continued

Hall continues: "Placing room functionalities, such as sinks and work counters, where they aid efficiency will save time and therefore labor costs. Additionally, families will become an important part of providing care, so the room must have space for them during all hours."

Flexible Design

Also key to saving money, the room must be universal enough to allow changes as hospital needs evolve. "During 30 years, a room may be part of a pediatric unit, an intensive care unit, or labor and delivery. The room even could be used for minor procedures, making it a treatment room and more of a profit center," says Hall.

Waugh points out that medical buildings need to be adaptable enough to work well even though no one can anticipate how medical technology will change. "For example," he says, "the building's structural, mechanical, and electrical infrastructure has to support new equipment."

With all these factors in mind, Ellerbe Becket's charette considered "inboard" toilet room designs (where the toilet is located along the corridor wall thereby allowing more natural light and extra space for family members) and "outboard" toilet designs (where the toilet is located along the exterior wall to provide maximum patient visibility for hospital staff). They finally decided on a room design with toilet areas side-by-side between patient rooms.

"While both inboard and outboard toilet rooms have merits, the side version allows the best of both worlds — a view to the outdoors and family space, while maintaining staff visibility into the room for better patient care," says Christine Hester Devens, IIDA, Ellerbe Becket project interior designer. "It's also flexible enough that remodeling to accommodate unit changes would be minimal. Only interior features would require changing. No plumbing needs to be relocated."

Patient Room Zones

Three distinct zones make up the oval-shaped side-toilet room design: one each for caregivers, the patient, and family members.

The portion of the caregiver zone outside the room entrance includes space for staff to perform electronic charting and a window for them to see into the room. Nurses can monitor several patients at once from this location.

In an anteroom, caregivers can don masks and gowns when caring for isolated, highly infectious patients. Low-wall exhaust quickly removes bad air, while supply vents near the ceiling continually import good air to better protect room occupants. Immediately inside the room, the caregiver has a hand-wash sink with laminar-flow wall faucet and hands-free infrared controls, a work counter, and easy access to the patient headwall.

The bed is the main feature of the patient zone, one that allows easy transporting to the bathroom to prevent caregiver injuries. All lighting, video, and window opacity are controllable from the bed. A curving, stretched fabric ceiling enhances acoustics and makes the room feel cocoon-like. It can be easily removed for cleaning.

Positive visual and auditory elements can be introduced on the room's video screen. "From their bed, a patient can pull up a wooded scene with a babbling brook, which can lower stress and aid recovery. This is especially important for hospitals in urban settings where there are no views of nature," says Devens.

"The video screen allows some patient control and also can be used for videoconferencing with their children at home, speaking to medical specialists, communicating with nursing staff, and more."

In the family zone, defined by a curved wood ceiling and floor-finish change, a day bed provides sleeping arrangements. A desk enables family members to continue work while supporting their loved one. Wireless technology gives network access throughout the room. A cabinet contains a lockable safe, open shelves for displaying personal items, and a small refrigerator for storing food and beverages.

"With fewer nurses, family members will assume more and more patient-care responsibilities," notes Hall. "They need space and amenities to be comfortable and continue their lives while doing this."

This side-toilet room design marries high tech with high touch. While it can accommodate the latest medical technology, it is serene, comfortable, and conducive to healing. "The environment is like a spa — calming and simple," explains Devens. "The curved wall and ceiling forms are a departure from the traditional institutional feel. Surfaces on walls, floors and furniture are textured but easily cleaned. Sights, sounds, and smells are appealing."

Assessing Size

One drawback of the side-toilet room configuration is that the floor plan is three feet (one meter) longer along the corridor than typical patient rooms. "This means longer travel times to support spaces for already-busy nurses," explains Hall.

However, this increase may be balanced by smaller nursing units in the future. Hall adds: "Overall, buildings with side-toilet rooms will be longer but not quite as wide, meaning costs typically won't increase."

Flexibility in design has been a goal of healthcare visionaries at least since the days when the Mayo brothers opened their first clinic. Durable, sustainable design, if implemented properly, can enable future healthcare managers to hold the line on costs while continually improving the quality of patient care.

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Michelle Moore is a freelance writer and communications consultant doing business as Vivid Communications in Overland Park, Kansas. She specializes in writing articles, marketing collateral, and online content; publications production; editing; and proofreading.

This article was originally published in Ellerbe Becket's Quarterly, Volume 5, Number 2 (Fall 2003), and is reprinted with permission of Ellerbe Becket.

In Ellerbe Becket's patient room of the future, a bed with therapeutic-massage options is oriented toward the large bay window. Dimmable sconces offer soft lighting, while glass doors and windows contain a liquid-crystal interlayer for privacy and light control. Image: Ellerbe Becket An optimal design places toilet areas side-by-side between patient rooms. This gives ample space for windows and family members and maximum visibility for staff. Image: Ellerbe Becket An "outboard" toilet room, along the exterior wall, allows maximum visibility into the room by staff but less space for family members. Image: Ellerbe Becket An "inboard" toilet room, along the corridor wall, allows a larger window and space for family but less visibility for staff. Image: Ellerbe Becket The Ellerbe Becket scheme proposes "full-body infection control" outside the room entry. Similar to an air-curtain in a vestibule, it eliminates infectious agents from anyone entering the room. Image: Ellerbe Becket View from the "family zone" through the patient and caregiver zones to the corridor. Image: Ellerbe Becket In the "caregiver zone," a sliding headwall panel conceals medical gasses when not in use. A curving, stretched-fabric ceiling has dimmable backlighting to allow shadow-free illumination for procedures. Image: Ellerbe Becket Shower wall in a private toilet room. Image: Ellerbe Becket   Click on thumbnail images to view full-size pictures.