When hospitals group patient rooms into small clusters, nurses have more time for their patients. But the design of these "bed clusters" is important.

This finding has emerged from a new report from hospital researchers at SINTEF. The "bed cluster concept" can have different configurations, but it means that patient rooms are grouped into clusters, with work stations for the nursing staff attached to each group. Shorter walking distances make it easier for the nurses to keep an eye on patients, prevent undesirable incidents and give them more time to care for patients.

The researchers have reviewed the literature and conducted interviews with nursing staff and managers at three of the hospitals using the concept. They compared and analysed existing hospitals and planned hospital projects.

Less walking time

Bed clusters are in widespread use in Norway's newer hospitals. St Olavs Hospital, Ringerike Hospital, Stavanger Hospital and the new Ahus have these clusters. Internationally, the trend is also towards clusters and "bed courtyards," and countries like the USA, the UK, Sweden, Denmark and Latvia use them extensively. The thinking behind this concept is that in the future there will be more and sicker patients, and that when nurses are closer to their patients, they can monitor them better.

The old ward design consisted of 20 or 30 rooms off a long corridor (or a double corridor). There was a nurses' room in the middle, and bed linen, sluice rooms, etc. were located in a central area or distributed between the rooms. In the bed cluster model, the rooms are grouped into a "courtyard," with beds in seven to nine rooms, and the old nurses' room has been replaced by three decentralised work-stations. Shared "support rooms" (sluice rooms, conference rooms) are positioned between the various bed clusters, with stores for bed linen and consumables integrated into each cluster. The researchers have found that a decentralized configuration saves the staff from enormous amounts of unnecessary walking along corridors. The environment becomes calmer, and the role of the nursing staff changes: part of what kept the nurses so busy before was walking to and fro between patients and to fetch equipment, but now the time they save can be devoted to patient care.

Several clusters in series is best

"What all the models have in common is a decentralized nurses' area, and bed areas divided into small groups, but their configuration and the way they are used are different. It is this effect we have been studying," says hospital researcher Marte Lauvsnes at SINTEF Technology and Society. "A hospital like St Olavs in Trondheim has configured the bed clusters in the new centres in several different ways. One area has three clusters in series. Another is built in short wings that put two clusters next to each other, while a third is separate. The final configuration was dictated by building area constraints, and the solution is clearly not as good as when the clusters are arranged in series."

No place to socialize The nursing staff find that the new organizational model means that they are alone more than they used to be. Since they now each work with fewer patients, and as there are often only two or three nurses on duty in a cluster during the day, they do not come into contact with their other colleagues as much. The hospitals vary in terms of the kind of support rooms they provide for professional discussions and social interaction, and this has an impact on nurses' job satisfaction and sense of community.

During night shifts, there may only be one nurse on duty per cluster, but if the clusters are arranged like "pearls on a necklace," this still allows nurses to come into contact with each other, and to talk and work together. "The design of the buildings must take into account the fact that individual nurses must have a sense of ownership of their ward as a whole, and not just of their small unit. Social areas for the staff must also be considered," says Marte Lauvsnes.

Building with activities in mind

The hospital researchers at SINTEF conclude that if a bed cluster model is chosen, it must be decided at an early stage in the building planning process. "The concept planning phase of a medical building has become more important than ever," says Lauvsnes. If a site is found at an early stage, and a proposal based on that site prepared before activities and the concept have been described, this limits the options for good solutions and effective operation. -- "Billions are invested in hospitals, but not one krone is given to evaluating how the design of the building affects operation. That is why SINTEF has financed this study itself," she says.

The researchers think that the traditional corridor system, with rooms designed for several patients, is the worst with the future in mind. It makes poor use of capacity and space, and also makes nurses less efficient in their daily work. From a patient's perspective, a combination of single rooms and bed clusters provides the highest quality, by increasing safety, reducing noise, minimizing the risk of undesirable incidents and giving them the best access to nursing staff.