1. Patient Visibility Ann Rogers Kushal Waghmare Wanlin Xiang Group IV

2. Patient Visibility What and Why? – Monitoring Noting changes in state Preventing falls Preventing suicide Verifying alarm falsity/veracity – Improved workflow Remembering patient conditions (out of sight, out of mind) Toyota Lean Principles Physical sightlines between patient and care staff (Open doors and blinds; Adequate lighting)

3. Visibility Analysis – No. of unique points visible from a particular point – Visibility Plots – Generic Visibility vs. Target Visibility Visibility can be measured/calculated mathematically

4. Spatial Positioning Tool – Measures visual relationship among selected positions – Isovist = (2d polygon – shadow space) – I/P file is a dxf file which contains 2d information Markhede and Carranza proposed an isovist based automated model developed in Java

5. Current Configurations Parallel Corridor Open/ClosedSurrounded Off Beds Spokes, No End Station Spokes With End StationEmbeddedU-Shaped

6. Visibility -> “Visibility” Physical proximity to patients = better than direct sightlines – HKS Study: Increased socialization, mentoring, consulting – In class: Empathy and Rapid assessments Smell, Hearing OutboardInboard

7. Observations Mortality rates of High-Visibility vs. Low-Visibility Rooms – Mortality rates (HVR) < Mortality rates (LVR) – Especially in Cardiac Arrests and Respiratory Issues – Patients have very little time to recover

8. NICU and PICU Neonatal & Pediatric ICUs – More vigilant, careful monitoring required – Signals indicating change in medical conditions are very subtle – NICUs should provide good visibility to infants – Control stations: within close proximity and direct visibility of newborn care area. – Incubators should be transparent from at least 3 sides to allow maximum visibility

9. When a re-design isn’t possible Higher nurse to patient ratio Minimize peer-to-peer relationships among nurses with decentralized nursing stations Place sickest patients in most visible rooms

10. DOs Position of the headwall canted toward corridor view window Room has a provision for a computer and supplies storage Standardized room size, layout Charting alcove with window Appropriate lighting St Joseph’s Hospital, St Paul, Minnesota

11. DON’Ts Small windows Centralized nursing stations Closed private rooms with more privacy Presence of blind spots Improper alignment of beds Large unit sizes with poor sightlines