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Table 2 AHRQ and CHD evidence-based safe design principles

From: SAFEE: A Debriefing Tool to Identify Latent Conditions in Simulation-based Hospital Design Testing

AHRQ and CHD evidence-based safe design principles 1

Design framework latent conditions

Examples

Minimize environmental hazards

Design should limit the placement of equipment, IV poles, and furniture in the path of movement.

Was there unnecessary crowding of equipment and/or personnel during patient care?

Improve visibility

Building design should facilitate visual access to patients.

Did the overall design impact visibility of patients?

Are there adequate visual sightlines to patient from corridor/decentralized nursing station (ability to see patient’s head)?

Standardization

Locations of equipment and supplies should be standardized to minimize cognitive burden on staff and decrease chances of error.

Did you notice any difficulty getting all necessary equipment and supplies to the patient(s) due to insufficient space or poor room layout?

Was the location of equipment and supplies accessible during high-risk care episodes?

Is there sufficient space and effective layout to adapt to different patient care needs?

Did the location of equipment and supplies create delays in patient care?

Minimizing staff fatigue based on unit layout and configuration

Unit layout should minimize extensive walking to hunt and gather supplies, and people, and should limit frequent work interruptions.

Does the layout require extensive walking to gather supplies or people?

Did the layout result in frequent work interruptions?

Did you notice any concerns related to provider fatigue during patient care?

Does location of storage areas allow for efficient workflow?

Control/eliminate sources of infection

Design should minimize healthcare-associated infections.

Is there an adequate physical separation and/or isolation method (e.g., separate soiled workroom) in the layout to prevent contamination of clean supplies and equipment?

Reduce communication breakdown

Communication discontinuities and breakdowns and lack of timely access to critical information may adversely affect patient safety.

Does the physical environment support effective teamwork and communication?

Protecting privacy

Was there privacy in clinical staff workstations?

Provide safe delivery of care

Does the design support error-free medication activities?

Does layout minimize walking distance from nursing stations to patient bed

Provide efficient delivery of care

Are there flexible but defined options for storage of common supplies (linens, medication, etc.) close to the patient (in or outside the room) to decrease staff time fetching supplies?

Does the design minimize environmental obstacles that interfere with care delivery?

Is equipment located where the caregivers can easily access it?

Reduce risk of injury

Did you notice any risks associated with movement of patients through the space? (e.g., ample corridor width, minimal turns, wide doorways, open layout to accommodate stretchers)

  1. 1Adopted from AHRQ and CHD safe design principles [15, 21]
  2. AHRQ Agency for Healthcare Research and Quality, CHD Center for Health Design