Healthcare Design - November 2022 - 33

2/5
performance. The new question became: Can a patient-centric, safe, universal
care/acuity-adaptable inpatient unit-that also enhances staff efficiencies
and satisfaction-be implemented?
Employing a Lean strategy, EUA team members analyzed patient and
caregiver movement through the unit and identified ways to improve the
user experience, including addressing complications added by pandemic
protocols such as visitor restrictions and the required use of personal protective
equipment. EUA team members made site visits to some of the existing
hospitals to observe shift changes among nurses' staff and stayed
throughout their shifts to understand how they utilized the unit, offices, and
supply rooms, as well the distance employees walked during those shifts.
The on-site visits were supplemented with meetings online, engaging
a wide swath of user groups. Similarly, due to the high level of demand on
UW Health employees, questionnaires and online surveys were also used
to include them in the design process. Interestingly, important information
was gleaned from that method, as staff members were more forthright
with their concerns. Mock-ups were also utilized during meeting times to
allow stakeholders to judge spatial relationships, especially considering
the medical equipment and controls that would be housed in the acuityadaptable
rooms.
UNIT FEATURES
Creating flexibility in serving a high-acuity patient environment meant
several changes had to be made from the typical medical/surgical patient
rooms. As a result, these design improvements were identified for the final
design of UW's new universal care inpatient unit:
* All inpatient rooms can switch to negative pressure, and the rooms
were made more robust with additional medical gases, electrical outlets,
and low-voltage capabilities.
* Observation windows and individual charting stations were added. Patient
observation windows allow staff a direct view into the room, with
monitors and controls placed outside the patient room, as well. In the
face of the pandemic, this allows staff to continue monitoring patients
without having to wear full personal protective equipment (PPE) when
they enter a patient room.
* Each room has a decentralized charting area, which will add up to 28
additional computer stations/seats. In the future, those additions will
also support the additional staff necessary when the unit needs to operate
in a higher-acuity environment, regardless of the medical incident.
* A larger collaboration area was added in the center of the unit to support
better communication among staff. The unit is accessible from all
parts of the central collaboration area.
* To reduce walking distances and give staff more flexibility for clinical
support, twice as many soiled rooms, clean storage rooms, and medical
equipment storage spaces were added.
* A focus room was created, which gives staff day-to-day and long-term
flexibility. Currently, it could be used for dictation or for a conference
among a nurse manager and nurses. In the future, it can be transitioned
into office space if necessary. Electronic ICU infrastructure was added
to allow communication with specialists from remote locations, as well.
* Dialysis capabilities were added to the rooms. Throughout the pandemic,
transporting patients with COVID-19 through the hospital to
dialysis treatment has been problematic. This is true for patients without
COVID-19, as well. Having dialysis access will allow patients to stay
within one room for all care.
* Bathrooms were designed to improve safety and functionality such as
redesigning the shower enclosure and adding
accessible features. Additional space
was added for staff support and shower
chair access, too.
While improvements for the project were
aimed at clinical outcomes, UW Health and EUA
also focused on the family, staff, and patient experience.
Wayfinding to the nurses' station was
improved with lighting, while materials were
also changed within the space to provide improved
acoustics. An ample staff break room
with large windows was added, as was family
space for patients.
MEASURING SUCCESS
The acuity-adaptable unit will help ready UW
Health's infrastructure for the next pandemic
or medical event. For example, rooms in the
renovated area can be converted quickly to
a higher acuity level for patients, which will
help staff to operate within spaces they're already
familiar with and, as a result, improve
user experiences.
And while it would be ideal to make universal
care inpatient units a system-wide change,
stakeholders understand it may not be feasible.
The reality is that the space necessary to convert
an existing room into an acuity-adaptable one
requires the conversion of two inpatient rooms
to renovate the space into one new acuity-adaptable
room, resulting in less overall bed count.
Success of the project will be determined by
comparison to metrics that UW Health already
tracks. Baseline levels of patient falls, hospital
acquired infections, etc., will be established and
compared with the same levels from inpatient
units on the fourth and fifth floors at East Madison
Hospital. These performance measures are
embedded within the project's design and are
being tracked throughout construction and into
post-occupancy evaluation (POE).
When the project is finished and the POE is
completed, a clearer picture will be revealed as
to whether dramatically increasing the volume
of acuity-adaptable rooms is medically necessary
and/or financially sound, and if staff and
patients will benefit from renovations made
throughout UW's hospital system. 
Michael McKay is director of UW Health Planning
Design and Construction (Madison, Wis.). He can
be reached at MMCKAY@UWHEALTH.ORG. John
Ford is a senior design architect with EUA (Madison).
He can be reached at JOHNF@EUA.COM. Ed
Anderson is a healthcare market leader with EUA
(Madison). He can be reached at EDA@EUA.COM.
NOVEMBER 2022
33
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