means the relative position (relative arrangement in space) of the individual elements vis-a-vis one another and the circulation paths. Thus, if the individual elements in a patient room are located to optimize a right-sided approach to the patient, it creates a right-handed configuration. It is noteworthy that the creation of a standardized configuration is possible without standardizing the design of individual elements.Consistency in the physical environment of care across all instances can be viewed on different scales, ranging from the element level (headwall, interior of supply cabinet, and so forth) to the caregiver zone level, the patient room level, and the unit level (Pati, Cason, Harvey & Evans, 2010). The argument in favor of the consistent design and location of physical elements or groups of elements is the resulting reduction in the complexity of human interactions with the physical environment and in search-and-locate tasks, which during emergencies could save valuable time and reduce errors (Reiling, 2007; Mc- Cullough, 2006). Although it has not been tested empirically in the domain of healthcare design, evidence in the aviation industry literature shows that standardization of the flight deck -with particular emphasis on such attributes as system layout, displays, and color philosophy, among others-improves safety (Spitzer, 2006).The prevailing focus on cognitive load reduction in healthcare environment standardization excludes a domain of healthcare delivery that could contribute significantly to safety and efficiency through standardization. The domain of caregiver biomechanics has to date escaped discussion. Appreciation of this expanded framework warrants revisiting the fundamental objective of standardization: improving safety, or providing safer care. In this context, standardization is defined as bringing "into conformity with a standard" (Merriam-Webster, 2010). This definition, in turn, poses a fundamental question regarding standards. What safety design standard should a patient room design conform with? Excluding life safety standards that are part of the building code and facility design guidelines (both representing standards of a different nature), no such standards have as yet been validated. …