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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
10/16/2013 3 EDRA Inaugural Fall Symposium
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
Center of Princeton at
Plainsboro
17
35
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Introduction & Guiding Principles
The Evidence Base
Integrating Original Research
Design Informed by Research
Research Results & Lessons Learned
Question & Answer
University Medical
Center of Princeton at
Plainsboro
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Oct.11.2013
Pebble Project
• Investigate
• Hypothesize
• Continue to Prove or Innovate
• Measure
• Share
Using the Evidence Base
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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
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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
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Oct.11.2013
Introduction & Guiding Principles
The Evidence Base
Integrating Original Research
Design Informed by Research
Research Results & Lessons Learned
Question & Answer
University Medical
Center of Princeton at
Plainsboro
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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
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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
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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
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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
Phase 1& 2: Mock-Up & Simulations
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Discussion Examination Proposed Change
Phase 1: Learning Lab Mock-Up
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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
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Code Blue Simulation Prevent Medication Errors Preventing Falls
Phase 2: Simulations
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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
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• Support Nurse Concentration
• Support Care Delivery
• Family Involvement
• Patient Falls & Recovery
• Headwall Implications
• Lighting & Power
(Watkins, N., Kobelja, Peavey, Thomas, Lyon. 2011)
Phase 1& 2: Mock-Up & Simulations
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Introduction & Guiding Principles
The Evidence Base
Integrating Original Research
Design Informed by Research
Research Results & Lessons Learned
Question & Answer
University Medical
Center of Princeton at
Plainsboro
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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
Design Informed by Research
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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
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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
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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
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Introduction & Guiding Principles
The Evidence Base
Integrating Original Research
Design Informed by Research
Research Results & Lessons Learned
Question & Answer
University Medical
Center of Princeton at
Plainsboro
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• 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
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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
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Current Room
Model Room
Orientation to Rooms
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Nurse Server I Room Size & Design I Lighting
Acoustics I Caregiver Presence I Hand washing
Topics Addressed
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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
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Statistically Significant Differences
Acoustics
• Door Noise
• Professional Conversations
• Equipment Carts
Lighting
• Bed Tasks
• Bed Reading
Hand Washing
• No difference found
Caregiver Presence
• Prepare Medication
Nurse Responses
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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
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0
1
2
3
4
5
Nurse Responses Room Size and Design
(*=significant at 0.05 level; **=significant at 0.01 level)
Nurse Responses:
Room Size and Design
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0
1
2
3
4
5
Current
Model
Nurse Responses Room Size and Design
(*=significant at 0.05 level; **=significant at 0.01 level)
Nurse Responses:
Room Size and Design
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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:
Room Size and Design
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Statistically Significant Differences
Room Size & Design
Lighting
Multidisciplinary Staff Responses
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0
1
2
3
4
5
Current
Model
Staff Responses (*=significant at 0.05 level; **=significant at 0.01 level
Multidisciplinary Staff Responses
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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
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Patient Experience
Responses
Our goal-
“less clinical more hospitable”* *Kim, S. Contract 2011. Vol. 52(8): 62
University Medical Center at Plainsboro
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Statistically Significant Differences
Environment of Care
• Valuables
• Belongings
• Color /Soothing Appearance
• Wellbeing
• Room Temperature
Hand washing
• No significant difference
Noise
• Equipment Carts
• Outside Room
Patient Responses
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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:
Room Size and Design
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• 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
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• 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
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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
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• 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
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• Must train staff to use the space
• Ambiance of the room
• And much more…
Lessons Learned
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Introduction & Guiding Principles
The Evidence Base
Integrating Original Research
Design Informed by Research
Research Results & Lessons Learned
Question & Answer
University Medical
Center of Princeton at
Plainsboro
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Thank you. Questions?
Contact information:
brabner@princetonhcs.org slorenz@princetonhcs.org julie.somarriba@hok.com erin.peavey@hok.com
Barry Rabner
Chief Executive Officer
Princeton Healthcare System
brabner@princetonhcs.org
Dr. Susan Lorenz, DrNP RN NEC-BC
Chief Nursing Officer
Princeton Healthcare System
slorenz@princetonhcs.org
Erin Peavey
Researcher Medical Planner
HOK Architects
erin.peavey@hok.com
Julie Somarriba
Associate
HOK Architects
julie.somarriba@hok.com
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