Moving to a Newly Built Adult Intensive Care Unit with Single Patient Rooms: Impact on Clinicians and ICU Performance
CCCF ePoster library. Laporta D. Nov 9, 2018; 233431
Dr. Denny Laporta
Dr. Denny Laporta
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Abstract
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Introduction

The adult intensive care unit (ICU) of the Jewish General Hospital (JGH) moved from a multi-patient room (MPR) to a single patient room (SPR) environment in 2016. The new adult SPR-ICU was built based on recent ICU design guidelines with the goal to create a healing environment. 

Objectives

To compare ICU clinicians' work stress, satisfaction, obstacles to work performance, team functioning, ability to provide family-centered care, with unit performance in an adult open ward to a new SPR-ICU. 

Methods

Design: A pre/post-test design was used for this study. 

Setting: This study was conducted at the ICU of the JGH. Prior the move, the ICU had a centralized nursing station and 22 beds of which 14 were in open areas, 6 were SPR and one was a double-patient room. After the move, the ICU had 36 beds all in SPRs with mini-workstations outside all patient rooms and decentralized nursing stations. Natural light is maximized through extra large windows in all patient rooms.  

Sample: Clinicians were eligible for participation if they were full- or part-time ICU employees. Temporary clinicians, students, medical residents, fellows and newly hired staff on orientation were excluded. Eligible clinicians willing to participate provided written informed consent and were asked to complete a questionnaire package prior to and 12 months after the move to the new SPR-ICU. 

Results 

A total of 83 clinicians (51 nurses, 21 respiratory therapists, 4 physicians, 4 physiotherapists and 3 orderlies) with an average of 10 years of ICU experience completed the questionnaires before and 60 of them at 12 months after the move. Clinicians perceived higher work stress (on a 1-4 scale) after the move (mean=2.13, SD=0.52) compared to before (mean=1.92, SD=0.48) (t (58) =4.95, p<0.001), and less job satisfaction (on a 1-5 scale) after (mean=3.47, SD=0.65) than before the move (mean=3.69, SD=0.47) (t (58) =2.70, p=0.009). Whereas clinicians reported experiencing more obstacles in performing tasks after the move, the use of technology and tools improved in the new SPR-ICU (p<0.05). The new SPR-ICU was associated with less collaborative work (on a 1-7 scale) (mean=5.11, SD=0.83) compared to the old ICU (mean=5.62, SD=0.76) (t (58) =4.45, p<0.001) in terms of communication, implicit coordination and synchrony. Clinicians did not perceive significant changes in their ability to provide family-centered care with the move to the SPR-ICU (t (58) =0.46, p=0.645), but believed that environmental noise was reduced (t (58) =5.34, p<0.001). The degree to which patient rooms were organized was perceived to remain unchanged (t (58) =0.44, p=0.659). 

During these same time periods, a 7% increase in ICU admissions was noted. Review of ICU performance indicators revealed the following trends: an increase in emergency admissions (medical and surgical) and in elderly (age>80) patients, and a decrease in ICU readmissions, VAP and hospital length of stay. Severity scores and mortality were unchanged. 



Conclusions

The new SPR-ICU was perceived to reduce obstacles in using technology and tools, and to decrease environmental noise, but was associated with more difficulty in working collaboratively, higher work stress and less job satisfaction. Whether clinicians’ perceptions were also influenced by changing clinical demands remains unanswered, but the resulting ICU performance indicators over this period remained the same or favorably improved. 



 


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