a model for success: the university medical center of princeton …€¦ · user discussions,...

A Model for Success:

The University Medical

Center of Princeton at

Plainsboro

Barry S. Rabner, President & CEO, Princeton HealthCare System

Susan Lorenz, DrNP, RN, NEC-BC, EDAC, Vice President of

Patient Care Services, Princeton HealthCare System

Erin Peavey, Associate AIA, LEED AP BD+C, EDAC,

Researcher + Medical Planner, HOK

Julie Somarriba, LEED AP BD+C, EDAC, Associate, HOK

10/16/2013 2 EDRA Inaugural Fall Symposium

Oct.11.2013

University Medical Center of

Princeton at Plainsboro


Oct.11.2013

Agenda

Introduction & Guiding Principles

The Evidence Base

Integrating Original Research

Design Informed by Research

Research Results & Lessons Learned

Question & Answer

University Medical


Plainsboro


Oct.11.2013


Oct.11.2013


The Evidence Base




Question & Answer

University Medical


Plainsboro


Oct.11.2013

Pebble Project

• Investigate

• Hypothesize

• Continue to Prove or Innovate

• Measure

• Share

Using the Evidence Base


Oct.11.2013

1. Reduce Stress, Improve Quality of Life and

Healing for Patients and Families

• Noise Reduction

• Positive Distractions

• Provide Social Support

2. Reduce Staff Stress / Fatigue,

Increase Effectiveness in Delivering Care

• Noise Reduction

• Patient Care Time per Shift

• Improve Medication

Processing & Delivery Times

• Improve Satisfaction

EBD Checklist:

Areas Known to Impact Outcomes


Oct.11.2013

3. Improve Patient Safety and Quality of Care

• Reduce Nosocomial Infections

• Reduce Patient Falls

• Improve Confidentiality

• Improve Communications

4. Improve Overall Healthcare Quality

and Reduce Cost

• Reduce Patient Transfers

• Reduce Length of Stay

• Staff Work Effectiveness

• Patient Satisfaction with

Quality of Care

EBD Checklist:

Areas Known to Impact Outcomes


Oct.11.2013


The Evidence Base




Question & Answer

University Medical


Plainsboro


Oct.11.2013

A hospital unit

is identified for

study.

Measure existing

conditions.

Impact on

outcomes.

Use as baseline.

Occupants

move in.

Measure impact.

Compare to

baseline or

original intent.

Results help

inform, inspire

design solutions

for new facility.

Innovate Existing Facility

New Facility

Assess

Use baseline to

inform innovative

design.

Validate

Infusing Research on Projects


Oct.11.2013

Phases of Physical Mock-Up Phase 1: Simple Mock-up

User discussions, testing headwall Gyp board, painters tape, foam core Internal Review Board (IRB) Exempt

Phase 2. Detailed mock-up

Testing scenarios, equip placement Patient actors IRB Exempt

Phase 3: Live Mock-up

Fully functioning Integrated with existing unit IRB Approved

Princeton (UPMC) Mock-Ups Mock-Up & Simulation Process


Oct.11.2013

Phase 1& 2: Mock-Up & Simulations

• Research Design

– Mixed Methods

– Qualitative & Quantitative

– Non-experimental comparative

• IRB Exempt

– Does not involve real patients

– Comparison of rooms using current practice

– No videotaping of participants


Oct.11.2013

What needed to start Basic equipment

Design

Project Time

Who to engage Interdisciplinary staff

Interior Designers

Medical Planners

Project Management

What to measure Impact on care, experience, safety

Ease of use

Princeton (UPMC) Mock-Ups

Staff participants

Convenient space

Building materials

What need to create Questionnaires

Built spaces



Oct.11.2013

Discussion Examination Proposed Change

Phase 1: Learning Lab Mock-Up


Oct.11.2013

Materials • Foam core, gypsum board,

plastic laminate Participants & Location • On existing nursing unit • Multidisciplinary Staff (N=175)

- Individual & Group

Purpose • Staff feedback • Test proposed changes • Validate design assumptions • Efficiency, Safety, Quality • Established design directives to

explored in later phases

Discussion Examination Proposed Change

Phase 1: Learning Lab Mock-Up


Oct.11.2013

Code Blue Simulation Prevent Medication Errors Preventing Falls

Phase 2: Simulations


Oct.11.2013

Materials • Trial finish materials

Participants & Location • On existing nursing unit • Interdisciplinary Staff • “Patient” Actors • Total Sim. N=39

Purpose • Test difference between rooms • Analyze steps for each scenario • Define important questions • Staff identify needed change

Code Blue Simulation Prevent Medication Errors Preventing Falls

Phase 2: Simulations


Oct.11.2013

• Support Nurse Concentration

• Support Care Delivery

• Family Involvement

• Patient Falls & Recovery

• Headwall Implications

• Lighting & Power

(Watkins, N., Kobelja, Peavey, Thomas, Lyon. 2011)



Oct.11.2013


The Evidence Base




Question & Answer

University Medical


Plainsboro


Oct.11.2013

ZONES: Patient I Family I Staff

LINK: http://www.princetonhcs.org/phcs-home/what-we-do/university-medical-center-of-princeton-at-plainsboro/who-we-serve/patient-resources/patient-rooms.aspx/utm_source=umcpphomespotlight/utm_medium=umcpphomespotlight/utm_campaign=umcpphomespotlightpatientroom

• All private rooms • Configuration of the room consists of:

• Nurse Server • Location of sink for hand washing • Location of bathroom

• Integration of IT and other technologies into the physical setting

• Space to support interdisciplinary communication and practice


http://www.princetonhcs.org/phcs-home/what-we-do/university-medical-center-of-princeton-at-plainsboro/who-we-serve/patient-resources/patient-rooms.aspx/utm_source=umcpphomespotlight/utm_medium=umcpphomespotlight/utm_campaign=umcpphomespotlightpatientroom



































Oct.11.2013

Hand railing to Bathroom

Night-light between patient bed and

bathroom

Soft bathroom light through sliding door

TV with education system, magnetic writing

surface, and wardrobe closet at footwall

Patient Zone


Oct.11.2013

Space for family, not in care zone

Sleeper Sofa with soft reading light

Work desk with multiple outlets and data

Closet room for luggage

Family Zone


Oct.11.2013

Visible hand washing

Easy access to gloves

Double- loaded server

Quiet loading of supplies

Face-to-Face View of Charting

Facilitate shared communication

Staff Zone


Oct.11.2013


The Evidence Base




Question & Answer

University Medical


Plainsboro


Oct.11.2013

• Compare impact of new vs. current hospital rooms on specific design elements

– care delivery

– caregiver satisfaction

– patient experience

– clinical outcomes

Phase 3: Purpose of the Study


Oct.11.2013

Participants:

• Patients & Care Staff (Orthopedic)

• Random Selection

Measures:

• Staff Surveys

– Periodic Surveys, Interdisciplinary

• Patient Survey

– During Hospital Stay

– Post Hospital Stay (Press Ganey)

• Clinical Outcomes

Phase 3 Process


Oct.11.2013

Current Room

Model Room

Orientation to Rooms


Oct.11.2013

Nurse Server I Room Size & Design I Lighting

Acoustics I Caregiver Presence I Hand washing

Topics Addressed


Oct.11.2013

Statistically Significant Differences

Nurse Server

• Height of Medication Preparation

• Medication Access

• Minimized walking

• Location of waste disposal

• Second RN Verification

Room Size and Design

• Location of the bed

• Space for patient’s valuables

• Color of the room

• Furniture functionality

Nurse Responses


Oct.11.2013


Acoustics

• Door Noise

• Professional Conversations

• Equipment Carts

Lighting

• Bed Tasks

• Bed Reading

Hand Washing

• No difference found

Caregiver Presence

• Prepare Medication

Nurse Responses


Oct.11.2013

0

1

2

3

4

5

Current

Model

Average Responses Nurse Server

(*=significant at 0.05 level; **=significant at 0.01 level)

Nurse Responses: Nurse Server


Oct.11.2013

0

1

2

3

4

5

Nurse Responses Room Size and Design


Nurse Responses:



Oct.11.2013

0

1

2

3

4

5

Current

Model

Nurse Responses Room Size and Design


Nurse Responses:



Oct.11.2013

Average Responses Room Size and Design (*=significant at 0.05 level; **=significant at 0.01 level

0

1

2

3

4

5

Current

Model

Average Responses:



Oct.11.2013


Room Size & Design

Lighting

Multidisciplinary Staff Responses


Oct.11.2013

0

1

2

3

4

5

Current

Model

Staff Responses (*=significant at 0.05 level; **=significant at 0.01 level

Multidisciplinary Staff Responses


Oct.11.2013

No significant difference observed between:

Pain Medication Utilization

–Model Room vs Current Patient Room

–Hip vs. knee patient

–Pain medication type

Medication Errors

Falls

Infection Rates

Clinical Data Comparison


Oct.11.2013

Patient Experience

Responses

Our goal-

“less clinical more hospitable”* *Kim, S. Contract 2011. Vol. 52(8): 62

University Medical Center at Plainsboro


Oct.11.2013


Environment of Care

• Valuables

• Belongings

• Color /Soothing Appearance

• Wellbeing

• Room Temperature

Hand washing

• No significant difference

Noise

• Equipment Carts

• Outside Room

Patient Responses


Oct.11.2013

0

1

2

3

4

5

Current

Model

Average Responses Total and by Category (*=significant at 0.05 level; **=significant at 0.01 level)

Patient Responses:



Oct.11.2013

• National patient experience surveys

• Mailed to patient home 2 weeks after

• Benchmarks data: national, state and

similar bed size organizations

Patient Experience:

Press Ganey Surveys


Oct.11.2013

• Overall Experience*

• Registration and

Admission

• Room*

• Meals

• Nurses

• Tests and Treatments

• Visitors and Families

• Physician

• Other Services

• Discharge

• Personal Issues

• Overall Assessment

Elements of Measurements

Press Ganey Significant Results with Various Scales (*=significant at 0.05 level; **=significant at 0.01 level)

Patient Experience: Press Ganey


Oct.11.2013

0123456789

10

Current

Model

Press Ganey Significant Results with Various Scales (*=significant at 0.05 level; **=significant at 0.01 level)

Patient Rm Satisfaction: Press Ganey


Oct.11.2013

• Return Press Ganey Surveys

– Not all patients returned Press Ganey surveys

– Due to randomization some patients received Press

Ganey after the initial two weeks of discharge

• Patient population:

– Unequal numbers of hips/knees

– Not controlled for age/gender

Limitations of Study


Oct.11.2013

• Must train staff to use the space

• Ambiance of the room

• And much more…

Lessons Learned


Oct.11.2013


The Evidence Base




Question & Answer

University Medical


Plainsboro


Oct.11.2013

Thank you. Questions?

Contact information:

[email protected] [email protected] [email protected] [email protected]

Barry Rabner

Chief Executive Officer

Princeton Healthcare System

[email protected]

Dr. Susan Lorenz, DrNP RN NEC-BC

Chief Nursing Officer

Princeton Healthcare System

[email protected]

Erin Peavey

Researcher Medical Planner

HOK Architects

[email protected]

Julie Somarriba

Associate

HOK Architects

[email protected]

a model for success: the university medical center of princeton …€¦ · user discussions,...

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