Vanderbilt Universityresearch.vuse.vanderbilt.edu/srdesign/2007/group15/Gr… · Web viewThe design of Valley View Hospital incorporated this philosophy through ample family space

Vanderbilt University 

Department of Biomedical Engineering  

Adaptable Room Design for a Critical Access Hospital

Team Members:Marti Chance, Elizabeth Copenhaver, Kelsey Hoffman,

Elizabeth Salmon 

Advisors:Jim Easter and Emily Mowry – Hart Freeland Roberts, Inc.

Submitted:April 22, 2008

Abstract

Hart Freeland Roberts, Inc. (HFR), an architecture firm in Nashville, has taken on the

task to construct a new campus for Memorial Hospital, a critical access hospital located in

Carthage, Illinois. We have teamed up with HFR to design the ideal inpatient room for

Memorial Hospital as our senior design project. This project involved much research from

literature, interviews with architectural professionals, close examination of hospital codes, and

tours of existing hospitals. Nursing opinions from surveys distributed in West Virginia and from

the nursing staff at Memorial Hospital gave us valuable insight and drove our design. Using the

software program Revit Architecture, we were able to design a floor plan for the ideal patient

room, create a three dimensional rendering and compose a walkthrough of our final design.

Some of the features that our final design included were a large family area, a short distance

from the patient bed to the bathroom, an inboard toilet design that still allowed the nurses to view

the patient from the hallway, and an efficient location of the nurses' sink, all while still being

both AIA and ADA compliant. All of this was incorporated into an aesthetically pleasing room

environment complete with a large window, wood laminate flooring, and colorful but calming

room walls. Through the use of the problem solving and engineering skills we have obtained, we

completed all of our project goals in a manner that was satisfying to our advisors.

Introduction

Project Description

Critical access hospitals (CAHs) can be found all across the United States as there are

around 1,300 hospitals operating under this status1. While imposing certain requirements, the

purpose of the CAH program is to improve the financial performance of hospitals—thus

reducing closures—by allowing hospitals to receive cost-based reimbursement from Medicare1.

In order to be certified as a CAH, a hospital must maintain twenty five beds or less, be located

thirty five miles or more away from any other hospital, and be located in a rural area1. One such

example is Memorial Hospital, a CAH located in Carthage, Illinois. A local Nashville firm, Hart

Freeland Roberts, Inc. (HFR), is working with Memorial Hospital to develop a master campus

plan for a replacement hospital.

HFR was established in 1910 and is a full-service architectural and engineering design

firm. One of the oldest firms in Nashville, HFR is a prominent company as seen through several

of its projects. HFR offers services in several areas including: healthcare planning, structural

engineering, civil engineering, and architectural design of educational and corporate buildings.

Headquartered in Brentwood, Tennessee, HFR also has offices in Kansas City, Missouri,

Louisville, Kentucky, Phoenix, Arizon and Jackson, Tennessee. We specifically worked with

the healthcare planning division at the Brentwood office to complete this senior design project of

designing the ideal hospital room for Memorial Hospital.

When collaborating with HFR to design the ideal hospital room, two major specifications

for the room design became apparent: the concepts of private hospital rooms and adaptable

rooms. The most important change Memorial Hospital is undergoing is the conversion to private

patient rooms.  This is mandated by American Institute of Architects (AIA) code 3.1.1 and is

considered an essential feature of hospital design according to independent studies and personal

interviews.  The rooms are also being designed to be adaptable, meaning that each room can be

converted to suit the changing needs of the hospital.

The design of the ideal patient room required our team to do much research—which we

did through literature reviews, interviews with healthcare architects, hospital tours, and surveys

directed toward healthcare professionals. Our designs are compliant with the codes and

regulations that are used by HFR architects in their designs.

Project Goals

Given this project we set out with several goals in mind. First, we wanted to research the

required elements of the patient room as mandated by hospital code. Also, we sought to gain

insight from architectural professionals, nurses, and patients. Along with these opinions, we also

wanted to design the room specifically with the nurses and patients of Memorial Hospital in

mind. Our deliverable was the design of the room itself, drawn in the software program Revit

Architecture. Since small scale models are deemed to be obsolete in the architecture field, we

decided that we would create a computer simulated walkthrough of our model instead.

Literature Review

The review of published literature was a crucial aspect of our learning process. Through

articles, we were able to gain a better understanding of the direction where healthcare planning is

headed, important information regarding asepsis, and the importance of some key features of our

patient room design. To see the direction that healthcare design is heading, we looked at a

couple of hospital designs that local architects have recently done. Earl Swensson Associates

Inc. recently designed a hospital in Frisco, Colorado. This design showed how important it was

to incorporate aspects of the community in design. The hospital was designed to mimic a ski-

lodge as the community is largely a resort town2. One idea we took away from the design was

their use of wood-look sheet laminate, a flooring material that looks hospitable, but is yet also

practical due to its low maintenance requirements2.

HFR has also exhibited the importance of modern design through their Valley View

Hospital project. This hospital is operating under the Planetree philosophy of care, which

“encourages patients and family members to become actively involved in the actual healing

process. The importance of ‘connecting patients, family, and staff was essential to the character

of the new facility3.” The design of Valley View Hospital incorporated this philosophy through

ample family space in the patient room and a comforting, hotel-like feel to the interior design.

Our group wanted to apply this philosophy to our room design, as we felt it was important in

how the patient healed. A therapeutic environment decreases the stress felt by both the patient

and healthcare professionals who treat the patients4. An aesthetically pleasing hospital design

also has the benefit of “enhancing the hospital’s public image and is thus an important marketing

tool4.”

Along with the aesthetically pleasing elements of design come the more practical features

that also decrease patient stress and increase the level of healthcare provided. It is shown that

natural light and noise reduction can greatly decrease the stress levels of both the patients and the

healthcare professionals5. The level of healthcare is increased by reducing nurses’ fatigue

through better design of the nurses’ access to patients and a nurse’s station5. With our design, we

wanted to create specific places in the room for the patient, the nurses, and the family to

incorporate this idea. With these zones, there is less chance of crowding and better flow to the

room design.

Finally, another important topic concerning room design that we looked into was

reducing the spread of infection and disease. The reason the AIA mandated that all new patient

rooms must be private was in large part due to research that suggested that infection rates were

lower in private patient rooms than in multi-bed patient rooms6. With private patient rooms,

there is less concern for the spread of airborne bacteria—and this can be reduced greatly due to

the way the rooms are ventilated6. Also, private patient rooms are easier to clean more

thoroughly after a patient leaves because the room is empty and there are no other patients

present as compared to a multi-bed room6. This really reiterated why we had the specification of

a private patient room for our design. Disease can also be spread by healthcare professionals, so

we equipped our room with an easily accessible nurse’s sink and antibacterial gel dispenser.

Additional Research

In addition to published literature, we also used several other resources for research on

hospital room design. The first of these very important resources was our advisors, who provided

not only essential information but also constructive feedback and input on our designs. Besides

our advisors, we also interviewed several other architectural professionals. Scott Corbin, the

head of HFR’s Kansas City office, stressed the importance of the family in the healing process

(Appendix V). Todd Robinson from Earl Swenson Architects focused on the financial reality of

critical access hospitals and designing on a budget (Appendix VI). We also interviewed with Al

Thweatt from Gresham, Smith & Partners, who emphasized designing for safety by putting the

patient bed close to the bathroom to reduce patient falls (Appendix VII).

We were also able to tour The Medical Center in Franklin, a critical access hospital in

Franklin, KY. This proved to be a very informative and critical part of our research. The

Medical Center was a newly renovated CAH that gave us many ideas for our own room design.

For example, many of the surfaces that were used in these rooms were easy to clean and

aesthetically pleasing: the couch was vinyl, the floors were wood laminate (which require only

mopping, instead of waxing and buffering like tile floors), and the shades were adjustable but

place between two window panes so that they would not have be cleaned everyday. The rooms

were also “mirrored” to allow for the lining up of plumbing and electrical wiring between

neighboring rooms. The rooms also included a heavy duty headboard on the wall to reduce

damage incurred from the patient bed and countertops in the bathroom to allow for patient

storage. We incorporated all of these elements into our room design. We also noted that their

patient rooms were very small and cramped, which was good to visualize before committing to

dimensions in our own room design. The hospital tour turned out to be an essential part of our

design process.

Finally, we collected the opinions of nurses and patients. The patients that we interviewed

stressed the importance of comfortable family seating and patient storage space. To gain the

opinions of nurses we distributed a questionnaire to nurses in the state of West Virginia. This

allowed us to gather a variety of different opinions, some of which conflicted with each other but

were nevertheless helpful. The most important and most common comment from these

questionnaires was that the inpatient hospital rooms were not large enough to accommodate the

needs of the nurses, family, and equipment within an inpatient room.

The most important step in our research was to interview

the nursing staff at Memorial Hospital. We learned that the

hospital staff does its charting on “cows”, or computers on wheels

that are kept within each room; therefore having a shelf for the

nurse would not be as beneficial as we had initially thought. Also,

we had to add some space next to the patient bed to make room for

these computers. Secondly, the nurses wanted a window from the

hallway into the patient room so that they could easily glance in at

their patients. This led us away from the design that hid the patient

bed from the door. Additionally, the nurses also liked the idea of

having a “nurse server”, or a small shelf that would be accessible

from both the hallway and within the room to exchange linens and medications without having to

enter the patient room. Finally, they liked the idea of artwork within the room along with

flooring, decorations, and wall coloring that would take away from the institutionalized feeling

of hospitals.

Methodology

Specifications

As is important to any engineering project, there were many specifications that our room

design had to meet. These were set forth by codes and regulations, the requirements of an

adaptable room, and customer demands. The codes and regulations that were incorporated into

our room design are those from the American Institute of Architects (AIA) and the Americans

with Disabilities Act (see Appendix I for a listing of important codes). These are the standard

Figure 1. This computer on wheels, or "cow", was in the hospital room which we toured in Franklin, KY. A similar system will be used in Memorial Hospital's new facilities.

codes and regulations used in healthcare planning. From our group’s experience, the most

difficult things to incorporate into room design were the Americans with Disabilities Act (ADA)

regulations for the elements of the bathroom. The five-foot turning radius required in the

bathroom to allow for the complete rotation of a wheelchair was a limiting factor in how the

bathroom could be laid out. Another important aspect to the adaptable patient room is the

inclusion of certain gases and specific number of electrical outlets. The rooms must be equipped

to have medical air, oxygen, and suction.

Customer Demands

A hospital must meet the needs of its customer—the patient—and does so through the

overall master campus plan as well as more specifically the patient room. Our team found it

important to look at the demographics of Carthage, Illinois and to incorporate these details into

our design. Carthage has a population of 2,725 with a median household income of $34,677.  In

order to incorporate the sense of community found in a small, rural town, we designed our room

to maximize the family area.  Additionally, we included comfortable family seating and

overnight accommodations. Although as a state, Illinois is ranked 23rd heaviest in the nation

with an adult obesity rate of 23.9%, we chose to omit bariatric lifts in the general inpatient room

to save money. This choice seemed reasonable considering obesity is not a primary concern

according to nurses at Memorial.

Also, from interviews, we learned that by designing to reduce the staffing requirements

of a hospital on a day to day basis, the hospital will save money long term.  Given that Memorial

Hospital is in a rural area and many critical access hospitals are financially struggling, we chose

flooring that takes a third of the time to clean than usual tile floors.  While this incurs a higher

initial cost, we believe that it will save money

in the long term.  This flooring is also more

aesthetically pleasing and creates a warmer,

more welcoming environment for the patient

and visitors. Nurses can also benefit from

this, as seen through the research and

interviews that we conducted.

Safety Considerations

Federal and state hospital codes have published standards to increase safety measures.

The AIA codes mandate all areas of the room to reduce the spread of disease, increase patient

wellbeing, and decrease employee contamination. For example, all countertops, flooring,

window blinds, etc. installed are designed for easy daily cleaning and sterilization between

patient stays. Also the employee sink and antibacterial station are at a convenient location, to

increase compliance. For patient safety, grab bars are located throughout the room well

traversed locations. They line the wall on the pathway to the bathroom and surround the toilet.

The distance from bed to bathroom has been minimized to reduce the time out of bed and chance

of falling. In the event a patient does fall, all sharp corners on beds, tables, and walls have been

replaced by rounded edges. The sightlines from door to bed are maximized so the medical staff

can periodically monitor the patients with minimal disruption. For nurse safety, sharp boxes,

glove dispensers, and waste bins are all congregated together and close enough to the patient for

ease of use.

Figure 2. The wood laminate flooring on the left is more aesthetically pleasing than the tile floor on the right.

Elements of Room Design

Each inpatient room is divided into four specific areas: the patient area, the family area,

the bathroom, and the nurse area. The patient area at minimum houses the patient bed,

monitoring equipment, the patient's nightstand, and the IV pole. This area can easily become

congested, but hospital code mandates that a clear space of at least 3 feet on each side be

maintained to assure proper care. This is also the most expensive portion of the room given the

high costs of hospital beds and the highly technical headboards that must be installed in the wall.

The second focus of our design was the family space, since through our research we

learned that the family is a significant part of the healing process. We also learned that in

hospitals that are on a strict construction budget, this is usually the first area to be reduced. The

family area ideally has plenty comfortable seating with overnight accommodations and does not

encroach on the nurse's area or patient area.

It is the nurses will be using the hospital room every day, and so the nurses’ station

within the room must also be carefully designed. Good design can encourage sterile practices:

placement of the nurses sink is critical. Also, newer room designs have a storage component

called a nurse server. Nurse servers are shelves that open to both the outside corridor and the

inside of the room that can be used for storage of linen and medications for easy access for the

nurse once within the room. This also allows the patient room to be stocked without disturbing

the patient and their family. These cabinets will be incorporated into our final design. In

addition to taking care of the patient nurses also must document their work by charting. Many

hospitals are moving to "cows", or computers on wheels that allow them to do all of the charting

in the patient room. Space must be allocated in the nurse area within the room for these portable

laptops.

Finally, there is the bathroom. Most patient falls in the hospital occur when the patient is

going from their bed to the bathroom, so the bathroom is ideally located close to the bed. The

decision of where to place the bathroom affects the overall room design. Three different

bathroom configurations are possible: centralized, inboard, or outboard, shown in Figure 3.

Each possible toilet location has unique advantages and disadvantages. Most bathrooms are

constructed to meet the minimum codes and regulations, rather than to create a comfortable

environment for the patient. The inboard toilet blocks the nurses’ views into the room from the

hallway and creates wasted space at the entryway of the room. On the other hand, the outboard

bathroom decreases the

window size and the

patient's view of the

window. It also

decreases the space

available for the family

area. The centralized

toilet, although it does

not impinge on any areas

of the room, does cause a

problem by increasing

the length of the hallway. This can be tiring to the nursing staff.

In order to decide on the best placement for the bathroom in our design, we used a

Quality Function Diagram (QFD) to score all the elements of each design, thus allowing us to

make the best decision for our specific needs (Table 2).

Figure 3. There are three possible bathroom configurations for a hospital patient room which are highlighted in yellow: centralized (top left), inboard (top right), and outboard (bottom left).

Two Initial Designs

After researching possible layouts, we developed two initial room designs that are

referred to as the original box and the original sawtooth designs (Figure 4). QFDs were

completed to determine the most ideal layout (Tables 3-6). These diagrams also helped us to

look at what features were most important. This helped us to incorporate them into the final

design no matter which overall shape was selected.

In the original box design, the nurses could not see the patient from the hallway when

looking into the room.

We wanted the final

design to correct for this

concern by having an

angled bathroom wall—

which was a positive

attribute that we saw from

the original sawtooth

design. The bathroom no

longer blocks the nurses’

views into the room from

the hallway. Also, both of

these original designs

allow for mini nurses’

station outside of each room, should Memorial Hospital be upgraded to this. One major problem

with the original sawtooth design was that the placement of the toilet inside the bathroom might

Figure 4. The original box (left) and original sawtooth (right) designs were created. We analyzed these designs and used these to guide our final room design.

have inhibited a wheelchair from entering. This was a problem that had to be fixed in the final

design.

Results

The final design was completed after looking at QFDs and distance measurements. We

were also able to incorporate suggestions provided by HFR. The final design represents a

combination of the best attributes of the two original designs and this feedback.

Distance and Area Calculations

The crucial distances and room dimensions are listed in Table 1 to compare the original

box design, original saw tooth design and the final design. To quantify improvement from the

original design to the final, the walking distance between key locations in the room were

measured. The main traffic pattern for nurses was considered entering the door to the patient bed

to the nurse station and exiting the door. It was also crucial to minimize the distance patients

must traverse from the bed to the bathroom.

Table 1. Area and Distance CalculationsBox Design Sawtooth Design Final Design

Room Area (sq ft) 335 238 288Open Area (sq ft) 127 107 144Bathroom Area (sq ft) 69 54 82Door to bed (ft) 17 11.5 14Bed to nurses’ sink (ft) 4 7 3Nurses’ sink to door (ft) 14 4 12Bed to bathroom (ft) 15 5 8.5Distance for nurse (ft) 18 11 15

Quality Function Diagrams

Throughout the designing process, QFDs were used to make crucial decisions. The

weights within each QFD were assigned based on the opinions of those interviewed. For each

category within the QFD, the room was ranked with a one, two, or three. One of the first major

decisions in the designing process was where to place the bathroom within the patient room. The

bathroom can be classified as an inboard, outboard or centralized toilet, illustrated in Figure 3.

Using Table 2, it was determined that the best option for Memorial Hospital was the inboard

toilet. Some of the key features include a large family area, decreased hallway length, and large

window.

Table 2. Bathroom Placement QFDInboard Outboard Centralized

Weight Value Product Value Product Value ProductSize of Family Area 4 4 16 1 4 3 12Window Size 3 3 9 1 3 3 9Sightline into room 2 1 2 3 6 2 4Nurse Station Size 3 2 6 2 6 3 9Reduced Hallway Length 5 3 15 3 15 1 5Patient Area 5 2 10 2 10 3 15Total 58 44 54

Initially the two designs (box and sawtooth) were broken into the four critical areas (patient,

bathroom, nurse, and family) and then critiqued individually. The designs were scored with a

one or two depending on which fulfilled the criteria better. First the patient room was examined

using the QFD in Table 3. In this QFD the sawtooth design scored higher with a 35 while the

Box design scored a 33.

Table 3. Patient Area QFDBox Design Sawtooth Design

Weight Value Product Value ProductAesthetics 3 1 3 2 6Distance Bed to Bath 4 1 4 2 8View out of the window 4 2 8 2 8Ease of watching TV 4 2 8 2 8Patient Privacy 5 2 10 1 5Total 33 35

The bathroom was then examined using the QFD in Table 4. In this, the box design scored

higher with a 30 compared to the sawtooth design with a 24. The key features in this portion of

the room were the ability for a wheelchair to enter and patient privacy. The sawtooth design

posed the problem of perhaps inhibiting a wheelchair from entering the bathroom due to the

location of the toilet. Patient privacy in the box design was increased because of the wall that

limited sight if the door was open.

Table 4. Bathroom QFD  Box Design Sawtooth Design

  Weight Value Product Value ProductAbility to Sanitize 4 1 4 2 8Counter space 3 2 6 2 6Ease of entrance for wheelchair 5 2 10 1 5Patient Privacy 5 2 10 1 5 Total  30 24

The nurses’ area is examined using the QFD in Table 5. For this area the sawtooth scored

exceptionally higher than the box design: 32 to 16.

Table 5. Nurses’ Area QFDBox Design Sawtooth Design

Weight Value Product Value ProductEase of Use 4 1 4 2 8Organized 3 1 3 2 6Storage 2 1 2 2 4Nurse server 5 1 5 2 10Charting Area 2 1 2 2 4Total 16 32

Finally the family area was examined in the QFD of Table 6. Again the sawtooth design scored

higher than box design, 32 to 27. The key features in this area of the room were the ability for an

overnight stay and the sightline to the television.

Table 6. Family Area QFDBox Design Sawtooth Design

Weight Value Product Value ProductNumber of Seats 3 2 6 2 6Overnight Stay 4 2 8 2 8Comfort 3 1 3 2 6Storage 2 1 2 2 4Sightline to TV 4 2 8 2 8Total 27 32

Based on the QFDs, we were able to determine the best features of both the box and the sawtooth

designs. For the final design, we ended up trying to combine the best of both designs instead of

just choosing one design over the other.

Final Design

Our final design was the integration of the two original designs: the box and the

sawtooth. The floor plan in Figure 5 and the 3 dimensional pictures in Figure 6 show our final

layout for the ideal patient

room for Memorial Hospital.

For a financial analysis of the

budget that we set, please

look at Appendix VII. As is

illustrated in the figures, we

were able to include our most

desired features in the room.

The crucial sightlines from

the patient bed to the hallway,

the patient bed to the television, and the patient bed to the window are optimized in this design.

The final design appeals to the nurses, the patient, and the family. It incorporates a

viewing window so that nurses can more easily check in on the patient, but its recessed position

makes it more difficult for people walking through the hallway to look in on the patient and

violate patient privacy. A nurse server is included so that linens and other supplies can be

restocked without disturbing the patient. The placement of the nurses’ sink near the bed allows

for the plumbing to line up with the bathroom, which will decrease construction costs. This

placement also makes it possible for the healthcare professional to talk to the patient while

washing their hands, which can save time during examinations. Even more importantly, this

placement encourages sterile practices. Another feature that this final design has that benefits

Figure 5. The integration of the original sawtooth and box designs can be seen in the floor plan of our final design.

the nurses are the mini nurses’ stations that can be set up outside of the patient room due to the

sawtooth design. The room also has plenty of space next to the patient bed which can be utilized

for the placement of “cows.”

Another important aspect in our final room design is the bathroom. We were able to

include a countertop so that the patient has a place to keep their personal toiletries. The toilet

and sink are located close to one another, while the shower is placed out of the way. This makes

trips to the bathroom easier and safer for a patient who has difficulty moving, and also provides

extra privacy when the patient showers. Also, the distance to the bathroom is short, which will

minimize patient falls. With the final design, we took into consideration how the plumbing will

line up between adjacent rooms. This helps to decrease construction costs.

Features were added to the room to benefit the well being of the patient. A large window

is placed to bring natural light into the room and give the patient a view of the outdoors. Blinds

will be available to adjust the amount of light for each room. The wood laminate flooring, while

helping to decrease costs for the hospital, is also very aesthetically pleasing and creates a warm

and welcoming environment. Since we were designing for the demographics of Carthage, we

wanted to include family and visitors in the healing process. There is ample family space with

plenty of seating options and a table for visitors. The configuration makes it possible for the

patient and visitors to see the television, which can be a good distraction while spending time in

the hospital.

Figure 6. 3 dimensional views from various angles show the patient and family emphasis of our room.

Conclusion

This project presented us with the chance to combine the skills we have learned through

the biomedical engineering curriculum with the completely new concept of healthcare planning.

We feel we were successful in our efforts to suggest a design for the ideal hospital room for

Memorial Hospital in Carthage, Illinois. Using innovative thinking and analytical and problem-

solving skills, we were able to meet the specifications required of our design. The private and

adaptable patient room will serve the needs of patients in Carthage. We were able to provide a

large family space that will contribute to the wellbeing of the patients. We were also able to

cater to the nurses’ needs through the addition of a hallway window that gives the nurses visible

access to the patient from the hallway as well as a nurse server. Since cost effectiveness is so

important, but space is also crucial, we were able to utilize a slanted wall design that offers an

area outside of the rooms for nurses’ stations. These elements of room design allow the nurses to

spend their time more efficiently. Besides accomplishing the task we set forth to do, we also

gained a greater appreciation for healthcare planning and hospital design. We now know what

goes into the design of a patient room and realize the importance of environment in a patient’s

recovery. Most importantly, we saw how our biomedical engineering background can be

applied to an untraditional engineering problem.

Recommendations

Due to a constrained budget, several compromises had to be made that may have made

the room better.  First, with Illinois and the rest of the nation having such a high obesity rate, we

would have liked to put bariatric lifts in every room.  However, with the costs of these

apparatus’s at approximately $3,000 per lift, this was not a feasible feature for our design.  Also,

the space between the patient bed and wall where the nurse usually works often becomes

cluttered with equipment.  This would happen even more so because Memorial Hospital uses the

computers on wheels that are also usually located in this space.  Had the budget allowed, a

touch-screen model that could have been incorporated into the wall would have alleviated this

problem. 

      As with all designs, other compromises had to be made between varying elements in the

room.  As mentioned before, the space between the patient bed and wall where the nurse works

often becomes cluttered, and one may notice that this is also the location of our nurse’s sink.  We

chose this location for two reasons: first, the location encourages the nurse to wash their hands

before attending to the patient, and secondly it better allows for the lining up of plumbing that

will reduce costs during the construction phase.  Another compromise made was at the entrance

of the room.  The two doors leading into adjacent rooms are very close to each other, but this is

because a viewing window from the hallway also had to be fit on that wall.  The window and the

door could not be switched, because then the nurse would have the tendency to open the door to

peak in on the patient, making the viewing window a wasted expense.  The wall also looks

somewhat crowded, but in order to make the bathroom ADA compliant and incorporate the

viewing window into the room, this wall had to be made crowded.  

      Also, with a more thorough training of Revit, we could have made our design even more

detailed to include elements like a more durable headboard behind the bed and the computers on

wheels that the nurses at Memorial Hospital will be using.  We also would have liked to include

electrical outlets and the proper gases and suction required in the patient room. However, given

that we had a limited amount of time and had to learn the software from self-tutorials alone, our

advisors at Hart Freeland Roberts were very pleased with the outcome of our computer-based

design. 

      Finally, the next step in our project would be to build a to-scale model of the room so that the

nurses at Memorial Hospital could actually walk through the design and critique it.  With our

limited operating budget and resources, this goal was not feasible.

References

1] “CAH Frequently Asked Questions,” Rural Assistance Center (October 22, 2007), 15 April

2008, < http://www.raconline.org/info_guides/hospitals/cahfaq.php#whatis>.

2] Garris, Leah, “Comfort Meets Technology,” Buildings (October 2006), 15 April 2008,

<http://www.buildings.com/articles/detail.aspx?contentID=3368>.

3] Adamson, Gary, “Beyond the Architecture,” Healthcare Design (November 2005), Vol. 5.

4] Carr, Robert, “Hospital,” Whole Building Design Guide (September 9, 2007), 15 April 2008,

<http://www.wbdg.org/design/hospital.php>.

5] Blum, Andrew, “How Hospital Design Saves Lives,” BusinessWeek (August 15, 2006), 15

April 2008, <http://www.businessweek.com/innovate/content/aug2006/

id20060815_289604.htm?chan=innovation_innovation+

%2B+design_innovation+and+design+lead>.

6] Ulrich, Roger, “Essay: Evidence-based health-care architecture,” The Lancet (December

2006), 15 April 2008, <http://www.sciencedirect.com/science?

_ob=ArticleURL&_udi=B6T1B-4MMNB3G-

R&_user=86629&_coverDate=12%2F31%2F2006&_rdoc=1&_fmt=&_orig=search&_so

rt=d&view=c&_acct=C000006878&_version=1&_urlVersion=0&_userid=86629&md5=

127d6b59071fcc4ded4ecff145ca2e1a>.

7] “ADA Standards for Accessible Design: 28 CFR Part 36,” Department of Justice (July 1,

1994).

8] “Guidelines for Design and Construction of Health Care Facilities,” American Institute of

Architects (2006).

Appendix

I. Codes and Regulations The codes that we followed were the Americans with Disabilities Act (ADA)7 and the American Institute of Architects Healthcare Guidelines (AIA)8.  Important codes from each are summarized below; for a complete listing both are available online.  

Americans with Disabilities Act:      

4.3:  Clear space-Where a turn-around maneuver must be made, a clear space of 60” in diameter must be provided.

4.17: Toilet Stalls (Specs given are the side approach to toilet that we used, for a diagram for this and other ADA approved stalls please consult the appendix II):   -56” clear space in front of toilet (measured from wall of toilet)    -toilet center must be 18” from wall on one side   -must be 48” of clear space from this wall (side wall) to any other obstruction   -grab bars behind toilet must be between 33-36” from the ground be at least 36”

long.    -grab bars must be located on wall next to toilet.  They must also be at least 42”

long and 12” from the corner   -the toilet paper roll must be 19” off the ground   -toilet seat height must be between 17-19”

4.19: Sinks and lavatories   -sinks must have 48” of clear space in front of them   -sinks must be no more than 34” tall and have at least 27” of clear space

underneath them.    -sinks must also have a knee clearance (depth) of 17”

4.21: Shower stalls   -showers must be at least 36”x 36”   -the shower seat should be 17-19” from the floor and opposite to the wall with

the controls   -grab bars must be installed on the wall opposite to the seat (see appendix)

4.26: Grab bars   -diameter must be 1¼ - 1½”   -must be 1½” from wall   -must be able to withstand 250lbs of force   

American Institute of Architects:

2.2.1:  Bathrooms must have toilet, shower and handwashing station.  Bathroom doors must be double acting or swing outward

2.2.2:  Patient rooms must have a wardrobe or locker avaliable for patient storage only. 3.1.1:  Patient rooms must be private (only one bed per room).  There must be a minimum

clear space of 120 sq ft in the room and a minimum of 3 feet clear around each side and end of the bed. Each patient must also have a window that is at least 7.5% of the total floor space of the room. 

3.1.1.2:  Patient rooms must be at least 12x13 feet (or approximately 160 sq feet).  3.1.1.4:  Patient rooms must have a hand-washing station in the bathroom and outside of

the bathroom for the nurse.  2.2.7:  Patient rooms must have accommodations to allow for the stay of an overnight

guest. 8.2.2.2:  Ceilings must be at least 7 feet 10 inches high. 8.2.2.3:  Doors into patient rooms must be at least 7 feet tall and 3 feet 8 inches wide.  

II. ADA Approved Bathroom Configurations7

*Note that we used Fig. 28b (middle), with the side approach.

III. ADA Approved Handrail Configurations7

IV. ADA Approved Shower Stall7

V. Interview Notes from Interview with Scott Corbin

Scott CorbinHFR, Kansas City OfficeJanuary 3, 2008 

1. What are the difference in operating a nursing unit in a CAH vs. a large medical center? a. Flexibility in nursing staff

b. Nurses must be able to do everything

i. Cross-training is essential

2. What are the pros / cons of building a universal or adaptable rooms?

a. Pros:  put anyone in there mother and newborn

i. Maternity = 30 ft. off and is not feasible for all

b. Universal:  family,

c. CAH:  room would be big enough for all equipment needed

d. Inpatient:  pretty sick today, because of advancement in medicine

i. Larger room to allow more family visitors

ii. Especially couch (usually below window) to increase seating

3. Is there a general questionnaire that you give to nurses before starting a design project? Patients? Doctors?  *In Nashville you mentioned accounting for nurses walking distances in room design.  What considerations do you make for nurses?

a. Yes, the questionnaire should be specified for each department.

4. Do you prioritize conflicting design considerations between nurses, doctors, and patients?

Usually nurses (inboard vs. out design) 

5. Do you take the population base of a community when designing a CAH? (Age, etc.?)

Yes, each project looks at the demographics of each community.  The statistics of birth per year, specific departments in hospital, illness and death rates.  Make sure that the wants of the hospital board match the needs of community and that there is funding to fulfill it. 

6. What design aspects usually raise cost significantly?  Are there any parts of the old hospital that can be carried over to the new one?  (ex. Beds, linens, etc.)

a. Surgery

b. Imaging

c. Kitchens

i. Rooms not bad, but equipment is costly

ii. Plumbing not as big of an issue, but is nice to match up on the wall to reduce cost.

iii. It is believed to reduce medical failures when the rooms are same-handed.

7. Once your research is complete how do you usually start designing the room?

a. Design around the patient bed

b. If it is important that the patient face the wall, will have angled bed

c. Then code dictations 3 ft around and 4 ft at the foot of bed.

d. Then the bathroom location :  how to get off bed and to bathroom

i. How to do with out nurse safely because in reality

e. Typical hospitals:  semi-private room

i. Cost vs. sharing room

ii. Can’t mix adult / child / man / woman / smoking / non-smoking

1. less feasible

VI. Interview Notes from Interview with Todd Robinson

Todd RobinsonEarl Swensson Associates Inc.January 29, 2008 

Codes:

AIA guidelines:  most states follow and gives minimums American Disability Guidelines

Life Safety Guidelines (fire, etc.)

ANSIA

How to start designing:

Interview the customer while gathering data Consider market competition

Understand the demographics of Carthage when designing

o Rural environment so money conscious

o More restraints on capital

Consider local codes / conditions

Consider all staffing positions, what can make their job easier:

o Food Serviceà delivery and disposal

o Respiratory Therapistà storage of equipment

o Physicianà Quick entrance, document and exit

Make documentation convenient to increase compliance

o Imagingà Mobility of equipment through room

Movement around bed may require increased floor space

*Spend money early to ease cleaning will reduce the cost per year.  “Its like the gift that keeps on giving.” 

Safety Concerns

Sight lines into the room o CAH patients are sick, but not drastic or would go to a bigger hospital

o Therefore could have reduced acuity

Patient lifts to prevent nurse injury

o These are mounted into the ceiling and especially important with the increasing size of the average American

Consider making the rooms mirror image of each on either side

o Reduces the risk of repetition when nurse enters the room

o Patients are less likely to get lost when returning to room, because half are different

o Reduces plumbing costs two rooms have pipes aligned on the same wall.

Criteria for Bathroom (Inboard vs. Outboard):

Good access for nurse / all hospital employee Shorten patient movement from bed to bathroom

Family concerns

Shelves should be incorporated for patient’s personal belongings

Nurse scrub sink located outside to decrease spread of infection

o Consider lining up with bathroom fixtures to further reduce plumbing cost

Flooring Considerations:

NO CARPET!! o Way too hard to keep sterilized between admitted patients

Suggestions: 

o VCT with a pattern since it is waxable

o Wood pattern gives home feel

Patient privacy

Importance stressed depending on location of hospital.  For example, its extremely important in the south and gradually decreases as move north.

Increase family experienceè credibility of hospital will spread by word of mouthè increased business and capital.

Color of Rooms:

Schemes to soothe the patient Keep trends similar to homes to increase comfort level

Implement wood / earthy tones

Try and break monotony

Balance room maintenance / sanitization and feeling of hospitality

Glass Window: 

Position bed to give patient good view of outside. Natural light is good, but patient must have means to block out if desired

Size of window will change the heating / cooling costs of the room

Artwork

Patient has something to ponder Consider a program to rotate different artworks through the rooms / hospital wing

Possible Companies to view:

o Mill Care:  Modular Cabinets that can change depending on patient needs o Wellness Environment:  Hospital Mock Room is located in Metro Center

Has relative durabilityà considered damage free

“Wall Armor” a way to protect the wall from head board damage

Metal but appears like wood

VII. Interview Notes from Interview with Al Thweatt

Al ThweattGresham Smith & PartnersFebruary 13, 2008

1. What set standards and regulations are you required to consider when designing a hospital room? (Ex. hospital codes)

State AIA Guidelines

o most states adopt these minimumso some do more, depending on affordability

2. How do you approach designing a room? Patient room design is not very different for CAH Choose inboard or outboard

o Inboard patient privacy staff zone patient family allows patient to be closer to toilet – reduce risk of fall angled bed lets patient see straight out window

o Outboard patient can't see window easy view of patient for nurse decreased patient privacy

Mirrored vs. same-sided roomso mirrored – nurse approaches patients from different sides

o same-sided – decrease risk of mistakes because everything is in the same place from room to room

3. What safety features do you include in a room? Same-handed rooms

o same gas hookups Railing to bathroom 10 ft. to toilet Family space integrated into the room Only 10% of rooms required to be ADA accessible

4. What are some material choices for floors and walls in patient rooms? Flooring

o hospital preference vinyl tile some like carpet for noise reduction carpeting in all on room but around bed maintain mostly hard surface

Wallo vinyl wall covering around bedo paint

5. What are some of the usual challenges in designing a room? Get everything in the room that is need while keeping reasonable square footage Door swing requires ample space Approximately 300 sq. ft $300/sq. ft.

6. In terms of cost efficiency, what are the problems that arise with universal rooms compared to adaptable rooms?

Universal roomso creates staffing problems

2 patients per nurse in ICU 6 patients per nurse in acute care

o ICU requires 2.5 times more gas hookupso More space required in ICU

handicap bathroom headwall 13' more electrical outlets

Adaptable roomso much less costlyo not all are required to have ADA bathrooms

7. What are some trends you are seeing in room design Access to light

Line of sight to window Larger sizes Windows for patient orientation – day or night 300 sq. ft. is high end

o AIA guidelines require much less space Software

o Microstationo AutoCADo convert between the two

75-80 ft. maximum from nurse station to end of hall

VII. Budget

To determine the cost of the room, each section of the room was analyzed individually to determine the price of its unique components. The total list of equipment appears in charts 1-5 in the appendix. For each piece of equipment, it is given a code depending on the source for which the price is quoted. The list of codes and sources appear in chart 6.

Source Patient Area Quantity Price Total Cost

JMUltra-Light Full Electric Bed - Drive Medical 1 1089 1089

HFR Headwall, Rail System 1 4,500 4500HFR IV Pole 1 124 124HFR Flowmeter (air) 1 90 90HFR Flowmeter (oxygen) 2 108 216HFR Lights (overbed wall mounted) 1 548 548HFR Ophthalmoscope (wall Mounted) 1 790 790HFR Infusion Pump 1 4150 4150HFR Suction 2 547 1094CME Sphygmomanometer 1 101.47 101.47HFR Table, Overbed 1 625 625CC Sony 26" Bravia S-Series LCD TV 1 749.99 749.99general Artwork 1 100 100HFR Waste Cans (step-on) 2 60 120WCM Auto-Touch OverBed Table (InvaCare) 1 79.99 79.99Target Armouire 1 300 300

TargetClock (Stainless Steel Wall Clock – Black ) 1 38.24 38.24Total Area Cost 14715.69

Nurse Quantity Price Total Cost

HFR Linen Hamper 1 291 291

HFRGlove Box Dispenser, Syringe disposal combo 1 101 101

HFR Vital Signs Monitor 1 4482 4482

AIRGOJO TFX Purell Automatic Foaming Hand Sanitizer Dispenser 1 34.99 34.99

CME Aero Model L Hand Sink 1 581.33 581.33AIR Electronic paper towel dispenser 1 99.99 99.99

Total Area Cost 5590.31

Bathroom Quantity Price Total Cost

HDPegasus Cottage Collection 1.28 GPF AIO HET Flapperless elong Toilet white 1 149 149

HDShower floor 36 In. x 36 In. Cascade Shower Floor, Biscuit 1 185.3 185.3

CME Aero Model L Hand Sink 1 581.33 581.33

WRHStainless Steel Surface Mounted Dual Roll Toilet Paper Dispenser 1 65.26 65.26

Target Mirror (Franklin Wall Mirror - White) 1 17.24 17.24AIR Electronic paper towel dispenser 1 99.99 99.99WCM Alert System 1 22.97 22.97GBS Shower Seat (Padded Fold-Down Shower Seat) 1 229 229HD Shower rod 1 13.89 13.89HD Shower facet 1 67 67

AIRB-156 Classic Series Surface-Mounted Liquid Soap Dispenser 1 9.99 9.99

Total Area Cost 1440.97

Family Quantity Price Total Costikea Side table 1 39.99 39.99HFR Waste can (open top) 1 10 10ikea EKTORP Sofa bed 1 749 749

ikeaArm Chair (EKTORP TULLSTA) 1 149 149Total Area Cost 947.99

Chart for Codes of Equipment Source

AIR www.airdelights.comCC Circuit City (www.circuitcity.com)CME Claflin Medical Equipment (www.claflinequip.com)GBS www.grabbarspecialists.comHD homedepot.com

HFRHartford Freeland and Roberts (Equipment Quotes for King's Daughter's Hostpital)

ikea www.ikea.comJM www.jansenmedical.netTarget www.Target.comWCM wheelchairmedical.comWRH www.wrhardware.com

VIII. Pictures from Tour of CAH in Franklin, KY

We documented the notable design aspects of the hospital room that we toured in Franklin, KY. The room included a sofa/pull out bed for family members, which is covered in an easily cleaned vinyl fabric (top left). A hardwood laminate flooring was used which is not only very aesthetically pleasing, but is also much more easily cleaned than traditional vinyl composite tile (top right). The windows had self-contained blinds which do not require the daily cleaning that external blinds do (bottom left). The room met minimum space requirements, which resulted in crowding of the patient and family areas (bottom right).

IX. Innovation Workbench

Ideation Process Project Initiation 

Project nameUniversally Suitable Hospital Room Design Project timelineCompletion by April 2008 Project team:  Marti ChanceElizabeth CopenhaverKelsey  HoffmanElizabeth Salmon 

Innovation Situation Questionnaire 

Brief description of the situation Improve convenience  The universal room will be placed in a critical access hospital.  The results of this research will be implemented into Memorial Hospital of Carthage, Illinois. Reduce cost  This hospital is already in a poor region of the country and is receiving most of its finanical needs from a Congress program.  Therefore the  Reduce wear Hospital rooms are used around the clock without a break.  Therefore the design should be able to withstand almost anything. Reduce contaminationThis is designed for a hospital where contamination is easy to encounter.  Systems should be put in place to reduce the possibility of contamination.    

Detailed description of the situation 

Supersystem - System - Subsystems 

System nameMemorial Hospital Renovation of Private Rooms Systems with similar problemsThe hospital system is extremely out of date.  The bland rooms without personality are extremely undesirale.  Therefore hospitals all across the country are renevating towards a more family friendly environment.   Input - Process - Output 

System inputsInputs for this design would be finances, medical experts advise, construction materials to build room, and medical devices to equip the room for all procedures. System outputsThe result of this design would create a happier and private patient room with less contamination. ?Most patients do not want to spend time in the hospital, rather they would like to return to their familiar home.  It is proposed that patients in a more family atmosphere would have a shorter happier stay in the hospital. Cause - Problem - Effect Problem to be resolvedGoal is to renovate a Critical Access Hospital to a modern hospital within the financial means of the project. As the hospital is situated in a rural environment, it has a limited number of rooms.  By implimenting a universal design, any patient could be placed in any room.   Other problems to be solvedCreate an environment that is comfortable for the family and a professional and efficient working envrionment for the medical staff.  Within the room some of the problems include: location of the bed, bathroom, window, and standard medical devices (for example IV maachine).  Some other considerations include the size of door for obese patients and the family area vs. medical personnel area.   Past - Present - Future History of the problemCongress created the Critical Access Hospital prgram in the mid 1990s.  Memorial Hospital of Carthage qualifies for the CAH program and is a client for the project's sponsor, HFR Design. HFR has been working with the hospital since 2003, designing a new campus plan. Due to funding problems, the project was pushed back to 2006 at which time the administration decided to proceed by building a replacement facility instead of renovating the existing facility. Pre-process time

Time Memorial Hospital was declared a Critical Access Hospital and before fundraising for the new hospital began. Post-process timeTime when the new hospital has completed construction Resources, constraints and limitations 

Available resourcesA grant has been submitted for this project.  Funding would come from this or the BME department for developing a small scale model. Allowable changes to the systemThe hospital is being completely rebuilt, therefore drastic changes are possible. Constraints and limitationsThe hospital is working with limited funding.  Space for the hospital on the new site location.Time deadline until construction begins. Criteria for selecting solution conceptsWill the final design function as a universal room for a rural hospital? 

Problem Formulation and Brainstorming Problem Diagram 

   Innovative Workbench was a very useful tool to outline exactly what we our Universal Hospital Room must do.  Our group now has guidelines to reach the final goal of a small scale model.  The workbench took our ideas and put them in concrete form using concept maps and the diagram pictured above.