Key Flow Processes on Wards.

OBJECTIVE: The aim of the study is to test a new nurse movement route analysis (NMRA) method for measuring nurses' traffic volume between rooms on wards. BACKGROUND: The World Health Organization calls for urgent investment in nurses. On the other hand, the challenges in the availability, direct care activity, and staffing of registered nurses make increasing the quality of care by process improvement a central objective for nursing. METHOD: The method is based on cellular operations with from/to matrix that describes nurse movements between rooms on a ward. The NMRA can be implemented by traditional manual observation or with a novel internet-of-things solution named SKAnalysis. RESULTS: The greatest nurse flows led to patient rooms, nurses' stations, and medicine rooms. The manual NMRA recorded a total of 3,040 room visits by nurses; visits to patient rooms accounted for 33% of all room visits, while visits to nurses' stations accounted for 28%, and visits to the medicine room for 10%. The internet-of-things NMRA recorded a total of 25,841 room visits by nurses; patient room visits accounted for about 43% of all room visits, while nurses' station visits accounted for 26% and medicine room visits for about 8%. Based on the results, researchers present the development examples and priorities for nursing. CONCLUSIONS: NMRA works and is a new universal method for analyzing nurses' traffic which is a basic premise for improving working methods and productivity on the wards. Internet-of-things solution makes the implementation of NMRA six times more efficient than by the manual NMRA.

Patient-Flow Analysis for Planning a Focused Hospital Layout: Tampere Heart Hospital Case.

OBJECTIVE: The objective of this study is present how a patient movement-based patient-flow analysis is performed for planning the new Heart Hospital of Tampere University Hospital and how patient transfer distances can be shortened by this method. BACKGROUND: The Heart Hospital had served patients as a service line organization for years. However, the Heart Hospital layout rather looked like functional layout instead of service line layout because the units of the Heart Hospital have been spread out around the large university hospital campus. METHOD: The flow routes of patients treated over the course of 1 year were analyzed by information technology systems in the hospital planning phase. Then, the proximity ranking of the main functions of the Heart Hospital was made. Layout planning was performed based on the proximity ranking. Nine months after the opening of the new Heart Hospital, the distances between the various hospital functions were calculated for the old Heart Hospital and the new one. RESULTS: In the old Heart Hospital, patients' transfer distance was 5,654 km (3,513 miles), while the corresponding figure for the new Heart Hospital was 3,797 km (2,359 miles), which means the distance was reduced by 33%. CONCLUSION: The patient-flow analysis works as it generated substantially shorter patient transfer distances in the new Heart Hospital. Shorter distances have supported more fluent patient flows that, in turn, has contributed higher productivity and quality of care.

The Elimination of Transfer Distances Is an Important Part of Hospital Design.

OBJECTIVE: The objective of the present study was to describe how a specific patient flow analysis with from-to charts can be used in hospital design and layout planning. BACKGROUND: As part of a large renewal project at a university hospital, a detailed patient flow analysis was applied to planning the musculoskeletal surgery unit (orthopedics and traumatology, hand surgery, and plastic surgery). METHOD: First, the main activities of the unit were determined. Next, the routes of all patients treated over the course of 1 year were studied, and their physical movements in the current hospital were calculated. An ideal layout of the new hospital was then generated to minimize transfer distances by placing the main activities with close to each other, according to the patient flow analysis. The actual architectural design was based on the ideal layout plan. Finally, we compared the current transfer distances to the distances patients will move in the new hospital. RESULTS: The methods enabled us to estimate an approximate 50% reduction in transfer distances for inpatients (from 3,100 km/year to 1,600 km/year) and 30% reduction for outpatients (from 2,100 km/year to 1,400 km/year). CONCLUSIONS: Patient transfers are nonvalue-added activities. This study demonstrates that a detailed patient flow analysis with from-to charts can substantially shorten transfer distances, thereby minimizing extraneous patient and personnel movements. This reduction supports productivity improvement, cross-professional teamwork, and patient safety by placing all patient flow activities close to each other. Thus, this method is a valuable additional tool in hospital design.

Participative Facility Planning for Obstetrical and Neonatal Care Processes: Beginning of Life Process.

Introduction. Old hospitals may promote inefficient patient care processes and safety. A new, functionally planned hospital presents a chance to create an environment that supports streamlined, patient-centered healthcare processes and adapts to users' needs. This study depicts the phases of a facility planning project for pregnant women and newborn care processes (beginning of life process) at Turku University Hospital. Materials and Methods. Project design reports and meeting documents were utilized to assess the beginning of life process as well as the work processes of the Women's and Children's Hospital. Results. The main elements of the facility design (FD) project included rigorous preparation for the FD phase, functional planning throughout the FD process, and setting key values: (1) family-centered care, (2) Lean thinking and Lean tools as the framework for the FD process, (3) safety, and (4) cooperation. Conclusions. A well-prepared FD project with sufficient insight into functional planning, Lean thinking, and user-centricity seemed to facilitate the actual FD process. Although challenges occurred, the key values were not forgone and were successfully incorporated into the new hospital building.

Production flow analysis: a tool for designing a lean hospital.

Production flow analysis (PFA) was used in the planning process for a new acute care hospital. The PFA demonstrated that functional organisation--for example, with centralised medical imaging-- generates a lot of back and forth patient transfers between functional units. This to-and-fro patient flow increases lead times of care processes and also exposes the patients to unnecessary complications. PFA produced an ideal patient flow model and layout model for the acute care hospital. Thus, PFA revealed information for use in proximity ranking of different units of the hospital; the planning team then decided which units should be placed next to each other. Medical imaging should be essentially ubiquitous, to achieve simple, high-velocity patient flow. Thus, a modern decentralized layout model for medical imaging was planned. Furthermore, PFA enables optimizing transfer routes for patients and also, e.g., lift capacity in the hospital.