Lessons Learned From Decentralization of an Elective Surgery Medical-Surgical Unit.

OBJECTIVE: The objective of this study was to examine changes in healthcare practitioners' perception of supportiveness of their physical work environment, and trend in patient fall, when moving from a centralized to a decentralized unit configuration. BACKGROUND: Previous studies on decentralization have not uniformly provided findings consistent with desired outcome. METHOD: A pretest-posttest study was conducted in an elective surgery medical-surgical unit in the mid-Atlantic region of the United States. The independent variable was the physical design supporting centralized versus decentralized nursing models. Data were collected from healthcare staff with a self-report survey "before" (September 2017; n = 42) and "after" (June 2019; n = 22), and interviews. Before-after data were analyzed using both parametric and nonparametric tests to identify significant differences. Qualitative responses were analyzed to identify triangulating evidences. Monthly patient fall data were collected for a 3-year period and analyzed using log-linear Poisson Regression model. RESULTS: Results show favorable assessments in the areas of overall supportiveness of design, equipment and soiled utility location, peer support, process flow visualization, and overall satisfaction. A reduction in patient falls was observed. Unfavorable outcomes were found in the contexts of walking distance, multidisciplinary collaboration, alarm audibility, nurse station size, and PPE location. CONCLUSIONS: This study underscores that the success of a unit cannot be achieved without coordinated and successful interventions in the areas of operations, processes, policies, culture, and the physical design.

The Impact of the Built Environment on Patient Falls in Hospital Rooms: An Integrative Review.

OBJECTIVES: The aims of this study were to identify and evaluate scientific evidence examining the impact of the built environment on patient falls in hospital rooms. METHODS: An integrative review (IR) with a systematic literature search was performed using the patient, intervention, comparison, outcome framework. We searched CINAHL, PsychINFO, PubMED, and Web of Science databases. The search included peer-reviewed studies from 1990 to 2017 written in English. An additional hand search was also conducted. Selected articles were reviewed and rated based on a hierarchical categorization, comprising six evidence levels, developed by the American Association of Critical-Care Nurses and adapted for evidence-based design systematic literature reviews. RESULTS: After a multitiered process, 30 articles met the selection criteria. Thematic areas were created based on the examined elements of the physical environment including patient room configuration and available space, bathroom configuration, bathtub and shower, door, bed height and bed rail, flooring, floor mats, patient chair, lighting, toilet, handrail, grab bars, intravenous pole, sink, ceiling lift, and wheelchair and walking aids. Findings of studies on each element are discussed in detail. CONCLUSIONS: Some environmental elements have not been examined in past relational or causal studies, and the level of evidence for the examined attributes is not high enough to gain robust confidence in healthcare design decision-making. Because of the low level of evidence for several environmental elements, conclusions must be taken with caution. More studies using quantitative, relational, or causal designs are recommended to develop actionable interventions on patient falls in hospital rooms.