HOSPITAL DESIGN & BUILD

Mobility as a Design Criterion for the Hospital
Joseph C. Livengood, MD, FACS & CEO at Livengood Medical

Patients are designed into their beds.  Architectural drawings depict the patient as a bed and patient-centric design tends to mean building patient care items around this fixed point.  This design is in direct conflict with the daily effort of clinicians to mobilize patients out of bed.  The treatment provided at a hospital occupies a small percentage of the patient’s time with most of the time spent in the recovery process during which mobility is critical.  Mobility restores the body to health, prevents complications that could derail recovery and provides patient empowerment and self-sufficiency.  The assumption that a patient is too sick to move is by far the exception rather than the rule to which we design.  A hospital designed to encourage and enable mobility as a constant activity is needed to implement one of the most basic tenants of health and patient care into our standard of practice.

Envision yourself as a patient, “A.J.” and read through the following scenario.  Designing mobility into the hospital allows us to incorporate mobility into every aspect of a patient’s day, completely redefine the clinical and personal experience and empowers patients to more fully participate in their path to wellness.

A.J. is a 44y.o. patient admitted with a bowel obstruction.  A naso-gastric tube (NGT) is placed on suction to decompress his abdomen.  An x-ray series on hospital day #2 shows slow transit of contrast to the colon.  After another day of suction, the patient remains obstructed and is scheduled for the OR on hospitalday #4.  A 3-hour surgery frees the obstruction and the patient remains in the hospital for another 7 days with discharge on hospital day #11.

T =Traditional Design; M=Mobility Design

Admission:
T – A.J. is admitted to a bed for the admission interview.  The NGT is attached to suction mounted to the wall.  Oxygen is provided from the wall as well.  A urinary catheter is placed and attached to a bag that hangs on the bed.  An IV is placed and attached to both an IV pump and pain pump mounted on two different poles.  SCDs are placed to prevent blood clots and the pump is hung over the foot of the bed.  An over-the-bed-table is positioned over the patient so that he has ready access to personal items, phone and remote.
M – A.J. is admitted to a recliner chair for his admission interview.  The NGT is attached to portable suction on a Mobile Patient Care Environment (MPCE) that also houses the IV pump, pain pump and oxygen generator.  The SCD pump is not required while the patient is mobile.  A drawer and surface are provided for personal effects, phone and remote.

Bathroom:
T – A.J.needs to use the commode.  AJ activates the call light for an aide.  The two IV poles are moved to the same side of the bed and the SCDs are removed.  The oxygen and suction are disconnected and the aide locates a portable oxygen tank.  The aide finds an additional person to help push the poles, carry the oxygen and catheter bag while helping the patient to the restroom.  On return to bed, the process is reversed though the aide forgets to reconnect the SCDs.
M – A.J. needs to use the commode.  A.J.moves to the side of the bed and pushes the MPCE to the restroom while using the MPCE for support.  On return, A.J. decides to sit in the chair for a while to watch TV.

Ambulate to the Sun Deck :
T – A.J. was unable to go to the deck because two aides could not coordinate enough time to help as needed for the bathroom trip.
M – A.J. walks with the MPCE to the front desk, checks-out with the nurse and takes the elevator to the sun deck.  Suction, oxygen and IV pumps continue to function without interruption.

Visitors :
T – A.J. receives visitors while lying in bed.  Half-eaten food remains on the over-the-bed tray and food has stained the front of the gown.
M – A.J. moves to the couch so that housekeeping can make the bed and straighten up the room for visitors.

Radiology :
T– A.J. traveled to radiology with the help of two transport personnel in a stretcher.  Transport took 10 minutes to prepare for the move and the SCDs were disconnected from power for the 1 ½ hours it took for the study.
M– A single transporter pushes A.J. to radiology in a wheelchair attached to the MPCE with no prep time required.

This scenario highlights a myriad of opportunities to exponentially increase the mobility of a patient by incorporating mobility into more activities throughout the day.  Mobility prevents a number of clearly defined preventable complications which include:  pneumonia, ileus, blood clots (DVTs), urinary tract infections (UTIs), and pressure ulcers.  Moving around and sitting up in bed do little to prevent these complications.  However, sitting in a chair, transporting in a wheelchair and improving the ability of patients to move about their room, createsthe optimal environment to turn every-day activities into therapeutic events.  This increase in activity also works to reduce the number of devices that exist simply as work-arounds for lack of mobility such as: Sequential Compression Devices (SCDs), the Inspiratory Spirometer (IS), Over-the-Bed Tables, Bed-Side Commodes, and the Over-use of Urinary Catheters.
A bold push towards building a “Mobility Hospital” is much needed.  This simple concept and revolution in design has the power to change the face of healthcare.

About Author:   
Joseph C. Livengood, MD, FACS is an Acute Care Surgeon in Colorado, U.S.A. with a particular interest in patient mobility.  Dr. Livengood provides consulting services in patient mobility, hospital design and emergency preparedness where he incorporates his biomedical engineering background and training in Lean Healthcare and ISO13485 Quality Management Systems. 
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