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Ruka KOSUGE Ph.D., Research Associate, Architect

2013.9.25. UIA/PHG 2013. COMPARATIVE STUDIES ON HOSPITAL-BED MANAGEMENT AND ENVIRONMENT BETWEEN ALL SINGLE-ROOM WARDS AND MIXED MULTI-ROOM WARDS. Ruka KOSUGE Ph.D., Research Associate, Architect. KOBE DESIGN UNIVERSITY, Japan Department of Architecture.

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Ruka KOSUGE Ph.D., Research Associate, Architect

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  1. 2013.9.25 UIA/PHG 2013 COMPARATIVE STUDIES ON HOSPITAL-BED MANAGEMENT AND ENVIRONMENT BETWEEN ALL SINGLE-ROOM WARDS AND MIXED MULTI-ROOM WARDS Ruka KOSUGE Ph.D., Research Associate, Architect KOBE DESIGN UNIVERSITY, Japan Department of Architecture

  2. USA: Guidelines for Design and Construction of Health Care Facilities 2006 Single vs. semiprivate room Surveys in USA Infection control First and operating costs/ Management Patient falls Hospital design and therapeutic impacts 4 bed rooms in Japan Part 2—Hospitals Single-bed rooms as the minimum standard for medical/surgical and postpartum nursing units in general hospitals Guidelines for Design and Construction of Health Care Facilities 2006

  3. Outside (Natural Light) Patient room Nagoya University Hospital Proposal Quasi-private patient rooms in Japan …Trial to get private window for each patient Nishi-Kobe Medical Center Minami-Aizu Hospital Kuroki Memorial Hospital

  4. JAPAN Ashikaga Red-cross Hospital Old Hospital Multi-Bed Room Wards Moved to Neighboring Site 2011.07 New Hospital All Single-Room Wards

  5. Old ward/ Surg. (MIXED MULTI-ROOM WARD ) 1 1 1 1 1 2 Beds 2 Beds 6 Beds 6 Beds Dining Staff Station 5 Beds 6 Beds 6 Beds EV hall 4 Beds 4 Beds 4 Beds 50 Beds / Ward Average Stay : 17.9 Days Bed Occupation Rate: 93%

  6. New ward/ Surg. (ALL SINGLE-ROOM WARD ) 35 Beds / Ward Average Stay: 14.5 Days Bed Occupation Rate: 104% Staff Station

  7. Expected Changes on Hospital Wards by Renovation to ALL SINGLE-ROOM WARDS Ward Management Reduction of Patient Transports Easy Bed-control (uniformly-modified single rooms) Increaseof Bed Occupation Rate Patients’ environment Inside of Patient Room Patient centered environ. (controllable by patients) Mutual complement Increase of Visitors Anxiety Patient Falls without help Not easy to contact with nurses/ patients Sense of Isolation Staffs’ environment Concentrated care in patient room Accident Delay in taking action to Patients’ troubles Changes in patient's condition Fire, Quakes… Rethink of Ward Structure Information Exchanges between staffs Long traffic of nurses Distributed Nursing Base Location of Supplies Resize of Number of Beds/ Ward

  8. Can all single-room ward reduce the number of patient transfers in a ward? 1. Patient Transfer Date Reason of Patient’s Relocation (in the ward) Patient’s ID From: Bed # Surveys : Written by Nurses Old wards/ Surg., Med. (MIXED MULTI-ROOM WARDS ) 28/3/2011-28/4/2011(32Days) New wards/ Surg., Med. (ALL SINGLE-ROOM WARDS) 7/11/2011-8/12/2011(32Days) To: Bed #

  9. Old ward/ Surg. (MIXED MULTI-ROOM WARD ) FINDINGS: - Nurses locate severe patients around staff station. - Extra room charge makes occupation rate lower. Group A -2 beds -No charge -Age 70.3 -Occup. 89% -Rotation 8.5 Group B -1 bed -Extra charge -Age 71.3 -Occup. 84% -Rotation 4.2 1 1 1 1 1 2 Beds 2 Beds 6 Beds women 6 Beds men Lounge 6 Beds women 6 Beds men Staff Station 5 Beds Group D -6 beds -No charge -Age 65.8 -Occup. 91% -Rotation 3.7 Group C -5 bed -No charge -Age 73.2 -Occup. 92% -Rotation 2.4 EV hall 4 Beds Men 4 Beds Women 4 Beds Men Group E -4 beds -Extra charge -Age 68.5 -Occup. 86% -Rotation 3.8

  10. Reasons of Patient Relocation Group A -2 beds -No charge Group B -1 bed -Extra charge FINDINGS: Nurses locate Patients by Grade of Severity, Needs for Observation, Terminal Phase, Patients’ requests etc… 1 1 1 1 1 2 Beds 2 Beds 6 Beds women 6 Beds men Lounge 6 Beds women 6 Beds men Staff Station 5 Beds Group D -6 beds -No charge EV hall Group C -5 bed -No charge 4 Beds Men 4 Beds Women 4 Beds Men Group E -4 beds -Extra charge

  11. Chain-Reaction of Patient Transfer Example: 26/4/2011 Surg. ward According to conditions of 2 terminal patients in the ward, nurses tried to move them near to staff station. Bed occupation rate at the day was almost full, so nurses had to move other patients who didn’t especially need to be relocated themselves. This case was not rare in this ward. Needless transfers occurred 9 times in a month during survey. 退院

  12. New ward/ Surg. (ALL SINGLE-ROOM WARD ) Group B -No charge -Age 74.7 -Occup. 100% -Rotation 3.7 Group A -No charge -Age 77.3 -Occup. 97% -Rotation 9.3 Staff Station Group D -No and low charge -Age 66.4 -Occup. 100% -Rotation 4.9 Group C -Extra charge (Rm with Shower) -Age 61.2 -Occup. 98% -Rotation 6.8 FINDINGS: - Nurses still locate severe patients around staff station.

  13. Reasons of Patient Relocation Group B -No charge Group A -No charge Staff Station Group D -No and low charge Group C -Extra charge (Room with Shower) • FINDINGS: • Total number of patient transfers reduced, especially by patients’ requests. • Extra room charges made new patient transfers.

  14. Reasons of Patient's Relocation(Multiple Answers) Bed adjustment Req. for window/ isle Patient wants to be in Medical Observation Care for Operation Nursing Observation Bed adjustment Req. for window/ isle Req. for Lower charge Patient wants to be in Nursing Observation Medical Observation Terminal Phase Reasons for medical needs were large in Surg. ward. Patients’ relocations rather reduced in Med. ward including chain-reactions. Extra room charge could be a new problem. Only Vacant bed Bed adjustment Req. for Lower charge Medical Observation Nursing Observation Bed adjustment Req. for Lower charge Nursing Observation Medical Observation Care for Operation

  15. 2. Number of Visitors Date Number of Patients in your visited room Number of people in your group Family / Others Collected totally 997sheets Surveys : Written by Visitors Old wards/ Surg., Med. (MIXED MULTI-ROOM WARDS ) 9/5/2011-31/5/2011(22Days) New wards/ Surg., Med. (ALL SINGLE-ROOM WARDS) 28/11/2011-18/12/2011(21Days) Time of Departure Time of Arrival

  16. Average Time Number of people in a groupand Sojourn time in a room(Surg. Ward) Multi-1 Single-1 Single-2 (Number of people in a group) Mixed Multi-Room All Single-Room Peak value is about 1 hour, to 4 hours. In the case of more than 2 people in a group, sojourn times were longer in all single-room wards than mixed ,multi-room wards.

  17. Other comments about All single-room ward by Hospital Staffs • Easy Infection Control • Reduction of Narcotic Medication • Reduction of Use of Portable Toilets • Patient’s own Lights-out time and Family visiting hours • Comfortable space to talk with each patient • Hard to hear alarms of infusion pumps inside patient rooms • Overuse of nurse call buttons by patients even not in emergency • Sometimes giving patients sense of isolation

  18. Thank you Kosuge-r@kobe-du.ac.jp

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