Photo Courtesy of HKS Inc.

Photo Courtesy of HKS Inc.

Impacts of Patient Room Physical Design Configuration on the Care Process, Caregivers and Patients

Read the journal paper here


Debajyoti Pati (PI), Tom Harvey, and Jennie Evans

Integris Baptist Medical Center, Oklahoma City, OK

HKS Inc.

What was the aim

The study objective was to understand the implications of toilet/shower room location. In addition the study explored whether cumulative minor irritants or hassles in the environment contributes to acute stress in care givers (drawing arguments from childhood developmental psychology). This study was designed to collect preliminary data to support a larger grant proposal.

Why is it important

Patient room configuration (particularly toilet/shower room location) is a key question raised in bed unit design. There are no empirical evidences however to support or oppose any design decision. What issues are affected by the variations in room configuration that arise from bathroom location? A complete articulation of the issues that potentially are affected by room configuration is not available in the literature.


A framework for multidimensional assessment of patient room configurations was developed by the authors in preparation for a symposium. Twenty-three issues were considered and categorized under six domains of assessment: (1) patient safety, (2) staff efficiency, (3) circulation, (4) infection control, (5) patient considerations, and (6) family amenities. The framework was used to rank issues by importance and to assess six alternative patient room configurations by a diverse group of experts. Variations in the configurations included: (1) three same-handed and three mirror-image rooms; (2) three outboard, two inboard, and one nested bathroom; and (3) three rooms with footwall bathrooms and three with headwall bathrooms. The symposium was organized in May 2007 and attended by 14 experts from four institutions. In a four-step process, the attendees ranked the issues, discussed them in detail, rated each room configuration against each issue on a seven-point suitability scale, and conducted an overall assessment of the six configurations.

WHAT did we find

Based on the ratings and rankings provided by the symposium participants, outboard bathroom locations were found to be most suitable, followed by nested and inboard configurations. Furthermore, configurations with patient bathrooms located on the footwall were rated as more suitable than headwall locations. The authors recommend, however, that the framework be used to determine a suitable room configuration in a specific context, rather than to identify configurations that will perform well universally.

What is next

Future empirical research on this framework should attempt to obtain objective measures of performance, which would supplement the (important) subjective assessments of experts.  Devel-oping precise operational definitions, identifying appropriate measures, and developing an empiri-cal evidence base introduce a set of priority focus areas for evidence-based design research. There also could be issues that this discussion might have missed, which could be added in future studies.