title: Rethinking efficiency in acute care nursing units: analyzing nursing unit layouts for improved spatial flow.
abstract: OBJECTIVE
  This paper introduces a new design tool to increase efficiency in acute care settings. This visual tool facilitates matching spatial flow with caregivers' workflow to reduce waste and redundancies, as recommended by Lean thinking. Providing work environments that protect caregivers from fatigue, interruptions, and redundancies can contribute to quality patient care.
  
  
  METHODS
  By studying the Guidelines for Design and Construction of Health Care Facilities and reviewing the literature, the authors identified the main clinical spaces supporting nursing care and their important linkages. Space syntax, a diagrammatic analysis of relationships, was used to decode spatial relationships among the clinical spaces in five case studies. The movement distributions were measured and possible conflicts with focus-demanding tasks, such as noise and interruptions, were identified. The information was summarized in a visual diagram providing the "syntactic anatomy" of the most important work spaces.
  
  
  RESULTS
  The main clinical spaces were the following: (1) patient corridor; (2) nurses' station; (3) medication area; (4) clean room; (5) soiled room; (6) physicians' dictation area; (7) report room; (8) restricted nourishment area; (9) equipment storage; and (10) unrestricted nourishment area. The report room, nourishment area, and physician workspace showed strong linkages to the patient corridor and nurses' station, although such spaces were not clearly discussed in the design guidelines. The most caregiver movement occurs in the patient corridor and nurses' station. These areas pose the greatest possibility of interruptions by persons. The results were translated into a visual design efficiency checklist.
  
  
  CONCLUSIONS
  Illustrating the spatial order of the support spaces-and comparing that to use patterns-enables designers to reduce the movement sequences nurses undertake when accessing resources and identify where the flow is disrupted by "displaced" functions.
authors.affiliation: Corresponding Author: Rana Sagha Zadeh, PhD, MArch, Design & Environmental Analysis, Cornell University, 2425 Martha Van Rensselaer Hall, Ithaca NY 14853 (rzadeh@cornell.edu).
authors.forename: Rana Sagha
authors.initials: RS
authors.lastname: Zadeh
authors.forename: Mardelle McCuskey
authors.initials: MM
authors.lastname: Shepley
authors.forename: Laurie Tranchina
authors.initials: LT
authors.lastname: Waggener
mesh_terms: D001291:Attitude of Health Personnel; D006801:Humans; D009726:Nurses; D009741:Nursing Staff, Hospital; D010820:Physicians; D057188:Workflow