Room Typologies

The article “Inboard, Outboard, or Nested?” by Camie Maize, AIA, LEED AP, takes a look at a how The University of Minnesota Children’s Hospital arrived at the final layout of their patient rooms. The factors involved in the planning of a facility involve the location of the headwall and mirrored or same-handed rooms among other design decisions; however, none are more important than the location of the toilet room. To maximize efficiency and minimize distractions, several layouts were carefully considered during a time consuming process. The location of the toilet room affects the layout of the patient room as a whole. Each scenario has its pros and cons.

The planners for the University of Minnesota Children’s Hospital asked themselves two questions:
o Will the room be acuity adaptable?
o Will the room be mirrored or same-handed?
These pre-design strategies lead to the most important question:
o Where is the toilet to be located?

Acuity Adaptable Rooms vs. Universal Rooms The universal patient room concept was designed to create a space that would allow inpatients to receive the same comfort level as their treatment changed. The patient would typically be relocated as their care differs. These rooms tend to be larger and can accommodate whatever type or level of care the patient requires. The acuity-adaptable room model is a standard layout with the equipment within the room to account for all levels of care. It is designed to bring the care to the patient without enduring multiple room transfers. This room model lowers the risk and accidents that may happen when moving equipment in and out of patient rooms. The key different between these rooms is the purpose: the acuity-adaptable room focuses on minimizing patient relocation, while the universal patient room is designed for flexibility and changes in clinical needs.

Mirrored or Same Handed Rooms In a study conducted by Herman Miller Healthcare, researchers used two patient room configurations: one was a left handed approach, the other right handed. Each unit was identically fitted with a headwall, bed, removable over-bed table, and other typical equipment. Nurses worked with nine different configurations consisting of caregiver zones being open, forced to the left or right, and moving the location of the IV pole. The nurses’ actions were videotaped and recorded, as well as conducted interviews post-study. The Key findings of the study were that:
  • Standardized headwalls are as effective as standardized same-handed rooms in supporting caregiver work patterns.
  • The location of the IV strongly influences caregiver work patterns regardless of layout.
  • To caregivers, the most important room attribute is having the ability, upon entering the room, to see and quickly assess the area around the patient
Having a caregiver that is comfortable in their environment means that the patient is less likely to be stressed. Clinician zones should always be standardized for ease and comfort of patients, families, and caregivers. In mirrored rooms, the location of the headwall is the same within each room; however, switching back and forth from a left to right handed approach can be stressful on the caregiver. Same handed rooms allow for every piece of equipment to remain in the same place from room to room, as well as lessening sound transmission between rooms.
Location of the Toilet Room
Room Typologies - Health Architecture
Carnie Maze advises designers to start with the big picture and establish the guiding principles and operational care model. Then allow those principles to help navigate through other decisions large and small, no matter how controversial.
Inboard – The toilet room is located on the corridor side of the room adjacent to the patient room door. This partially obstructs views to the patient, but allows the patient a complete view to the outdoors. This layout is the most accessible for housekeeping and patient assistance, as they would not have to traverse the room to clean. More privacy is given to the patient.

Room Typologies - Health Architecture

Outboard – The toilet is located on the exterior wall in this layout. It allows for maximum visibility to the patient and a reduced distance from the bed to the corridor.
In this layout, the window is far away from the patient and usually is slightly obstructed by the toilet. Housekeeping has to traverse the room to clean the toilet.
Room Typologies - Health Architecture
Same-handed – This layout is repeated throughout the design. The toilet can be either inboard or outboard. This typology is thought to reduce medical errors because each room is oriented and kept the same. o Canted rooms – These layouts increase patients’ views to the outdoors and visibility from the corridor into the room.
Room Typologies - Health Architecture
Midboard– Toilets are located back to back between patient rooms and allows the room to be square or rectangular. There is maximum visibility from the corridor and to the outdoors. The bed is closer to the door creating a better access distance for the nurse and the patient. This layout is a safety concern because the patient will have to cross the room/travel a longer distance. Also, this design adds an extra six feet to the length of the corridor, meaning nurses will have a longer distance to travel.

Maze, Carnie. Inboard, Outboard, or Nested?. Healthcare Design Magazine. March 1, 2009. Ulrich R, A Review of the Research Literature on Evidence-Based Healthcare Design. Health Environments Research & Design Journal, Spring 2008.

More pages