Simulation to help inform health care design

Simulation can be used in a variety of ways to inform important design and construction decisions. Three recent papers from The Center for Health Design’s Knowledge Repository use different simulation methods to identify real-world workflows and their implications for design.

Dubé and colleagues describe how human factors and systems-focused simulations were integrated to determine whether to maintain or replace a passageway connecting two health care buildings in Canada. They present the steps used during a short, one-month timeline. Using observations of current passageway traffic patterns, the team worked with stakeholders to develop two scenarios to test.

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The Center for Health Design Knowledge Repository

First, volunteers (e.g., nurses, respiratory therapists (RTs), management, porters and security) simulated the transport of a weighted bariatric bed passing a standard bed during typical traffic flow. The second simulation involved the deterioration of a bariatric patient and required the transport team to turn the weighted bariatric bed around in the passageway during typical traffic flow. During the debriefing and failure, mode and effects analysis used to identify safety risks, decision-makers determined that the passageway was unsafe and that a new one was needed.

In another paper, a team marshaled by Hosseini used a computer-based, design-led simulation-optimization (DLSO) process to design a centralized medical office building check-in and reception area. The team first analyzed data from interviews, observations and historical volumes to develop the model and system inputs. They collaborated with stakeholders to test-fit the architectural design, conduct future state design mapping, identify key performance metrics and develop scenarios.

The authors created plans in Revit by Autodesk Inc., San Francisco, and imported them into FlexSim by FlexSim Software Products Inc., Orem, Utah, to study movements of patients and staff, allowing the team to experiment with different layouts and scenarios.

Because some patients used a pre-registration app, designers developed different configurations, including both traditional check-in desks and check-in kiosks. The team ran scenarios that accounted for desired wait times, staff volume, number of patient companions, patient arrival times and high-volume periods. Accounting for multiple operational variables, the team ran two different volume scenarios. Overall, the DLSO findings allowed the team to validate the consequences and tradeoffs of different options.

In a third paper, Mihandoust and colleagues detail a three-phased simulation conducted to study caregiving flow disruptions as part of a pediatric intensive care unit (PICU) design.

Nurses, RTs, physicians and extracorporeal membrane oxygenation (ECMO) staff participated in simulations and testing that occurred in a full-scale, cardboard PICU mock-up. The simulation included admission and intubation, a code and high-frequency oscillatory ventilation, and planned ECMO cannulation. Researchers recorded the simulations and reviewed them with a clinician to ensure accuracy.

A zoning map of the room was created, and each observation was coded according to type, subtype, severity, location, equipment and staff that was involved. Results indicating that the position of equipment or furniture, collisions or bumping, impeded visibility and excessive reaching occurred most frequently in the RT and nurse zones helped designers understand where the layout needed to be adjusted.

Research used for this column

The following research citations from The Center for Health Design’s Knowledge Repository of health care design resources were used by the author when writing this column:

• M. Dubé et al., “Applying Human Factors and Systems Simulation Methods to Inform a Multimillion-Dollar Healthcare Decision,” HERD: Health Environments Research & Design Journal (2024): in press.
• M. Hosseini et al., “Innovate and Validate: Design-Led Simulation Optimization to Test Centralized Registration Feasibility in a Multispecialty Clinic,” HERD: Health Environments Research & Design Journal (2024): in press.
• S. Mihandoust, A. Joseph and N. Colman, “Identifying Built Environment Risk Factors to Provider Workflow and Patient Safety Using Simulation-Based Evaluation of a Pediatric ICU Room,” HERD: Health Environments Research & Design Journal, vol. 17, no. 1 (2024): 92–111.

About this column

“Design Discoveries” highlights research from The Center for Health Design’s Knowledge Repository, a user-friendly library of health care design resources. This research effort is supported by the American Society for Health Care Engineering, the American Institute of Architects, the Academy of Architecture for Health Foundation and the Facility Guidelines Institute. It can be accessed at healthdesign.org/knowledge-repository.

Yolanda Keys, Ph.D., R.N., EDAC, research associate, The Center for Health Design.