WHD_2014_Where Research Meets Design

1. WHERE RESEARCH
MEETS DESIGN
Using Parametric Modeling to Optimize Walking Distances
and Enhance Workflow

2. • Adeleh Nejati, MArch, EDAC
• Tom Harvey, FAIA, MPH, FACHA, LEED AP
• Upali Nanda, PhD, Assoc. AIA, EDAC
• Heath May, AIA
• Ryan Gathmann, AIA

3. WHY RESEARCH IS “IN”

5. 3
INITIATIVES

9. PARAMETRIC MODELING

10. • Designing a process rather than
a form
• Designing a reusable and
configurable process
• Creating a nearly infinite number of
variations from one rule set of
inputs, decisions and actions
• Optimizing by quickly creating,
testing and comparing multiple
options
IMAGE
PARAMETRIC MODELING

11. THEORETICAL
FRAMEWORK

12. DRIVER
(MANIPULATED FEATURE)
Distance from a Patient Room to:
• Medication Room
• Clean Supply room
• Soiled Utility Room
• Equipment Holding room
• Crash Cart Alcoves
• Documentation Station(s)
DRIVEN LEVEL 1
ENVIRONMENTAL QUALITY
• Walking Distance
- PR to Support Area
- Support to Support
- Support to PR
DRIVEN LEVEL 2
HUMAN OUTCOME
• Time in Bed-side Care
• Time in Non-Value
Added Activities
• Nurse Fatigue
DRIVEN LEVEL 3
HUMAN/ ORGANIZATIONAL OUTCOME
• Med Errors
• Falls
• HCAHPS
• Nurse Retention
CONSTRAINT
(CONTROL/CONFOUND)
• Room Size
• Unit Size
• Minimum Clearances
(patient bed, toilet)
• Maximum Distance
THEORETICAL FRAMEWORK

13. CASE STUDY
Centralized vs. Decentralized Nurse Stations

14. PATIENT ROOMS
CENTRALIZED
NURSE STATIONS
36
3
METHODIST CHARLTON HOSPITAL
DALLAS, TX
DECENTRALIZED
NURSE STATIONS
18
Each nursing unit
in this hospital has:

15. IMAGE
METHODIST CHARLTON HOSPITAL
DALLAS, TX
Scenario 1
Scenario 2
Scenario 3
36 Bed Unit

16. METHODIST CHARLTON HOSPITAL
DALLAS, TX
Scenario 1

17. Location Activity
Minimum Roundtrips
per Primary Shift1
Documentation Station(s) Documentation 10.0
Consultation/Collaboration
Socialization
Medication Room Meds Management/Admin 5.0
Med Prep
Med Supply Acquisition
Clean Utility Room Supply Use Management/Admin 3.0
Medical Supply Acquisition
Clean Linen Acquisition
Soiled Utility Room Waste Disposal 2.0
Dirty Equipment Holding
Soiled Linen Holding
Equipment Holding Room Equipment Storage 1.0
Broken Equipment Holding
Nourishment Room - Meals Food Tray Hold/Retrieval 3.0
Used Tray Holding
Nourishment Room - Ice/Snacks Snack/Drink Acquisition 4.0
Ice Pack Acquisition
Break Room Personal Effects Access/Toilet 3.0
Education
Respite
Patient Transport (Service Elevators) Link to Surgery, Imaging, Other D&T 0.2
Link to other Bed Units
Link to Discharge (Lobby)
1These figures are theoretical assumptions for purposes of this study. Actual trip counts measured through shadowing in the field often show higher frequencies.
Round Trip and Distance Parameters for Nurse Travel from Patient Rooms
METHODIST CHARLTON HOSPITAL
DALLAS, TX

18. Patient
Room 1
Patient
Room 2
Patient
Room 3
Patient
Room 4
TOTAL
Centralized 0.673 0.708 0.681 0.819 2.881
Scenario 1 Decentralized 0.491 0.549 0.55 0.67 2.26
% reduced %27.0 %22.5 %19.2 %18.2 %21.6
Centralized 0.857 0.831 0.805 0.796 3.289
Scenario 2 Decentralized 0.702 0.635 0.56 0.509 2.407
% reduced %18.0 %23.6 %30.4 %36.0 %26.8
Centralized 1.346 1.183 1.167 0.952 4.647
Scenario 3 Decentralized 1.063 0.942 0.929 0.795 3.729
% reduced %21.0 %20.3 %20.4 %16.5 %19.8
METHODIST CHARLTON HOSPITAL
DALLAS, TX
Walking Distance for Centralized vs. Decentralized Nurse Stations

19. METHODIST CHARLTON HOSPITAL
DALLAS, TX
0.000
0.200
0.400
0.600
0.800
1.000
PR1 PR2 PR3 PR4
Scenario 1
0.000
0.200
0.400
0.600
0.800
1.000
PR1 PR2 PR3 PR4
Scenario 2
0.000
0.500
1.000
1.500
PR1 PR2 PR3 PR4
Scenario 3
0.000
0.500
1.000
1.500
2.000
2.500
3.000
3.500
4.000
4.500
5.000
Scenario 1 Scenario 2 Scenario 3
Centralized Nurse Station
Decentralized Nurse Station
Walking Distance for Centralized vs. Decentralized Nurse Stations
21.6%
26.8%
19.8%

20. IMPLEMENTATION
IN PRACTICE

21. WINGS
NURSE STATIONS
2
4
PROMEDICA TOLEDO HOSPITAL
TOLEDO, OH
PATIENT ROOMS
40
Each nursing unit
in this hospital has:

22. 20 Beds
20 Beds

24. 200.075
115
83
81.55
79.725
68.25
59.875
59.325
50.8
24.125
0 50 100 150 200 250
Break Room
Nourishment
Conference
Soiled Work
Equipment
Ice
Main Nurse Station
Meds
Linen
Wow Stations
AVERAGE
DISTANCE
FROM PR TO
SUPPORT
SPACES

25. NURSE WALKING DISTANCES
Excessive
Distance
Reasonable
Distance
UNIT AREAS
PATIENTROOMS

27. IMPLICATIONS
FUTURE RESEARCH

28. • Increased value of care giver time – by optimizing time with
the patient rather than time wasted in hunting and gathering
activities.
• Enhanced understanding of design implications – informed
by quality data relative to spatial configurations on the
workflow, unit organization and human behavior
• Enabled purposeful scenario planning of workflow, space
allocation and spatial configurations that then inform
operational planning and space programming that drive design
goals.
IMPLICATIONS

31. • Building a tool providing the
planner/designer with the
ability to set a specific criteria
of maximum threshold for
walking distances, and input
parameters related to the
specific site and program to
generate geometry within a
parametric model.
• Building a generic solver to
automate the process of
iteration and allow for
numerous alternates to be
tested against user-defined
criteria and sorted for fitness.
IMAGE
FUTURE RESEARCH

32. Thank you
for your attention 