Magazine article Health Facilities Management

Building a Safe Environment: Health Care Designers Prioritize Patient Safety While Crews Limit Construction Effects

Magazine article Health Facilities Management

Building a Safe Environment: Health Care Designers Prioritize Patient Safety While Crews Limit Construction Effects

Article excerpt

In this era of closer scrutiny of cost and quality of care, patient safety is front and center even before construction starts and the design is still in the planning stage.

The stakes are higher than ever due to changes in federal reimbursement rates impacted by readmissions and patients' perceptions of care. Adverse events, including falls, medication errors and health care-associated infections (HAIs), affect reimbursements.

Because research shows that the construction process and choice of design and materials used in a facility can impact the frequency of adverse events, builders and designers are heavily involved in the patient safety equation.

"Patient safety has increasingly become a consideration since the publication of the Institute of Medicine reports about harm in the 2000 era," says Ellen Taylor, AIA, EDAC, director of research, Center for Health Design, Concord, Calif. "Now that outcomes are included as part of the Affordable Care Act (ACA) and reimbursement, patient safety has even more focus."

Fortunately, an expanding base of knowledge as well as new technology and products are available to help builders and especially designers protect patients. Joint Commission construction requirements and the 2014 Facility Guidelines Institute (FGI) Guidelines for Design and Construction of Hospitals and Outpatient Facilities further inform the process to protect patients during and after the work is done.

Taylor says the FGI Guidelines for construction and design requires that a safety risk assessment be conducted early in the design process, which proves invaluable for designers. The risk assessment is conducted by an interdisciplinary team that might include facilities, interior designers, architects, infection preventionists, nurses and others, she says.

"This is for multiple patient safety components, including infection control, medication safety, falls, patient handling, injury of behavioral health [patients], security and immobility," Taylor adds.

Similarly, the Joint Commission, Oakbrook Terrace, Ill., requires builders to conduct a Preconstruction Risk Assessment (PCRA) and an Infection Control Risk Assessment (ICRA) prior to beginning a project.

An ICRA addresses the risk of infection caused by harmful particulates that may flow from the construction site, whether outdoors or inside, to patient areas.

"You take every step possible to isolate and separate construction-related activities from patient care," says Russ Korcuska, director of national health care projects, Kitchell Contractors, Phoenix.

One trend that benefits both patients and builders is the increased use of prefabrication for parts of the patient room or entire spaces within a facility, Korcuska says. Reducing on-site production eliminates noise and airborne particles at the construction site.

Kitchell is exploring the use of prefabrication on mechanical-electrical-plumbing racks, bathroom pods and exam rooms on a major emergency department expansion at Phoenix Children's Hospital and built exterior walls for one project in Las Vegas, he says.

As challenging as it may be, the trick is to make construction inconspicuous. "The idea is to be as invisible as possible to the public. We try to make ourselves blend in," he says.

Software monitoring

Skanska USA Building achieved that objective on at least one of its projects, according to Andrew Quirk, senior vice president and national director, Healthcare Center of Excellence. HCAHPS scores at a hospital in central Ohio actually went up 2 percent during the construction project.

"We were very cognizant of proactive communication, wayfinding and cleanliness so as not to impact the daily activities of patients and staff," Quirk says.

He also credits the success to the use of Insite, a software system that provides remote asset monitoring to aid in maintaining patient safety. …

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