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The purpose of our project was to evaluate St. Luke's Emergency Room facility design in concert with operational design and track the impact of such designs on patient care.Using MedModel, we simulated the combination of three different physicaldesigns with three different operational approaches to make sure therewas a fit between the two.
In fact, the hospital actually ended up spendingmore money in the redesign than they had planned but clinical capacityand nursing reach was increased upwards of 40%.The ProblemThe Emergency Room under study had been redesigned, redirected and addedto over many years. Unfortunately, no master plan was ever developedthat dictated exactly what was to be achieved by each change. Simplyput, new equipment was purchased and new nursing processes and staffinglimitations were implemented without the benefit of a single coherentmanagement vision. Simulation helped us combine operational redesignwith physical redesign so that the two, often evaluated separately,were not only compatible but also mutually supporting when brought together.The first thing we did was identify and document the various problems. Through observation we found that St. Luke's was losing over 35% of their available nursing time, simply because of the way the unit was laid out.
In essence, there was no ability to share nursing hours between patients; the problem was lost nursing ability. As a result, waiting times were incredibly long, often averaging in excess of 3.5 hours!The SolutionInitially, the emergency room was divided into five nursing units, mostof which were physically separated and out-of-sight from the others.Recognizing the fact that by reducing the amount of time nursing personnelwere isolated with specific patients, we would be able to increase availablenursing time to do other tasks.
We asked the following questions: 'Whatif we removed the limitations? What if we allowed nurses located indifferent pods to share patient supervision and care time?' In response,the hospital suggested several designs ranging from five nursing unitsto two or three. Our idea was why stop there? Let's try to achieve adesign that depends on a single nursing group. In other words, let'sachieve as much sharing as possible.
Once we did that, we started seeingsome major decreases in patient length of stay. With the model, we couldquickly test different scenarios very easily. More importantly, if themodel showed improvement in nurse utilization or a reduction in patientwaiting time, management was willing to consider the optionand some of the ideas were fairly radical.Finally, we designed a new system for triage which focused on gettinga lot of testing and specimen collection done up front. We called thisredesign, 'Triage Plus'. Triage Plus depended on using nurse practitionersas screening agents with the skill and experience to identify and requestmore advanced testing in a more timely manner.
This advanced classificationsystem kept 20% of the patients out of the ER. In fact many of themnever left Triage.The ResultsWhat we ended up with was a system of totally de-specialized treatmentrooms, the elimination of all nursing pods, and a greatly increasedand far more efficient triage area characterized by a new way of collectingand processing samples as well as getting timely, case-based x-rays.What the design achieved, according to the model, was a decrease inlength of stay in the unit by as much as 40%! The quality of care increasedalong with nursing satisfaction as well. The staff was able to do whatthey needed to do more efficiently and with greater safety.A Lesson in ComplexityAs an architect, I approach modeling differently than most analysts.For example, I've found through experience that most design questionsdon't require models of extreme complexity and overwhelming detail.What they do require, however, is an initial vision of what needs tobe done and what members of the staff have experience with respect topossible improvements. Combining each option with its parallel designis the real task and the one that produces the greatest benefit.
Inshort, keeping things simple makes modeling easier and far more productiveand generally doesn't sacrifice one bit of validity!-Victor Lange, ProModel Corporation.