Patient Visibility
Ann Rogers Kushal Waghmare Wanlin Xiang
Group IV
Patient Visibility What and Why?
– Monitoring • Noting changes in state• Preventing falls• Preventing suicide• Verifying alarm falsity/veracity
– Improved workflow• Remembering patient conditions (out of sight, out of mind)• Toyota Lean Principles
Physical sightlines between patient and care staff (Open doors and blinds; Adequate lighting)
Visibility Analysis
– No. of unique points visible from a particular point– Visibility Plots– Generic Visibility vs. Target Visibility
Visibility can be measured/calculated mathematically
Spatial Positioning Tool
– Measures visual relationship among selected positions
– Isovist = (2d polygon – shadow space)– I/P file is a dxf file which contains 2d information
Markhede and Carranza proposed an isovist based automated model developed in Java
Current Configurations
Parallel Corridor Open/Closed Surrounded
Off Beds
Spokes, No End Station
Spokes With End Station Embedded U-Shaped
Visibility -> “Visibility”Physical proximity to patients = better than direct
sightlines – HKS Study:
• Increased socialization, mentoring, consulting
– In class: Empathy and Rapid assessments• Smell, Hearing
Outboard Inboard
ObservationsMortality rates of High-Visibility vs. Low-Visibility Rooms
– Mortality rates (HVR) < Mortality rates (LVR)– Especially in Cardiac Arrests and Respiratory
Issues– Patients have very little time to recover
NICU and PICUNeonatal & Pediatric ICUs
– More vigilant, careful monitoring required– Signals indicating change in medical conditions are
very subtle– NICUs should provide good visibility to infants– Control stations: within close proximity and direct
visibility of newborn care area. – Incubators should be transparent from at least 3
sides to allow maximum visibility
When a re-design isn’t possible
• Higher nurse to patient ratio
• Minimize peer-to-peer relationships among nurses with decentralized nursing stations
• Place sickest patients in most visible rooms
DOs Position of the headwall canted toward corridor view window Room has a provision for a computer and supplies storage Standardized room size, layout Charting alcove with window Appropriate lighting
St Joseph’s Hospital, St Paul, Minnesota
DON’Ts
• Small windows• Centralized nursing stations• Closed private rooms with more privacy• Presence of blind spots• Improper alignment of beds• Large unit sizes with poor sightlines