Environmental Design in Acute Care Settings: A Case Study of a Neurological Rehabilitation Unit

Lindsay J. McCunn, University of Washington Tacoma
Robert Gifford


OBJECTIVE: The purpose of this case study was to examine environmental variables that lead to staff error in acute care settings: noise; lighting; ergonomics, furniture, and equipment; and patient room design and unit layout. BACKGROUND: Chaudhury, Mahmood, & Valente (2009) reviewed a number of design considerations related to reducing errors by nursing staff in acute care settings. The Neurological Rehabilitation Unit (NRU) at one hospital served to further examine the design recommendations outlined by Chaudhury et al. (2009). METHODS: Based on photographs, a site tour, interviews with the NRU manager and with the son of a patient of 5 months, comparisons were made between the NRU and the acute care setting design considerations reviewed by Chaudhury et al. (2009). RESULTS: The NRU appeared to comply with many recommendations: enforced noise reduction was facilitated through limiting both the number of patients per room and the number of patients admitted to the unit. Distinct rooms were used for various tasks that helped to contain activity-based noise. A combination of daylighting and artificial lighting was in place, but efforts to control glare and thermal comfort were not integrated into the design. The ergonomic needs of employees were incorporated in the design of the NRU, and the layouts of patient rooms and the layout of the NRU in general also were compatible with the design recommendations reviewed by Chaudhury et al. (2009). CONCLUSIONS: Many of the design attributes advocated by Chaudhury et al. (2009) were included in the NRU. Supplemental research should be undertaken, however, to objectively measure nursing error, efficiency and staff satisfaction with respect to the comparisons and assumptions presented in this study.