Patient Visibility

Ann Rogers Kushal Waghmare Wanlin Xiang

Group IV

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)

Visibility Analysis

– No. of unique points visible from a particular point– Visibility Plots– Generic Visibility vs. Target Visibility

Visibility can be measured/calculated mathematically

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

Current Configurations

Parallel Corridor Open/Closed Surrounded

Off Beds

Spokes, No End Station

Spokes With End Station Embedded U-Shaped

Visibility -> “Visibility”Physical proximity to patients = better than direct

sightlines – HKS Study:

• Increased socialization, mentoring, consulting

– In class: Empathy and Rapid assessments• Smell, Hearing

Outboard Inboard

ObservationsMortality 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

NICU and PICUNeonatal & 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

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

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

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