Have you ever wondered why there is significant variation in the nursing unit space per bed from project to project? Particularly when the number of beds is the same. Historically, this variation was attributed to the mix of private, semiprivate, and multiple-bed patient rooms. However, even today when most hospital building projects in the U.S. have all private patient rooms, the nursing unit space per bed continues to vary. Contributing factors include the size and layout of the private patient room and adjoining toilet/shower room, the specific grouping of the patient rooms within the unit, and the overall design and layout of the floor itself. The amount of family, visitor, and staff amenities provided on the floor and the extent of point-of-care clinical and support services are also factors.
Starting in the 1980s, healthcare strategists and policy experts encouraged hospitals to reduce their surplus inpatient bed capacity in response to declining admissions, use rates, and lengths of stay — as a result of the advent of Medicare’s diagnosis related groups (DRG) payment methodology in the public sector and managed care in the private sector. Hospitals responded to changes in demand by shifting their resources. Between 1980 and 2003, community hospitals in the United States took 175,000 inpatient beds out of service — an 18 percent reduction — through downsizings, consolidations, and closures. At the same time, skilled nursing and subacute care facilities were developed to provide a less expensive and less resource-intensive alternative for patients requiring a lengthy recuperation. Home health agencies also proliferated. Since 2003, the number of hospital beds has declined less dramatically — a reduction of another 12,700 beds. Although, nationally, inpatient admissions rose from 1992 to 2012, both the rate of inpatient admissions per 1,000 population and the average length of stay have declined to an all time low — resulting in an overall decline in the demand for inpatient beds.
Many hospitals feel that they never have enough intensive care beds and are constantly pressured to expand existing units or create new units. Historically, intensive care units (ICUs) have provided intensive observation and treatment of patients in unstable condition. Because of the high-tech requirements and highly skilled staff, these units are expensive to build and operate. Insufficient intensive care beds also affects the ED, as high-acuity patients waiting to be admitted backup in the ED when the ICUs are full.
Observation was meant to be a short period of time for healthcare providers to assess patients and decide whether a patient requires admission for inpatient care or can be discharged. Typically this was meant to last less than 24 hours and only rarely spanned longer than 48 hours. Over the past ten years, however, the incidence and duration of observation status stays has increased significantly as a result of changes in Medicare reimbursement.
The Facility Guidelines Institute (FGI) has developed a new standard titled Guidelines for Design and Construction of Residential Health, Care, and Support Facilities. This document provides minimum recommendations for new construction and renovation of nursing homes, hospice facilities, assisted living facilities, independent living settings, adult day care facilities, wellness centers, and outpatient rehabilitation centers. According to the FGI website, the new standard has been developed in response to the widespread adoption of person-centered care and deinstitutionalization in the residential care industry. Based on Part 4 (Residential Care Facilities) of the 2010 edition of the FGI Guidelines for Design and Construction of Health Care Facilities and public proposals submitted on that text in fall 2011, the book is divided into a section on planning and predesign, a section on design and construction elements common to all facility types in the book, and sections grouped by facility type. This document was first published in early in 2014 and was updated in 2018.
This article is an update of a previous post.
Mercy, a not-for-profit Catholic health care organization located in the Midwest, opened a four-story, 125,000 square-foot Virtual Care Center in Chesterfield, Missouri. The facility not only houses the nation’s largest single-hub electronic intensive care unit, but also provides a center for telemedicine innovation and a testing ground for new health care products and services. Using highly sensitive two-way cameras, online-enabled instruments and real-time vital signs, clinicians “see” patients that may be in one of Mercy’s traditional hospitals, a physician office, or in some cases, the patient’s home — 24/7, 365 days per year.