Research has shown that good design can impact length of stay (LOS), patient safety, and outcomes. Health Facilities Management published a round table discussion on Nursing Unit Planning and Design. Much of the discussion centered on traditional nursing units and how they're crowded, noisy and chaotic. In response to this there is a trend to moving caregivers closer to the patients. A number of the participants also indicated that their hospitals were moving to in-room computers.

We have found success combining centralized and decentralized design. The centralized area is what we often refer to as the work and care area. It’s a place for physicians to talk with patients. It’s a place for the unit clerk, the social workers and the case managers, and it’s a place for folks to coordinate their care of patients. It’s the social aspect of what oftentimes the nurses and the physicians need to ensure proper communication.

Certainly, the decentralized area ensures that the nurses are not walking as far to fetch various things. They’re closer to their assignment areas, and getting away from stress, which is what we’re trying to mitigate in our architecture for the nurses, the patient and families, and the physicians.

So how do we do that? How do we mitigate the noise issue? In design, I struggle with how to balance that. I struggle with getting things close or farther away. I struggle with noise, equipment, beds that are moving around, things coming up on the floor. It’s a balance of doing both centralized and decentralized.

It seems that technology could greatly reduce nursing unit noise. Wireless communications devices like phones or Vocera badges would eliminate much of the overhead pages and shouting down the hall that occurs now. A nurse carried alarm notification device would minimize device alarm noise at the central station central station and remote annunciators.

These changes in work patterns will have a major impact on medical device design, especially central stations. If nurses spend much less time at the nurses station, the operating costs for central stations will go up as monitor techs are hired to cover for absent caregivers.