Oxford Method Research Programme

A Review of Current Best Practice in Healthcare Accomodation and Observations on Future Directions - SYNOPSIS

1. WELFARE

• Human needs of patients not to be neglected in the creation of technically efficient facilities.
• Patient empowerment, the desire to retain control and independence.
• Disturbance to rest and sleep. Control of noise (separation).
• Feeling of warmth and welcome - pleasing décor, art shape and appearance of rooms.
• Low cill heights.
• External landscaping.
• Motorised blinds and curtains.
• All beds to receive natural daylight.
• Courtyards with good access.

2. THEORY/PLANNING

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• A preference is emerging for a four-bedded room with designated sanitary facilities for each bedroom accessed not from within but from just outside the sleeping area. Each patient has a corner to provide a “home base”, the distance to washing and lavatory facilities is short.
• Each multi bedroom should include or have easy access to a sitting area.
• All single bed and multi bed rooms should have an ensuite WC and shower designated for use by people of one gender at a time.
• All sanitary facilities should be accessible and manageable by people with physical or sensory disabilities, and should be no more than 12m from bed areas or the day room.
• Bidets should be provided.
• If multi bed rooms are used there must be a quiet separate room for consultation.
• Informal social spaces with window seats and low ceilings/alcoves are preferable to large impersonal day rooms.
• Occupancy and lengths of stay are dramatically improved by the introduction of single bed rooms (occupancy grew from 75% to 90% and average length of stay reduced from 10.2 to 7.4 days). Readmission rates are also dramatically improved.
• Single bedrooms has the implication of requiring large bed spaces. The business case will depend therefore on the high utilisation opportunities of single bed rooms.
• Contrary to staff expectations at Poole Hospital most patients said they preferred small ward-based accommodation rather than single bed rooms.
• The Poole Hospital conversion clearly demonstrates that a building designed originally for multi-bed room layouts with an average of 25% circulation is inefficient in design terms for single bed room solutions.
• The larger the area per bed in a room the lower the travel component as more equipment can be brought to and stored at the bedside.
• Increasing the floor area allocated to bed areas increases the percentage of time spent on patient specific activities.
• There are 49 known ‘stressors’ in hospital. The highest stress level is caused by unfamiliarity of surroundings (having a stranger sleeping in the same room, being woken up in the night etc).
• One of the most taxing problems for patients and staff alike is trying to maintain privacy and dignity. In an open ward of any configuration, any conversation, any clinical intervention and any action on the part of the patient can be overhead.

 

3. AREAS

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• The addition of clinical and family support zones to the bed space will result in an increase in size from previous single bed room of 14m².
• BCIS survey of 75 projects showed average refurbishment costs as 68% of new build.
• Since the 1950’s the provision of space in wards has remained fairly constant averaging about 25m² gross area per bed.
• The area per bed space as a proportion of the whole has remained fairly constant at a mean of approximately 60% of the total floor area.

4. THE FUTURE

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The volume of activities that centres on the patient in the bed space is increasing. The level of dependence and disability is high movement around the patient is considerable, and there is likely to be a high use of equipment and aids around the bed. Relatives and visitors are more involved and prepared to assist in patient care and support.

Single beds provide:

• Complete flexibility of use for patients of either gender, any age and most clinical conditions including source isolations.
• Increased opportunity for shortening turnover intervals thus raising annual occupancy.
• Privacy for treatment and personal activities.
• Confidentiality of discussion.
• Quiet for sleep and rest.
• Staff travel distance reductions.
• Patient control of environment.
• The ability to have visitors without causing disturbance (including ‘sleep overs’)

Good control of infections by:

• min bed pitch of 2.7m
• smallest possible numbers of beds in each grouping
• toilet facilities at min 12m distance from beds
• removal of baths
• provision of single rooms
• sufficient sinks and basins
• dirty and clean utility rooms
• hard flooring
• good staff changing facilities

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