Author: ngawali

The Realizing Improved Patient Care through Human-Centered Design in the Operating Room (RIPCHD.OR) learning lab uses a socio-technical approach incorporating human factors engineering and evidence-based design principles to create an optimal ergonomically sound operating room that results in improved patient and staff safety. A multidisciplinary team comprised of human factors and industrial engineers, architects, environment and behavior researchers, medical equipment planners, anesthesiologists, nurses and quality and patient safety experts from Clemson University and the Medical University of South Carolina (MUSC) have worked collaboratively to develop, test (through iterative design cycles), implement and evaluate various OR design solutions. Some of the concepts developed as part of this learning lab are being implemented in two new ambulatory surgery centers built at the Medical University of South Carolina (MUSC) in Charleston.

Sponsor: Agency for Healthcare Research Quality

Project period: 2015 to 2020

Three highly interrelated and integrated patient safety focused projects related to key aspects of OR suite design have been undertaken over the course of the RIPCHD.OR project

Project 1: Unmasking of anesthesia-related alarms and communications This work extends what is known about alarms, interruptions, and distractions in the operating room by examining them from a systems perspective. Project 1 involves several phases with the goals of: 1) developing and evaluating systems design methods that account for masking affect tasks within the OR environment and 2) exploring interface design as a means to mitigate the effects of masking.

Project 2: Traffic flow and door openings in the OR This project focuses on understanding factors impacting traffic flow in the OR suite. Using a systems approach, the flow of supplies, equipment, information and people in the OR is being studied and the factors impacting traffic flow and distribution are being analyzed to develop solutions that minimize door openings and flow disruptions in the OR.

Project 3: Integrated OR suite design This project provides the overall framework for integrating the work of this learning lab. This project is developing an overall framework and methodology for designing an ergonomic and human-centered operating room that will improve patient and staff safety and outcomes in the OR. The project team for OR suite design has worked closely with the other project cores to determine optimum procedure room configuration, orientation and intra-room zoning that supports the performance of the surgical team, improves workflow within the team, enhances visibility of work and team members, minimizes distractions of team members and reduces risk of surgical site infections.

AIM 1: Formally structure the RIPCHD OR learning lab and establish laboratory infrastructure and team management.

AIM 2: Develop a systematic approach to evaluating the impact of people, tasks, tools and technology and the built environment in developing ergonomic and human-centered operating room design solutions.

AIM 3: Develop evidence and recommendations related to the use of advanced displays and multimodal displays for anesthesia tasks to mitigate the masking of important signals.

AIM 4: Develop process design recommendations to support key OR flows (OR team members, supplies, patient, equipment, information) that impact patient safety outcomes such as surgical site infections and surgical errors.

AIM 5: Develop an evidence-based framework and methodology for designing operating rooms that achieve the desired patient and staff safety outcomes.

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The collaborative project, funded by a gift from Haworth through the Watt Family Innovation Center, explores preoperative and postoperative workspaces within complex ambulatory surgery centers (ASC). The spatial layout, furniture, and equipment of these work spaces should support patient, care partner and staff experiences within the context of emerging technologies and models of care. Multiple studies over the course of the project have examined a human centered approach to designing preoperative and post-operative spaces in ASCs.

Sponsor: Gift through the Watt Family Innovation Center from Haworth

Project period: 2015 – 2018

Study 1: Observational study of preoperative and postoperative work spaces- This observational study used a multimethod approach consisting of in-depth literature review, behavior mapping, shadowing, spatial analysis, and semi-structured interviews with nursing staff to understand the work patterns of nurses in preoperative and post-operative workspaces of ambulatory surgery centers. This study identified environmental design strategies that support or act as barriers to critical interactions between care teams (care providers, patients and care partners) and addressed the emerging role of technology in ambulatory surgery workspaces as well as issues associated with integrating technology into existing workspaces.

Study 2: Development and application of ergonomic assessment tool- This study involved the development of an ergonomic evaluation framework and design tool that focused on the work system versus the workstation in preoperative and postoperative workspaces in ASCs. As part of this study, the tool was tested and refined across several facilities with varying spatial configurations and workstation types.

Study 3: Comparing design alternatives using virtual reality- This study involved designing and testing innovative solutions of pre/postoperative rooms addressing a range of design and performance goals including the integration of a computer workstation to support electronic charting. Architecture + Health studio (class of 2018) participated in a two-week design intensive to develop and design three distinct prototypes of pre/postoperative rooms with varying types of workstations integrated into their work system. Each of these prototypes were evaluated by nurses using virtual reality to understand how well user goals were met. From these three prototypes, one was chosen and modified to incorporate the findings from the evaluation. This new prototype will be tested for its functional capabilities with users in a full-scale cardboard mock-up.

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Waiting rooms in healthcare environments have been previously studied to understand how factors such as aesthetics, privacy, comfort and incorporation of positive distractions impact user perception of quality of care. Though care partners of patients undergoing surgery often spend long hours in the surgical waiting rooms, no studies have examined how the built environment including the layout of the waiting area and design of seating could support their waiting experience.

Sponsor: Gift through the Watt Family Innovation Center from Haworth

Project period: 2018 to 2020

This study determines how furniture location impact care partners’ choice of seating in a virtual outpatient surgery waiting area during various tasks including patient check-in, receiving a phone call, getting coffee, and waiting for surgery to end. A multimethod approach including a survey and semi-structured interviews was utilized to capture participants’ seat selections as well as their feedback on how certain factors (e.g., visibility, accessibility, privacy, comfort, and aesthetic quality) impacted their choices. Additionally, the researchers obtained feedback on usability, comfort and aesthetic quality of seating furniture products that were incorporated in the virtual environment.

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The purpose of CU@Home is to understand the feasibility of using a technology-based intervention to proactively assess the home and community environment of older adults scheduled for joint replacement surgeries. The feasibility study is conducting an in-depth literature review; a series of interviews and focus groups with key stakeholders (primary care physicians and clinical staff, discharge planners, home health nurses, patients and families) to clearly understand all aspects of the problem; and to explore potential data needs, data sources, and technological solutions required to develop this intervention.

Sponsor: Clemson Faculty Research Development Program

Project period: 2019 to 2020

The overall broader research plan of this multidisciplinary team is to develop a technology-based intervention that could be used prior to joint replacement surgeries to help older adults evaluate their own homes for safety risks and to identify resources in their community to support home modifications. We envision that this tool would support both the clinical team as well as the older adult and their families in coming up with built environment solutions that would prevent falls and support their care needs. The tool would also help the patient access resources in their community to enable home modifications and to support safe recovery post-surgery. We also envision that this tool would be connected to the patient’s health record or patient portal such that this data will be available to other care teams that interact with the patient at different stages (e.g. a hospital discharge planner who may need to need to know key characteristics of the home while transitioning a patient back after a hospital stay).

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The major goal of Identifying and Reducing Errors in Perioperative Anesthesia Medication Delivery (OR SMART) is to engineer reductions in anesthesia medication errors in operating rooms. This study uses a systems’ engineering approach to improve decision making, reduce procedural and technological vulnerabilities and improve the work environment and culture. A highly experienced multi-disciplinary team of clinicians, scientists and engineers is using a combination of innovative techniques to address this threat to patient safety in the most comprehensive study of anesthesia medication safety systems ever conducted.

Sponsor: Agency for Healthcare Research Quality

Project period: 2018 – 2021

AIM 1. Explore Solutions to Failures in Diagnosis, Selection and Prescribing of Intraoperative Anesthesia Medication.

AIM 2: Develop methods to reduce failures in the preparation, administration and recording of intraoperative anesthesia medication

AIM 3: Understand and improve workspace design and safety culture to influences anesthesia medication selection and delivery.

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This collaborative project examines the process flow, workload and usability issues associated with ambulance-based telemedicine to evaluate and provide the requisite treatment to stroke patients in transit to the hospital. The goal is to understand the cognitive, physical and temporal demands placed upon caregiving teams in geographically dispersed remote locations, and to evaluate the potential for user/design errors that characterize the use of Information Technology (IT) systems in high-stress environments.

Sponsor: Agency for Healthcare Research Quality

Project period: 2019 – 2020

AIM 1. Evaluate the demands placed on the caregivers, the usability of the telemedicine system, and the barriers in the workflow associated in a telemedicine-integrated, ambulance-based setting for stroke care using the SEIPS 2.0 framework.

AIM 2: Iteratively develop and refine guidelines and recommendations for large-scale implementation of telemedicine systems for stroke care in ambulances.

The project seeks to develop guidelines for a system that can efficiently integrate telemedicine systems on ambulances to enhance caregiver-telemedicine system interaction and streamline workflow without increasing the physical, cognitive and/or temporal workloads on the stakeholders who use these systems.

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The simulation team at Children’s Healthcare of Atlanta has conducted several simulation-based evaluations of physical mock-ups as part of the design process for a new 400-bed freestanding children’s hospital. These simulations have highlighted the specific human factors and workflow challenges posed by room design, especially in critical high-risk situations. The purpose of this project is to focus on one particular high-risk patient care environment – the pediatric intensive care unit (PICU) room. This study utilizes videos of simulations conducted in high-fidelity physical mock-ups of PICU:
1. To conduct a systems evaluation of the PICU room in the context of multiple scenarios associated with a high-risk patient.
2. To simulate observed workflows and disruptions in a mirrored PICU room to identify design challenges and potential solutions
Sponsor: Children’s Healthcare of Atlanta
Project period: 2020

Several studies have shown that daylight has a significant impact on patients in healthcare facilities including reduced length of stay, reduced perceived pain, reduced intake of pain medication, and reduced depression. Other studies have shown that the type of window view (nature vs. non-nature) also impacts health outcomes such as perception of pain and length of stay. However, none of these published studies describe in any detail how windows should be designed and incorporated into patient rooms to achieve the maximum benefit in terms of health outcomes, patient experience and satisfaction. The purpose of this two-part study is to obtain users’ perceptions about the windows in their room during their inpatient hospital stay and to get input regarding different aspects of window design.
1. The first part of the project will involve an online survey conducted with individuals who have received inpatient care in the last one year.
2. The second part of the project involves evaluating the impact of different window/blind conditions on patients receiving care on an inpatient unit.
Sponsor: View, Inc.
Project Period: 2020-2021

Innovations in Hospice Architecture by Stephen Verderber and Ben J. Refuerzo

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This fully revised, new edition of Innovations in Hospice Architecture responds to the need for an up-to-date, theoretically based reference book summarizing key historical and recent developments with respect to this rapidly evolving building type. This Second Edition presents:

• an overview of the historical origins of the contemporary hospice
• the diverse variations on the basic premise of hospice care
• a review of the scant architectural literature published on this subject to date
• a broad series of case studies of exemplary hospices around the world
• planning and design concepts for palliative care environments.

Case study projects are from Japan, Canada, Europe, Africa, Australia, Indonesia, China, the United States and South America. Thirty-six case studies are individually presented and comparatively analysed, and prognostications for the future of hospice architecture are examined. Each case includes floor plans, technical drawings and beautiful, full colour illustrations. Through an in-depth discussion of the inner profundities of hospice architecture, the book presents this type as a humane, genuine expression of the spiritual, physical and psychosocial dimensions of the contemporary death and dying movement. Written with a broad audience in mind, the book provides both technical and conceptual information, blending narrative, images and diagrammation so that the audience may understand and articulate the complexities of this specialized building type in professional practice contexts.

Sprawling Cities and Our Endangered Public Health by Stephen Verderber

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Sprawl is an unsustainable pattern of growth that threatens to undermine the health of communities globally. It has been a dominant mid-to-late twentieth century growth pattern in developed countries and in the twenty-first century has shown widespread signs of proliferation in India, China, and other growing countries. The World Health Organization cites sprawl for its serious adverse public health consequences for humans and ecological habitats. The many adverse impacts of sprawl on the health of individuals, communities, and biological ecosystems are well documented. Architects have been rightly criticized for failing to grasp the aesthetic and functional challenge to create buildings and places that mitigate sprawl while simultaneously promoting healthier, active lifestyles in neighborhoods and communities.

Sprawling Cities and Our Endangered Public Health examines the past and present role of architecture in relation to the public health consequences of unmitigated sprawl and the ways in which it threatens our future. Topics examined include the role of twentieth century theories of architecture and urbanism and their public health ramifications, examples of current unsustainable practices, design considerations for the creation of health-promoting architecture and landscape urbanism, a critique of recent case studies of sustainable alternatives to unchecked sprawl, and prognostications for the future.

Architects, public health professionals, landscape architects, town planners, and a broad range of policy specialists will be able to apply the methods and tools presented here to counter unmitigated sprawl and to create architecture that promotes active, healthier lifestyles. Stephen Verderber is an internationally respected evidence-based researcher/practitioner/educator in the emerging, interdisciplinary field of architecture, health, and society. This, his latest book on the interactions between our buildings, our cities and our health, is an invaluable reference source for everyone concerned with sustainable architecture and landscape urbanism.