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Using evidence-based design to improve patient safety

Toronto, June 5, 2013

By Leslie Shepherd

A mock-up of ICU rooms showing a decentralized work station looking in at two patient rooms.
A mock-up of ICU rooms showing a decentralized work station looking in at two patient rooms.

Several evidence-based design features of the new patient care tower, from the decentralized care stations to hand rails, night lights and ceiling tracks, are expected to reduce falls and improve patient safety.

Kirsten Martin, a consultant in the Planning Department, said at-risk patients often fall when they are unobserved and unassisted. There is promising evidence that several of these design features bundled together will have an impact on reducing falls, in addition to their other benefits.

  • Decentralized care stations located outside of pairs of patient rooms will place nurses and other health care workers physically nearer to patients, allowing them to observe them more closely and respond more quickly.
  • Building family space into patient rooms will provide another set of eyes on the patient, as well as involving the family in the patient’s care.
  • Rooms in the new medical-surgical and coronary intensive care units will be mirrored – meaning patients in adjacent rooms will face one another so caregivers can easily see both patient faces from the work station.
  • Bathrooms in in-patient rooms will all be located on the same wall as the head of the bed, meaning patients don’t have to cross the room to reach the toilet and, again, it’s easier for the caregiver to see them. There will be a handrail running from the bed to the bathroom and a night light under the rail to guide the way. During the day, patient rooms will have more natural light, also helping to reduce falls.
  • Ceiling-mounted lifts in every in-patient room to help move patients from a lying to sitting position or from sitting to a wheelchair or walker should reduce falls by both patients and staff.
“We are very optimistic that the evidence-based design principles included in the tower design coupled with the rigorous falls reduction program developed by Nursing Professional Practice will result in an improved quality experience for all our patients at St. Michael’s,” Martin said.

Falls are the sixth leading cause of death in Canada and account for 20 per cent of all injury-related deaths among seniors. The incident of falls among elderly hospitalized patients in higher than among those living in the community. Several researchers have reported fall rates in hospitals range from 2.2 to 7 per 1,000 bed days in acute care hospitals.