Field Research and Parametric Analysis in a Medical-Surgical Unit.

OBJECTIVE: To study the workplace in a medical-surgical (med-surg) unit and to identify suboptimal environmental conditions that can be improved in the current unit and avoided in future design, through rapidly deployed field research and timely simulation. BACKGROUND: Literature emphasizes the importance of the healthcare workplace and the effect on patient outcomes. What is lacking are studies conducted on-site and used for immediate application in design to assess and improve workplace conditions. METHODS: A rapidly deployed field research and simulation study was conducted in a 40-bed med-surg unit of a large healthcare system as part of the process of designing a new medical tower. Online surveys, systematic behavioral observations, semi-structured interviews, sound studies, and advanced spatial analysis through parametric modeling were conducted. RESULTS: The following created challenges for patient monitoring, care coordination, and management: (1) waste and variability in walking, (2) limited point-of-use access to supplies, (3) large distances traveled for minor tasks, and (4) low visibility and connectivity. The corridor is used as a workspace/communication hub. There is a distinct difference in beginning of day and night shift patterns and between walking "distance" and walking "sequence." There is a tendency for nurses to multitask, but a simulation exercise shows that for key tasks like medication delivery, multitasking may not always reduce walking distances. CONCLUSION: Co-location of medications, supplies, and nourishment; accommodation for work on wheels; and spatial and technological connectivity between care team and patients should be considered while designing a med-surg unit. Understanding the key activity sequences helps determine the proximity of spaces in relationship to patient rooms and each other.