Healthcare Design - August 2017 - 52

P L A N N I N G C O N S I D E R AT I O N S

Patients with mobility issues often require equipment such as wheelchairs, lift chairs, and motorized scooters to help them move. Departments and rooms should be designed to accommodate this additional
equipment and ensure necessary clearances, including around beds and
toilets and in showers.
In the International Health Facility Guidelines, released in 2015 by
TAHPI, an international healthcare architecture, planning, and software development firm, section "Part B-Health Facility Briefing &
Design, 105 Inpatient Unit" begins to outline the unique requirements
associated with bariatric design, such as key departmental adjacencies
and equipment clearances. The 2014 Facility Guidelines Institute's
(FGI) Guidelines for Design and Construction of Hospitals and Outpatient Facilities also addresses the topic, suggesting inpatient spaces be
designed to account for the proportion of the population considered
bariatric and/or mobility impaired, but it doesn't yet provide specific
design directives.
It's also important to plan how a patient with impaired mobility will circulate around the hospital, through corridors, and between floors. For example, some bariatric-sized equipment used to transport patients, such as
motorized stretchers/wheelchairs and hydraulic gurneys, requires wider
thresholds and turning radiuses and larger elevators. Lifts or specialty
beds designed to aid in patient-handling tasks, such as lateral rotation,
transportation, and bringing patients to sitting positions, should be accounted for in architectural, structural, and equipment planning. Designers should also incorporate storage in patient-accessible areas on inpatient
floors for portable ambulation assistance devices and equipment.

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Patient lifts are becoming standard equipment
in patient rooms to assist
staff in the transfer of
bariatric patients from
stretcher to bed as well
as from bed to toilet.

F O C U S O N FA L L P R E V E N T I O N

Some of the conditions that make a patient most vulnerable to falls include
uneven floor transitions, long corridors, and uneven lighting conditions.
Most patient falls occur in the evening or at night, in the patient room, and
when patients are unassisted. Bathrooms are the second most common loca-

52

AUGUST 2017

HCDMAGAZINE.COM

tion of falls. The most likely activity performed at
the time of a fall is ambulation.
Designing to prevent falls should begin with
the regulations codified in the Americans with
Disabilities Act Standards for Accessible Design, which outlines specific design solutions to
minimize changes in floor elevation, limit protruding objects, and ensure the correct placement of handrails.
In 2014, FGI introduced a section into its
guidelines that outlines how to perform a safety
risk assessment. The new section, and a Patient Handling and Movement Assessments
(PHAMAs) subsection, was added to initiate hospital-specific research and implementation of
both safety protocols and design strategies. FGI
published a white paper outlining and explaining the PHAMA subsection, followed in June
by a new white paper, "A Patient Handling and
Movement Needs Assessment Toolkit," cowritten by myself and James Harrell, senior medical planner at PDT Architects (Cincinnati). The
paper was published by the American College
of Healthcare Architects as a supplement to the
guidelines and to provide specific instruction on
how to design to mitigate patient falls. The publication includes a comprehensive list of mobility
assistance equipment, reviews patient-handling
procedures and policies, and provides a patient
handling and mobility assessment template.
Measures to consider during design that aren't
prescribed in codes but support fall prevention
efforts include:
* Improving lighting conditions to be both
brighter and more evenly distributed to account for the deterioration of vision that's
common in older patients
* Minimizing transitions between floors and the
depth and unevenness of flooring materials
* Locating the bathroom near the patient bed to
minimize travel distance
* Providing easy-to-read and obviously placed
directional signs to minimize confusion and
disorientation
* Ensuring corridors are clear of equipment and
clutter by providing adequate storage space in
each department
* Making mobility-assisting medical equipment, including walkers, canes, lifts, repositioning aids, and lateral transfer devices, more
available to patients by incorporating storage
directly in the patient room
* Designing wayfinding to mitigate the stress
and confusion of navigating a hospital floor
through the use of physical landmarks, clearly
defined entryways, and shortened hallways.

E4H ENVIRONMENTS FOR HEALTH

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Healthcare Design - August 2017

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