Supporting Infrastructure


Once the acuity level of the patient room is established, the model of nursing care must be determined. Historically, documentation revolved around the location of the paper charts. With the advent of the electronic medical record (EMR), any clinician can access charts from any location. The first wave of EMR patient unit designs enthusiastically decentralized all documentation activities to bedside computers or to charting “cockpits” outside two to four patient rooms, sometimes eliminating the central nursing station altogether. The advantage of this concept is to bring nurses closer to patients with direct visibility into patient rooms-a plus for more acute patients but a rather costly solution. Postoccupancy evaluations show that clinicians gravitate to central workstations because of a strong need to collaborate.

The question then becomes: Are decentralized stations necessary at patient rooms and, if so, how? Loyola University Medical Center in Maywood, Illinois, is using furniture instead of fixed counters in alcoves designed to accommodate stationary computers, assuming that handheld computers or computers on wheels (COWs) will become the norm in the future. Some hospitals are assuming the existence of this technology now in their designs. The number of patient care stations in the core and the distance from these stations to patient rooms are key considerations, given the aging of staff and the growing acuity of patients.

Supply Distribution

Supporting Infrastructure - Health Architecture

Example distribution scheme
Source unknown

Another key design element is the hospital's supply distribution model; i.e., how much supply inventory control is required. The less inventory control, the more likely that supplies will be replenished continuously as they are depleted—in or just outside a patient room for easy access to most-used items. If a centralized automatic dispensing system exists, then fewer supplies are stored in the room; they are stored in centralized clean-storage rooms. Likewise, hospitals must decide whether linens will be available in patient rooms, since linens must be rotated when a new patient arrives. The more cabinetwork in a room, the greater the cost, especially since its installation is multiplied many times.

text from: Sheila F. Cahnman, AIA, ACHA
-Healthcare Design, April 2006

More pages