Designing a Patient Room as a Fall Protection Strategy: The Perspectives of Healthcare Design Experts.

Melissa Piatkowski,Andrew Merryweather,Ellen Taylor,Dorothy Taylor,Bob Wong,K Bo Foreman

doi:10.3390/ijerph18168769

Melissa Piatkowski, Andrew Merryweather + Show 4 more

Open Access

https://doi.org/10.3390/ijerph18168769

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Abstract

Despite decades of research into patient falls, there is a dearth of evidence about how the design of patient rooms influences falls. Our multi-year study aims to better understand how patient room design can increase stability during ambulation, serving as a fall protection strategy for frail and/or elderly patients. The aim of this portion of the study was to ascertain the architect’s perspective on designing a room to mitigate the risk of falls, as well as to evaluate the face validity of a predictive algorithm to assess risk in room design using the input of a design advisory council (AC). The purpose of this paper is to provide insight into the design process and decision-making for patient rooms; summarize the impressions of industry experts about the configurations and layout of the patient rooms tested in a preliminary augmented reality model; establish the face validity of modeled heat maps depicting risk; and report the results of a pre-meeting and post-meeting survey of expert opinions. Feedback was coded using human factors/ergonomic (HF/E) design principles, and the findings will be used to guide further development of an “optimal” prototype room for human subject testing. The results confirm the challenges that architects face as they balance competing priorities and reveal how a participatory process focusing on preventing falls can shift assumptions about design strategies, especially subtle changes (e.g., toilet orientation).

Highlights

Falls resulting in serious injury while a patient is being cared for in a healthcare setting have been classified in the United States (US) as a “never event” or “serious reportable event” since 2002 [1]
The results include a summary of Advisory Council (AC) views on the design process and decisionmaking, AC impressions of the patient rooms simulated in augmented reality (AR), findings of face validity of the heat maps as compared to the AR scenarios, AR and overall debriefs, and pre- and post-session survey results
The AC panel described the design process as starting with a functional program. This is the critical thinking for a project that starts with asking, “What are you designing for in order for the design to match the operational needs?” The functional program is a “living” document that evolves over the course of design that identifies adjacencies, patient populations, workflow, and patient flows

Summary

Introduction

Falls resulting in serious injury while a patient is being cared for in a healthcare setting have been classified in the United States (US) as a “never event” or “serious reportable event” since 2002 [1]. HACs. The scorecard data from 2014–2017, for example, indicate a 5% reduction in the rate of injurious falls, as compared to adverse drug event reductions (28%) and reduced rates of Clostridioides difficile infections (37%) [5]. While risks for inpatient falls include intrinsic factors such as cognitive or mobility limitations, acknowledged extrinsic risk factors include physical hazards and latent conditions in the patient room design [6,7,8]. The influence of built environment conditions as a risk factor for falls has been studied using biomechanics around the patient bed [9,10] and bathroom [11], experimental trials of specific material interventions (e.g., flooring) [12,13], and the nascent development of predictive models to evaluate room design undertaken

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