Photo Courtesy of HKS Inc.

Photo Courtesy of HKS Inc.

Towards Optimizing Inpatient Unit Design and Operation: A Measure to Predict Nurse Walking Distance on Hospital Bed Units

Read the journal paper here


Debajyoti Pati (PI) and Tom Harvey 

Doug Bazuin, Researcher, Herman Miller, Zeeland, MI
The Research and Education Institute (TREI) of Texas Health Resources

Herman Miller Grant

WHAT was the aim

The objective of this study was to understand the impact that decentralization of nursing support spaces may have on the total distances nurses walk and hence the magnitude of time that can be diverted to productive use. For the purpose of this study, it was assumed that operational interventions can be implemented, and culture can be successfully changed. With this objective, the fundamental question of the study was: What is the magnitude of difference in walking distance and unproductive time affected by decentralization of nursing support spaces?

Why is it important

Excessive nurse walking on inpatient units has attracted attention, with some studies showing 3 to 5 miles of walking during typical shifts. Such excessive walking, potentially, interact with operational stressors to create fatigue and hence impact efficiency and patient safety. Since waking is a function of nursing model, task frequency and physical design, walking distance predictions based solely on floor plan dimensions provide inaccurate results.


A simulation-based experimental design was adopted to examine the study question. A computer-based sim-ulation tool was used to predict walking distances of nurses. The simulation tool automates calculation of walking distances on any floor layout, responding to programmed information. Several factors were standardized, including the floor layout, unit size, staff-ing ratio, and frequency of different tasks, among others. The task frequency data were collected from a national sample survey of 700 RNs. The modal values of the frequencies were programmed into the simulation software. All nurses on this standard, hy-pothetical, 30-bed unit were made to walk to per-form the programmed tasks over a 12-hour day shift. The only variables that were manipulated in the series of simulation runs were the locations of 8 nursing support spaces. With each manipulation of support spaces, the change in walking distance was recorded for all nurses, compared with a baseline centralized condition.

What did we find

Findings suggest that total walking time can be reduced by as much as 67.9%, depending on the level of decentralization. Care quality and efficiency issues can be significantly addressed through appropriate levels of decentralization. Manipulation of individual elements of the nursing support spaces could impact total walking between 1.18% and 15% depending on the specific support manipulated in the simulation. When the simulation was conducted on a decentralized model, the estimated total walking distance (per RN) was reduced by 26.8%. The room/bedside model resulted in an estimated walking distance reduction of 67.9% to 10 890 ft per shift per RN. 

What is next

It is expected that further studies will be conducted to test the validity of predictions in other systems, other locations, and other shifts (8-hours, 10-hours, night shift, etc). Future phases should also include other specialized unit types such as neonatal, pediatric, labor & delivery, and so forth. In addition, it can be asserted that a similar strategy can be adopted to predict walking in other important areas of a hospital, such as emergency department. Insofar as the set of tasks conducted by clinicians remain the same or similar, the walking distance measure developed in this study can be adopted with modifications for validation and use in other settings.