title: Shifting Landscapes: The Impact of Centralized and Decentralized Nursing Station Models on the Efficiency of Care.
abstract: OBJECTIVE
  The focus of this research was to analyze the impact of decentralized and centralized hospital design layouts on the delivery of efficient care and the resultant level of caregiver satisfaction.
  
  
  BACKGROUND
  An interdisciplinary team conducted a multiphased pre- and postoccupancy evaluation of a cardiovascular service line in an academic hospital that moved from a centralized to decentralized model. This study examined the impact of walkability, room usage, allocation of time, and visibility to better understand efficiency in the care environment.
  
  
  METHODS
  A mixed-methods data collection approach was utilized, which included pedometer measurements of staff walking distances, room usage data, time studies in patient rooms and nurses' stations, visibility counts, and staff questionnaires yielding qualitative and quantitative results.
  
  
  RESULTS
  Overall, the data comparing the centralized and decentralized models yielded mixed results. This study's centralized design was rated significantly higher in its ability to support teamwork and efficient patient care with decreased staff walking distances. The decentralized unit design was found to positively influence proximity to patients in a larger design footprint and contribute to increased visits to and time spent in patient rooms.
  
  
  CONCLUSIONS
  Among the factors contributing to caregiver efficiency and satisfaction are nursing station design, an integrated team approach, and the overall physical layout of the space on walkability, allocation of caregiver time, and visibility. However, unit design alone does not solely impact efficiency, suggesting that designers must consider the broader implications of a culture of care and processes.
authors.affiliation: 1 College of Design, University of Kentucky, Lexington, KY, USA.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Fay
authors.affiliation: 1 College of Design, University of Kentucky, Lexington, KY, USA.
authors.forename: Allison
authors.initials: A
authors.lastname: Carll-White
authors.affiliation: 2 College of Pharmacy, University of Kentucky, Lexington, KY, USA.
authors.forename: Aric
authors.initials: A
authors.lastname: Schadler
authors.affiliation: 3 UK HealthCare, University of Kentucky, Lexington, KY, USA.
authors.forename: Kathy B
authors.initials: KB
authors.lastname: Isaacs
authors.affiliation: 4 College of Communication and Information, University of Kentucky, Lexington, KY, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Real
mesh_terms: D000046:Academic Medical Centers; D056044:Actigraphy; D002497:Centralized Hospital Services; D004526:Efficiency; D006749:Hospital Design and Construction / Q000592:standards*; D006801:Humans; D009732:Nursing Care; D009741:Nursing Staff, Hospital; D063187:Nursing Stations / Q000592:standards*; D010362:Patients' Rooms; D011795:Surveys and Questionnaires; D016138:Walking / Q000706:statistics & numerical data
keywords: nursing unit design; operational efficiency; postoccupancy evaluation (POE); pre-/postdesign