Penn Medicine Chester County Hospital

PENN MEDICINE CHESTER COUNTY HOSPITAL | LASKO TOWER

POST OCCUPANCY EVALUATION

EXECUTIVE SUMMARY The new Lasko Tower at Chester County Hospital continues the hospital’s commitment to delivering patient-centric care for its rapidly growing community. The 93,000 SF, four-story building adds 72 new private patient rooms for telemetry, surgical care, and maternity units, as well as a stateof-the-art radiation oncology treatment suite.

Space and light are key components of this expansion. Spacious, but right sized, patient rooms allow the comfortable coexistence of clinicians, patients and families during the treatment and healing processes. The placement of the caregiver stations and touchdowns within the 24-bed floor plan decreases the distance between work space and patient, allowing the caregivers to spend more time at the bedside. Large windows bring natural light and outdoor views to waiting areas, patient rooms, interior family lounges, staff lounges and conference rooms.

Ballinger conducted a Post Occupancy Evaluation in the Summer of 2016, which was +/-12 months after the last floor of the building was completed and occupied. Because of the sequential openings of each of the patient floors, while the 2nd floor had been occupied for only 12 months, the 3rd floor 18 months and the 4th floor close to 3 years.

The objective of the evaluation is to understand which planning and design interventions have been most successfully realized. Because these floors were built consecutively, the team compared where the staff requested design changes based on clinical needs, and what affect if any these changes had on staff and patients across the units.

It is a unique opportunity to compare not only how the slight differences over the 3 floors altered the patient and staff perceptions, but also the baseline data from the Ground West. Further data and survey from the Ground West existing building and unit are used as a baseline comparison, since these patients and staff had relocated to Lasko 3.

LASKO TOWER POST OCCUPANCY EVALUATION

METHODOLOGY Data was collected through anonymous electronic survey of staff. Patients who were on the unit were offered the opportunity to participate in an online survey or to fill out the paper copy of the survey which the team would then input into the final survey report. Additional patient interviews were complete by the staff and compiled.

ONLINE + WRITTEN SURVEYS FOR PATIENTS AND STAFF

REPORT LEGEND

ONSITE OBSERVATIONS

STAFF RESPONSES

PATIENT RESPONSES

LASKO 4: TELEMETRY

LASKO 3: ORTHO

LASKO 2: OB

GROUND WEST: ORTHO

ONSITE INTERVIEWS WITH STAFF

PROJECT SCHEDULE 2010

2011

2012

2013

2014

2015

2016 POST OCCUPANCY EVALUATION

DESIGN

CORE + SHELL L4: TELEMETRY

L3: ORTHO

L2: OB

2

PENN MEDICINE CHESTER COUNTY HOSPITAL

KEY FINDINGS OF THE POST-OCCUPANCY EVALUATION Decentralized stations matter as much or more to patients than to the staff.

66% of the staff felt that decentralized stations improved their ability to deliver quality patient care, while 91% of patients said that the stations improved the way they felt cared for in the new building.

66%

STAFF FEELTHE DECENTRALIZED STATIONS IMPROVE PATIENT CARE

Because patients admittedly felt more cared for in the new units, the decentralized station can likely be seen as a contributing component to the the double digit increases in the HCAPHS scores for the new units.

91%

PATIENTS SAY THE DECENTRALIZED STATIONS IMPROVE THE WAY THEY FEEL CARED FOR

Additional investigation into the travel distances of staff, their time spent with patients, and the impact of whether staff were sitting at the central nurses station or utilizing the decentralized stations uncovered a direct relationship to more time providing patient care.

L2 spent a reported 71% more time at the decentralized stations than their counterparts on L4. By investigating the travel distances to from the decentralized station to supplies and patients, it was determined to fetch the same items compared to staff on L3 who utilized the central station more, staff would walk 41% less.

L2 SAW OVERALL

41%

REDUCTION IN TRAVEL DISTANCES

BY SITTING AT THE DECENTRALIZED STATIONS

This time and effort savings was corroborated by the staff on L2 reporting that they spent 16% more time providing direct patient care than their counterparts on L3 or L4.

87%

93%

HCAHPS

13%

HCAHPS

19%

L4

L3

L2

AVERAGE INCREASE OF THOSE WHO RATE HOSPITAL 9-10

LASKO TOWER POST OCCUPANCY EVALUATION

L4

L3

L2

AVERAGE INCREASE OF THOSE WHO WOULD RECOMMEND THE HOSPITAL

L2 SPENT

16% MORE TIME

PROVIDING PATIENT CARE THAN L3 AND L4 L2 SPENT

71% MORE TIME AT THE DECENTRALIZED STATIONS THAN L4

ACKNOWLEDGEMENTS This Post Occupancy Evaluation was performed as part of a research endeavor between PennMedicine Chester County and Ballinger to assess the efficacy and design iterations between 3 successive patient bed floor projects. The information was used to adjust the previous Lasko bed floor template and begin an investigation on a new bed tower expansion. The new tower will also expand the ICU capabilities of the hospital.

A special thanks to Cathy Weidman, MPA, BSN, RN CNML and Director of Medical Surgical Services at PennMedicine Chester County Hospital who generously participated both in the research and production of the POE, but also in its presentation as part of the 2016 ASHE PDC Summit in San Diego.

PENN MEDICINE CHESTER COUNTY HOSPITAL

BALLINGER

Michael D. Barber Chief Operating Officer

Louis Meilink, Jr., AIA, ACHA, ACHE Principal

Angela R. Coladonato, DNP, RN, NEA-BC Senior Vice President/Chief Nursing Officer

Christina Grimes, AIA, LEED AP BD+C, EDAC Senior Associate, Healthcare Planner

Tina Maher, BSN, MA, RN, NE-BC Director, Telemetry Services

Debbie Phillips, AIA, ACHA, EDAC Senior Healthcare Planner

Cathy Weidman MPA, BSN, RN CNML Director of Medical Surgical Services

Whitney Wexler Associate, Communication Design

Frances Doyle, MSN,RN,CNML Director, Maternal Child Services

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PENN MEDICINE CHESTER COUNTY HOSPITAL

CONTENTS 1.0

PROJECT OVERVIEW

2.0

POST OCCUPANCY EVALUATION Respondent Profile Satisfaction Patient Safety Decentralized Stations

LASKO TOWER POST OCCUPANCY EVALUATION

PROJECT OVERVIEW In a project completed in 2015, Ballinger architects designed a hospital addition at Penn Medicine Chester County Hospital. Spanning three floors and 72 patient beds, the addition included three medical/surgical patient care units with decentralized caregiver stations between each pair of patient rooms.

The 3 floors were conceptualized as an expansion of bed capacity in order to decant many of the existing double patient rooms to single beds, and

LASKO TOWER POST OCCUPANCY EVALUATION

provide 72 new all private rooms to the campus. Because further additions were planned, these patient units were to take advantage of the existing entry sequence, public and patient/staff elevators and leave in place the opportunity for the next phase of expansion.

As the first major step to an all private room model, the decisions and investigations in the 3 patient floors worked to define a new standard and flexible template for all future patient rooms.

The team investigated the patients and staff on the Ground West unit (constructed in 1962, with a cosmetic renovation in 1998) for a baseline.

Ground West was also the location of the same orthopedic patients and staff patients who transferred over to the third floor of the new Lasko Tower building. The Ground West unit was built as a double loaded corridor of rooms with a single caregiver station, no decentralized station, and limited support space for staff, compared to the new Lasko Tower units that featured a central work core. By isolating the staff and patient populations, the team could more closely link correlations to the physical changes in the new unit.

WEST BUILDING (GROUND WEST) • 13,295 UNIT SF • 20 BEDS • 210 SF / ROOM • BUILT 1962, RENOVATED 1998 • 1 CENTRAL CAREGIVER STATION

LASKO TOWER • 23,300 UNIT SF • 24 BEDS

75%

• 320 SF / ROOM • BUILT 2013

INCREASE IN SPACE FROM GW TO LASKO

• 2 SMALL CAREGIVER STATIONS (L2) • 2 CENTRAL CAREGIVER STATIONS (L3 + L4) • 12 DECENTRALIZED STATIONS (ALL)

ONLY

20% MORE BEDS

GW: ORTHO

8

4 3 2 1 G

L4: TELEMETRY L3: ORTHO L2: OB

PENN MEDICINE CHESTER COUNTY HOSPITAL

The new Lasko Tower units used decentralized stations between every pair of patient rooms, two large stations for collaborative care discussion, and a physician dictation room on the fourth floor for six additional staff members. The second floor post-partum unit required a 16-bed nursery, which displaced some of the clinical staff and created smaller opportunities for caregiver stations within the core. Â The fourth floor had a total of 30 seats within the central core for a telemetry unit, 24 seats on the third floor for an orthopedic unit, and 12 seats on the second floor for a post-partum unit. The reduction in seats available on the successive units likely encourages caregivers to use the decentralized stations more. The interviews with staff also suggested that on the fourth floor, which has three locations for staff within the core, there were increased problems with locating physicians, who could be at either of the two stations or in the small dictation room.

LASKO 4: TELEMETRY

By posing the same questions for patients in Ground West and Lasko floor three, the investigators were able to identify differences based solely on the infrastructure and facilities changes, as the patient population and nursing staff were consistent before and after the move. The subtle differences in the nursing layouts over the floors and similar finishes on floors three and four of the Lasko Tower allow for comparison between standard units and varied patient needs. Lasko second floor and its contrasting layout of caregiver station within the core, as well as the shift to only 12 centralized seats, creates another level of detail for comparison while maintaining a control for finishes and aesthetics.

LASKO 3: ORTHO

LASKO 2: OB

GROUND WEST: ORTHO

LASKO TOWER POST OCCUPANCY EVALUATION

STAFF

PATIENT

L4

L3

L2

GW

10

PENN MEDICINE CHESTER COUNTY HOSPITAL

ALL PRIVATE ROOMS MIRRORED IDENTICAL CARE GIVING

DECENTRALIZED CARE STATIONS BETWEEN EVERY 2 ROOMS

PATIENT / FAMILY AMENITIES IN ROOM

OUTBOARD TOILETS

TEMPLATE DESIGN FOR M/S, IMU AND ICU CAPABLE WITH RENOVATION

The patient rooms across all 3 floors of the Lasko tower maintained the same new standard and flexible template. While Lasko only included Medical/Surgical patients the template was design to accommodate an ICU footprint as well, with minor adjustments. All rooms were mirrored with outboard toilets and had increased amenities in the room for family or care givers to sleep over with the patients.

LASKO TOWER POST OCCUPANCY EVALUATION

The decentralized stations between each pair of patient rooms allowed space for 1 staff member to sit and access the electronic medical record of any patient.

Each room also had a wall mounted computer within the room as well.

While all 3 floors had the same patient rooms, variations and adaptations were accommodated within the support core. These differences did impact some of the findings between the units.

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PENN MEDICINE CHESTER COUNTY HOSPITAL

POST OCCUPANCY EVALUATION To begin the evaluation, the team was comprised of both members of the original design team, and members who had not worked on the initial project to bring a level of unbiased opinion to the research. The team gathered both qualitative and quantitative data regarding the project from a diverse group within the building. Three methods for information gathering were selected: An on-line survey for the patients and staff, on-site interviews with staff, and on-site observations by the team. These varied collection points allowed the evaluation team to triangulate those issues which permeated the discussions from a variety of vantage points.

ONLINE + WRITTEN SURVEYS FOR PATIENTS AND STAFF

The results have been evaluated in 4 categories.

• RESPONDENT PROFILE: Breakdown of staff and patient respondents by floor, experience, and age.

ONSITE OBESERVATIONS

• OVERALL SATISFACTION & HCAPHS IMPACT: Evaluations of patient and staff reported levels of satisfaction regarding the unit and patient room design, planning decision, amenities within the unit and how the self reported scores and the HCAHPS scores were impacted across the patient floors.

• PATIENT SAFETY IMPACTS: Understanding of both the self reported patient and staff information combined with data analysis of Pre-Occupancy fall rates and infection control rates for the same patient and staff populations were analyzed to determine the affects on these safety metrics within the new units.

ONSITE INTERVIEWS WITH STAFF

• DECENTRALIZED STATION: Noting both staff and patients reported information and combining these results with analytical information and travel distances based on the variations of the floor plans across the units, the investigation assesses the locations at which staff are charting, the proximity to supplies, and time spent on patient care.

LASKO TOWER POST OCCUPANCY EVALUATION

STAFF

PATIENT

L4

L3

L2

GW

RESPONDENT PROFILE Patients and staff were both well represented from from each of the 4 floors surveyed. The majority of staff were nursing staff, the largest group were those on Lakso 3.

Staff also came relatively equally split among the Boomer, GenX and Millennial Generations, with a slightly larger group of Millennial respondents. The Patient’s also included members of the Silent Generation and were typically much older than the caregivers on the units.

88%

OF RESPONDENTS ARE NURSING STAFF

Many of the staff were seasoned professionals, and had worked at other facilities, giving them not only comparison among these 4 patient units, but a comparison to other institutions as well as a basis for their considerations.

12%

ADMINISTRATION

10%

10%

L4: TELEMETRY

OTHER

28%

L4: TELEMETRY

10%

GW: ORTHO

31%

GW: ORTHO

50 PATIENT RESPONDENTS

117 STAFF RESPONDENTS

35%

L3: ORTHO

23%

L2: OB

30%

L3: ORTHO

14

24%

L2: OB

PENN MEDICINE CHESTER COUNTY HOSPITAL

RESPONDENTS BY GENERATION 1945 – 1965

2-4 VISITS

1982+

31%

28%

60%

41%

5+VISITS

8%

1 VISIT

32%

20%

35%

22%

24%

VISITS TO PMCCH BORN PRIOR TO 1945

1966 – 1981

18%

0-4 YEARS

30%

46%

5-14 YEARS

52%

13%

15-24 YEARS

8%

24%

25+ YEARS

11%

TIME IN HEALTHCARE INDUSTRY

LASKO TOWER POST OCCUPANCY EVALUATION

NO OTHERS

37% 5+ FACILITIES

TIME AT PMCCH

STAFF

PATIENT

L4

L3

L2

OF STAFF HAVE WORKED IN 1-2 OTHER FACILITIES

3-4 FACILITIES

GW

SATISFACTION Overall the satisfaction scores at 94% & 96% were remarkably high for the the 3 patient units.

The Ground West Unit was the previous home for the L3 units patient and staff prior to the opening of the new tower. With a reported increase of 113% from the same patient cohorts from Ground West, to those on L3, the increase of the patient satisfaction is even more apparent.

L4

94%

As seen in the word cloud on the adjacent page, the main staff comments for Lasko focused the improved light and beauty of the new unit, along with the ability to do their electronic charting at the computers throughout, and the space and amenities for their patients.

While Ground West staff did focus on the small patient rooms and the lack of computer access they did comment frequently on some of the less tangible items such as their co-workers which maybe encouraged by the central caregiver station for collaboration.

Patients in the Lasko Tower focused both on the size of the patient rooms and the amenities throughout the unit, as well as how the staff improved their stay.

GW

45%

L3

94%

L2

96% 16

PENN MEDICINE CHESTER COUNTY HOSPITAL

NEW AND CLEAN

ROOM FOR FAMILIES

SIZE OF ROOMS

CENTRAL NURSES STATION

SPACIOUS ROOMS

PRIVATE ROOMS

COMPUTERS AT BEDSIDE

BRIGHT NATURAL LIGHT

LARGE BATHROOMS ARE EASIER FOR PATIENTS

ABILITY TO HAVE NATURAL LIGHT

ABILITY TO STEP OUTSIDE

LOTS OF COMPUTER ACCESS BEAUTIFUL PLACE TO WORK STAFF IS THE BEST MED ROOM IS LARGE BRIGHT + CLEAN LOVED THE SHOWERS

SPACIOUS ROOMS

PRIVATE ROOMS

THE NURSES ARE GREAT

PLENTY OF COMPUTER WORK AREAS

COMPUTERS TO LOG ON ANYWHERE

DECENTRALIZED STATIONS

REALLY GREAT COWORKERS LARGE ROOMS

SPACE FOR FAMILY

PLENTY OF COMPUTERS

SNACKS FOR FAMILY

THE BATHROOMS ARE VERY VERY NICE!

TELEVISION

WE HAVE ROOM FOR ALL THE EQUIPMENT WE NEED LASKO TOWER POST OCCUPANCY EVALUATION

STAFF

PATIENT

L4

L3

L2

GW

PATIENT SATISFACTION Beyond just reporting high levels of patient satisfaction within the PostOccupancy questions, the hospital has received a significant increase in their reported HCAPHS scores through the Centers for Medicare and Medicaid Services. The Value Based Purchasing program withholds a percentage of money (1.75%) with the incentive to earn back the money based on performance in four areas: efficiency, patient satisfaction, patient safety and clinical outcomes. The HCAPHS scores are used to determine whether an institution receives this incentive.

caregiver station, no decentralized station, and limited support space for staff. Though it is difficult to contribute all of the increase to the inclusion of the decentralized station, it should be noted that through the survey and interview process, both patients and staff consistently included mention of the decentralized station in their remarks related to satisfaction, perception of care, and work-flow improvements.

Across all units, the hospital had a dramatic increase in their HCAHPS scores for groups before the move to after the move into Lasko Tower, with average increases of 13–18 percent over their pre-move units. All of the units in the existing conditions were similar to the Ground West in that they were built as a double loaded corridor of rooms with a single

• The size of the private patient room and toilet room

87%

In addition to the decentralized stations, the patients repeatedly reported the following item contributed to their satisfaction: • The light and views throughout the unit • The quietness of the rooms • The space and amenities for family

93%

HCAHPS

13%

HCAHPS

19% 18

L4

L3

L2

L4

L3

L2

AVERAGE INCREASE OF THOSE WHO WOULD RECOMMEND THE HOSPITAL

AVERAGE INCREASE OF THOSE WHO RATE HOSPITAL 9-10

PENN MEDICINE CHESTER COUNTY HOSPITAL

Since the landmark study “View Through a Window May Influence Recovery from Surgery� Roger S. Ulrich, the design community has invested in the views to nature and light as a healing element.

Using the Ground West unit as a base line, the data controls for both staff and patient population. This limits the affect on the data to the physical configurations and material choices employed within the Lasko Tower.

With a 390% staff increase in the reported therapeutic feel of the patient room, compounded with a 213% staff increase in the views to nature the data points to a dramatic improvement based on the design of the Lasko Tower.

The patients in general were more complimentary across all questions, but for the color palette selection noted a 223% increase satisfaction.In general the look and feel of the unit was well received and impactful for both patients and staff.

98% 100% 20% 64% THERAPEUTIC FEEL OF ROOMS 94% 100% 30% 87% VIEWS TO NATURE 96% 100% 30% 100% ACCESS TO DAYLIGHT 95% 100% 40% 31% COLOR PALETTE LASKO TOWER POST OCCUPANCY EVALUATION

STAFF

PATIENT

L4

L3

L2

GW

The new rooms within the Lasko tower were all +/- 320 SF with a decentralized station between every pair of rooms. The additional 110 SF in each room is a 52% increase over the existing patient rooms in the Ground West building.

The Design layout and the over all space allows for the care giver zone, the patient zone and the family zone, the rooms patient rooms were right sized to provide adequate space for the delivery of care.

DESIGN / LAYOUT TV

ROOM SIZE / BATHROOMS

FAMILY AMENITIES

GROUND WEST

HIGHEST SATISFACTION: PRIVATE ROOMS

The patient toilet rooms were all designed to be ADA compliant, have a rain shower head, and a frosted window to provide natural light. These rooms are large enough for care givers to assist patients, and also contributed to the reported satisfaction at 35% of patients ranking the size of the toilet rooms as the most impactful.

60%

GROUND WEST: 210 SF

HIGHEST SATISFACTION: ROOM SIZE / BATHROOMS

DESIGN / LAYOUT

35% LASK0 TOWER AVERAGE

TV

FAMILY AMENITIES

PRIVATE ROOMS

LASKO AVERAGE: 320 SF

20

PENN MEDICINE CHESTER COUNTY HOSPITAL

In addition to the traditional waiting rooms off the units on each level, all 3 floors also included a smaller gathering area within the unit.

Both L2 and L3 reported that many family members utilized this additional amenity. L4 had a dramatically different usage, which maybe attributed to its use as a telemetry unit. If patients are unable to use the area with their family member, they may spend more time together in the patient room.

As part of the Obstetrics program on L2 an additional nourishment station was included and open to the families and patients for use during their stay.

Families had access to the snacks and coffee 24hours a day within the unit.

93% 94%

ARE SATISFIED WITH OVERALL FAMILY AMENITIES ON THE UNIT

FAMILY MEMBERS UTILIZE UNIT AMENITIES

L4

20%

LASKO TOWER POST OCCUPANCY EVALUATION

STAFF

PATIENT

L4

L3

L2

L3

100%

GW

L2

100%

PATIENT SAFETY Design and construction of new patient units has been increasingly linked to patient safety for slip and falls and Healthcare Associated Infections (HAIs). The research focused on both the material selections and the design layout of the patient rooms and patient toilet rooms to understand any correlations.

The initial investigation included looking at all infections across the units pre-and post move into the Lasko Tower, and also looking at C Diff and Pneumonia separately as those are some of the most common and difficult HAIs. The 52% decrease was for all infections from the calendar year prior to the move compared to the calendar year after for Lasko 3.

HAIs HAVE DECREASED

52%

In addition to including a hand washing station at the entry to every patient room, a Hand sanitizer dispenser was located both directly inside the door and outside the door for each patient room. Material selection such as Solid Surface counters and integral flooring products are also potential contributors to this decrease.

SINCE THE MOVE

79%

ARE SATISFIED WITH SELECTION OF MATERIALS AND HOW THEY HAVE HELD UP

90%

HCAHPS

28%

97%

SATISFIED WITH STANDARDIZATION OF HEADWALLS

22

L4

L3

L2

AVERAGE INCREASE IN SATISFACTION WITH CLEANLINESS PENN MEDICINE CHESTER COUNTY HOSPITAL

CCH FALL RATES DROPPED

28%

AFTER CONVERSION STATE AVERAGE FELL 3.31% DURING SAME TIME

82%

STAFF ARE SATISFIED WITH THE LAYOUT + DESIGN OF PATIENT CARE AREAS TO PROMOTE SAFETY

PATIENT COMMENT

The addition of the decentralized caregiver station was also a potential contributing factor to the reduction of falls, as staff could see if a patient was exiting their bed unassisted.

“I FEEL SAFE IN THIS ROOM”

LASKO TOWER POST OCCUPANCY EVALUATION

STAFF

PATIENT

L4

L3

L2

Many of the patient falls occur when patients attempt to use the restroom un-assisted or within the shower. The hospital and the design team used an integral poured flooring product within the patient toilet room to decrease any level changes or grout, provided handrails throughout the toilet room and at the exterior door to the toilet room, and included a recessed shower shelf to reduce the risk of falls.

GW

ACOUSTIC PRIVACY Acoustic privacy has become an important issue for patients and staff, driven in part by the Health Insurance Portability and Accountability Act (HIPPA) which mandates the standards for privacy of individually identifiable health information. This mandate has driven changes in STC ratings for construction, variations in locations for private patient conversation, and is included in the HCAPHS questions.

Only 19% of patients felt the Ground West Unit provided adequate sound control within the patient rooms. The Lasko Tower showed 410% increase in the patient satisfaction with the sound control, which was likely impacted by the race track design, higher STC rated wall construction, limiting conversation/gathering at a central caregiver station, and increased performance in the ceiling tiles.

SATISFACTION WITH SOUND CONTROL

77% 45%

80% 64%

91% 36%

AT NURSE STATION

IN CORRIDORS

IN PATIENT ROOMS

100% 25%

94% 31%

97% 19%

24

89%

HCAHPS

34%

L4

L3

L2

AVERAGE INCREASE IN SATISFACTION WITH QUIETNESS

87% 97%

ARE SATISFIED WITH SPACES FOR PRIVATE CONVERSATION

PENN MEDICINE CHESTER COUNTY HOSPITAL

DECENTRALIZED STATION

L2 SPENT

The new Lasko Tower units use decentralized stations between every pair of patient rooms, two large stations for collaborative care discussion, and a physician dictation room on the fourth floor for six additional staff members.

The second floor post-partum unit required a 16-bed nursery, which displaced some of the clinical staff and created smaller opportunities for caregiver stations within the core.

16% MORE TIME

PROVIDING PATIENT CARE THAN L3 AND L4

The fourth floor had a total of 30 seats within the central core for a telemetry unit, 24 seats on the third floor for an orthopedic unit, and 12 seats on the second floor for a post-partum unit. The reduction in seats available on the successive units likely encourages caregivers to use the decentralized stations more. The interviews with staff also suggested that on the fourth floor, which has three locations for staff within the core, there were increased problems with locating physicians, who could be at either of the two stations or in the small dictation room.

PHYSICIAN DICATION STATION

LASKO TOWER POST OCCUPANCY EVALUATION

THAN L4

STAFF REPORTED THEY WILL USE ANY AVAILABLE WORKSPACE

24 CENTRAL SEATS

2 LARGE STATIONS

LASKO 4: TELEMETRY:

71% MORE TIME AT THE DECENTRALIZED STATIONS

76%

“It is ALMOST IMPOSSIBLE TO KNOW IF SOMEONE IS IN ANOTHER NURSING STATION if you are in the other.

A LOT OF WALKING BACK AND FORTH”

30 CENTRAL SEATS

L2 SPENT

12 CENTRAL SEATS

2 LARGE STATIONS

2 SMALLER STATIONS

LASKO 3: ORTHO

STAFF

LASKO 2: OB

PATIENT

L4

L3

L2

GW

The staff of Lasko floor three had six fewer seats than Lasko floor four staff, which resulted in an additional reported increase of 31 percent more time spent at the decentralized station. Lasko second floor staff had18 fewer seats on their unit and reported an additional 71 percent increase in time spent at the decentralized station and a 16 percent increase in time spent at the patient bedside over Lasko floor four.

66%

STAFF FEELTHE DECENTRALIZED STATIONS IMPROVE PATIENT CARE

With 91 percent of patients reporting increased satisfaction in the care they receive with decentralized stations and staff reporting a 16 percent rise in time spent providing patient care, the decentralized station proves to be a valuable addition regardless of the patients’ care level. The additional increase in the HCAPHS scores shows that patients in these units appreciate the care being delivered, which translates to financial incentives for the institutions.

91%

PATIENTS SAY THE DECENTRALIZED STATIONS IMPROVE THE WAY THEY FEEL CARED FOR

L4 staff reported spending 38% more time at the central station than the decentralized station, which created longer walking distances to the support spaces and to the patient rooms, and left them less time in their day for patient care than either L3 or L2 where staff elected to use the decentralized stations more often.

8% DECENTRALIZED STATION

36% PROVIDING PATIENT CARE

26% CENTRALIZED STATION

L4

TELEMETRY

13% FETCHING ITEMS FOR PATIENT CARE

26

13% COMPUTER IN PATIENT ROOM

11% DECENTRALIZED STATION

38% PROVIDING PATIENT CARE

22% CENTRALIZED STATION

L3

43% PROVIDING PATIENT CARE

13% CENTRALIZED STATION

L2

ORTHO

12% FETCHING ITEMS FOR PATIENT CARE

14% DECENTRALIZED STATION

OB

14% COMPUTER IN PATIENT ROOM

16% FETCHING ITEMS FOR PATIENT CARE

8% COMPUTER IN PATIENT ROOM

PENN MEDICINE CHESTER COUNTY HOSPITAL

LASKO TOWER POST OCCUPANCY EVALUATION

STAFF

PATIENT

L4

L3

L2

GW

SATISFACTION: BETWEEN STAFF WORK AREAS

78% 62% 34%

VISIBILITY

L4: TELEMETRY 30 CENTRAL SEATS

53% L3: ORTHO 24 CENTRAL SEATS

To isolate whether it was a visibility issue or a proximity issue related to staff being able to find each other on the unit, the team looked at the satisfaction levels of the staff with both metrics.

With staff embracing the decentralized model they were able to located their coworkers more easily, and could view them down the length of the corridor

For the staff to staff visibility, L2 which has the most remote workspaces had the highest level of staff satisfaction related to being able to see each other. This is likely because the staff on L2 were 72% more likely to sit at the decentralized stations.

L4 had the lowest level of satisfaction with the physical travel distance between the 3 centralized staff work areas, but also the least physical distance of all the units.

28

Staff also reported loosing each other as they went from one station to the other looking for

85% 63%

L2: ORTHO 12 CENTRAL SEATS

staff. Some comments suggested that the private dictation room and its additional 6 seats was also a hindrance to locating each other. This room had solid walls and a door, which while increasing privacy appears to affected the staff access to one another.

L2 had an additional 60’ of physical travel distance between their central staff work areas.

To reconcile the physical differences, the team recognized that additional factors were at work to beyond the locations of the central stations.

PENN MEDICINE CHESTER COUNTY HOSPITAL

SATISFACTION: BETWEEN STAFF WORK + PATIENT CARE AREAS

78%

76% 41%

86%

93%

85%

VISIBILITY

L4: TELEMETRY 30 CENTRAL SEATS

L3: ORTHO 24 CENTRAL SEATS

L2: ORTHO 12 CENTRAL SEATS

The metrics for staff to patient visibility and proximity all tended higher than the staff to staff metrics, which began to reinforce the role that the decentralized station might have in the data.

The team began to investigate the impact of staff on L2 reporting a they 72% more likely to sit at the decentralized stations.

THERE WAS AN 85% INCREASE IN VISIBILITY SATISFACTION DESPITE 18 LESS SEATS AND AN ADDITIONAL 60 FEET BETWEEN THE CENTRAL STATIONS ON L2

All three units had equal access to the decentralized stations, but L2 had consistently rated their visibility and proximity to each other and patients the highest. This is despite a 60% decrease in the number of centralized staff work seats, and an 66% increase in the distance between the centralized staff work areas.

LASKO TOWER POST OCCUPANCY EVALUATION

STAFF

PATIENT

L4

L3

L2

GW

DECENTRALIZED STATION EFFECT ON SATISFACTION After noticing the staff satisfaction scores, and the 16 percent rise in time spent providing patient care, the team investigated possible drivers in how this additional time could be found during the busy shift of the caregivers.

By looking at the floor plans of the three floors, the investigators created a Proximity Index. The team evaluated the fetching distances of staff who were presumably starting their trip from the central station compared to that of staff with a similar roundtrip beginning from a decentralized station.

The team then compared each of the sets across the three floors of new construction.

0

20

40

60

80

100 120 140 160 180 200 220 240 260 280 300 320

DISTANCE (IN FEET)

CENTRAL STATION

For Lasko floor four, a model with the soiled, clean, meds, or equipment storage ran typically from one corridor to the other corridor through the core, with access employed from both corridors into the rooms. In this model, a single soiled room and single equipment rooms showed the longest travel distances for both trips from the central station or from the decentralized stations. Both the clean holding room and the meds rooms were duplicated on the units and showed consistently shorter travel distances. Â

DECENTRALIZED STATION L4 SAW OVERALL

26%

REDUCTION IN TRAVEL DISTANCES

BY SITTING AT THE DECENTRALIZED STATIONS

L4: TELEMETRY

30

PENN MEDICINE CHESTER COUNTY HOSPITAL

For Lasko floor two, a model with a cross-corridor through the core and the rooms opening off this corridor was used in a blended model where these frequently accessed rooms were decentralized. Two soiled rooms and two meds rooms were both off the cross corridor. Two additional clean supply rooms used the coast to coast model, and a single storage room was located near the far end of the unit. Â For post-partum patients, the largest needs expressed by the clinicians were centered on the meds, soiled, and clean supply rooms, with little use of equipment. This drove the shift in the core design and contributed to the request of an additional soiled utility room. Lasko floor two shows significantly longer travel distances to the storage room, and this was discussed as a trade-off for this floor. In exchange, the travel distances to the soiled rooms is much shorter than those on Lasko floor four.

0

20

40

60

80

100 120 140 160 180 200 220 240 260 280 300 320

CENTRAL STATION

DECENTRALIZED STATION

L2 SAW OVERALL

41%

REDUCTION IN TRAVEL DISTANCES

BY SITTING AT THE DECENTRALIZED STATIONS

LASKO TOWER POST OCCUPANCY EVALUATION

L2: OB

STAFF

PATIENT

L4

L3

L2

GW

32

PENN MEDICINE CHESTER COUNTY HOSPITAL