STATUS IN WALES

1 For queries on the STATUS of this document contact or telephone 029 2031 5512 STATUS Note amended March 2013 Ward layouts with single rooms and space for flexibility 2008 STATUS IN WALES INFORMATION This document sets out the evidence supporting the provision of sufficient space around the bed and more single rooms. In addition it shows how this can be achieved within current cost allowances. It is not intended to form the basis of design briefing. The diagrams throughout the document are provided to support the evidence. They are not design solutions and should not be used as such. Ward layouts with single rooms and space for flexibilityDH INFORMATION READER BOXP olicyEstatesHR / WorkforcePerformance ManagementIM & TEstatesPlanning FinanceClinicalPartnership WorkingDocument PurposeFor InformationROCR Ref:0 Gateway Ref.

2 0 TitleAuthorPublication DateTarget AudienceCirculation ListDescriptionCross RefSuperseded DocsAction RequiredTimingContact DetailsFor Recipient's UseWard layouts with single rooms and space for flexibilityHarrogate HG1 2PW001423 857221 Sue TaylorNHS EstatesWindsor HouseCornwall Road0 NHS EstatesN/A0N/A01 May 2005 Project design teams, estates departments and their staff, PFI consortiaDepartment of Health libraries, House of Commons library, Strategic Health Authorities, UK Health Departments Document that sets out the evidence supporting provision of sufficient space around the bed and more single rooms. In addition it shows how this can be achieved within current cost allowances. For information only for NHSFTs and NHS layouts with single rooms and space for flexibilityLondon: The Stationery OfficePublished by TSO (The Stationery Office) and available , Telephone, Fax & E-mailTSOPO Box 29, Norwich NR3 1 GNTelephone orders/General enquiries 0870 600 5522 Fax orders 0870 600 5533E-mail Shops123 Kingsway, London WC2B 6PQ020 7242 6393 Fax 020 7242 639468 69 Bull Street, Birmingham B4 6AD0121 236 9696 Fax 0121 236 96999 21 Princess Street, Manchester M60 8AS0161 834 7201 Fax 0161 833 063416 Arthur Street, Belfast BT1 4GD028 9023 8451 Fax 028 9023 540118 19 High Street, Cardiff CF10 1PT029 2039 5548 Fax 029 2038 434771 Lothian Road, Edinburgh EH3 9AZ0870 606 5566 Fax 0870 606 5588 TSO Accredited Agents(see Yellow Pages)

3 And through good booksellers Crown copyright 2005 Published with the permission of NHS Estates, an Executive Agency of the Department of Health, on behalf of the Controller of Her Majesty s document/publication is not covered by the HMSOC lick-Use Licences for core or added-value material. If you wish to re-use this material, please send yourapplication to:Copyright applicationsNHS EstatesWindsor HouseCornwall RoadHarrogateHG1 2 PWISBN 0-11-322719-1 First published 2005 Printed in the United Kingdom for The Stationery OfficeThe paper used in the printing of this document(Revive Silk) is 75% made from 100% de-inked post-consumer waste, the remaining 25% being mill brokeand virgin fibres. Recycled papers used in itsproduction are a combination of Totally Chlorine Free (TCF) and Elemental Chlorine Free (ECF). It isrecyclable and biodegradable and is an NAPM andEugropa approved recycled report is the result of a three-year programme ofresearch by NHS Estates, which examines the benefitsof single rooms in acute hospital accommodation andestablishes the minimum space requirements around thehospital bed.

4 This is not intended to form the basis ofdesign briefing, but will underpin the updating of HBN 4which is currently in main issues addressed in the research are: contributing to control of healthcare associatedinfections (HCAI); complying with the Disability Discrimination Act 1995; meeting the needs of the Manual HandlingOperations Regulations 1992, particularly with regardto lifting patients; meeting the needs of patient privacy and addition, perhaps the most important item has beento seek an affordable solution that encompasses all ofthe above research has been conducted through literaturesurveys, ergonomic studies using mock-up bed spaces,and the production of a series of exemplar ward layoutswhich have been costed against the currentDepartmental Cost Allowance Guides (DCAGs) toassess key findings are as follows:1. Single rooms provide considerable benefits forpatients, clinicians and NHS trusts, which includecontributing to the control of infection, reducing therisk of adverse clinical errors, allowing privacy, andproviding flexibility with the potential for With the provision of single room accommodation inacute hospitals currently at less than 20%, there is aneed to significantly increase numbers of There is a need to provide a minimum clear space of3600 mm x 3700 mm around in-patient beds in bothsingle and 4-bed rooms.

5 This space is adequate toaccommodate most activities at the bedside,including the use of equipment and the manoeuvringof wheelchairs and mobile Through the application of the minimum clear spaceof 3600 mm x 3700 mm around each bed to a seriesof 32-bed ward layouts, it has been shown that thisspace can be accommodated within current spaceallowances for 50% single/50% 4-bed In addition, with a minor modification to the scheduleof accommodation, it has been shown that 100%single rooms can be accommodated within the samearea as 50% single/50% 4-bed The cost per bed of 100% single roomsaccommodated within the 50% single room spaceallowance is negligibly higher. It may be possible tooffset this cost by increased capacity and taking anew approach to service planning and There are indications that there may be costadvantages to the provision of single rooms throughreduced costs from the containment of HCAI,increased flexibility, shorter patient stays, easieraccess for cleaning, and compliance with health andsafety and other statutory summaryExecutive summaryMethodology for the researchpage 2 Achieving more single rooms and more spaceSingle roomsSpace around the bedStatus of this documentpage 31 Introduction to the studypage 4 Drivers for changePlanning for the future2 Achieving more single rooms and sufficient spacearound the bedpage 6 IntroductionCriteria used in the studyWhat impact does the application of a clear minimum space around the bed have on single and 4-bed rooms?

6 Applying a clear minimum space around the bed to a 32-bed unit with 50% single/50% 4-bed roomsCan 100% single rooms be achieved within the same space allowance as 50% single/50% 4-bed rooms?Cost implications3 Providing more single roomspage 24 Evidence supporting multi-bed roomsEvidence supporting single roomsImpact on the organisation of in-patient careBalancing affordability4 Providing sufficient space around the bedpage 31 IntroductionKey factors influencing space around the bedKey activities at the bedsideMinimum dimensions for space around the bedOverall space requirementsFour-bed room showing activities in all bed spacesAppendix 1 The case for single rooms: a trust perspectivepage 46 South Devon Integrated Care Network South Devon Healthcare NHS TrustSummaryDeveloping the case drivers for changeCosting informationAppendix 2 Current STATUS of single-bed in-patient accommodationpage 49 Appendix 3 The benefits of single rooms provision and their impact on staff and patient healthoutcomes within the NHS in Englandpage 50 Flexibility of managing bed availability and patient placement in appropriate bedsOverall bed occupancy levels and capacityInfection control, cross-infection and infection ratesPatients moves and transfers Patient satisfactionDealing with different specialtiesSize.

7 Critical dimensions of the single room and design of nursing unitAppendix 4 The views of patients and their families and other researchpage 54 Research in the Netherlands 2001 Other research in the UKAppendix 5 Activities at the bedsidepage 57 Clinical treatment and carePersonal care and maintenanceSupport activitiesAppendix 6 Referencespage 58 Acts and RegulationsBritish StandardsNHS Estates publicationsDepartment of Health publicationsOther Government Department publicationsOther publicationsContents1 This document brings together a number of studiescarried out by NHS Estates with assistance from MORE SINGLE ROOMS AND MORESPACETo establish the affordability of providing more singlerooms and more space, MAAP Architects haveproduced a series of theoretical ward layouts based onthe current space allowances in the Schedules ofAccommodation ( April 2003 HBN 4).SINGLE ROOMSA study on single room accommodation, including aliterature review, has been carried out by the School of Architectural Studies, The University of SheffieldSchool of Architecture; MAAP Architects; and HERCA ssociates.

8 This is the basis for the information inChapter 3. It also draws on the report of an NHSE states workshop, Exploring the patient environment (2003), which includes a presentation from ProfessorRoger Ulrich, Director of the Centre for Health Systemsand Design at Texas A&M University in the USA. Inaddition, a summary of an interim report by theUniversity of Sheffield School of Architecture on thebenefits of single rooms provision and their impact onstaff and patient health outcomes within the NHS inEngland is provided in Appendix AROUND THE BEDTo establish a clear evidence base for the minimumspace required around the bed, significant research hasbeen undertaken. Aware that, over time, the dimensions for space aroundthe bed varied over the HBN series, in 2000 NHSE states commissioned a study by MAAP Architects tocompare the differences in each document and to try toestablish an optimum space standard this unpublishedreport was the starting point for the current the past two years, two further studies have been carried out by NHS Estates to study bedsidemanoeuvring and transfer space.

9 The first was at LeedsGeneral Infirmary and the second with Robert FeeneyAssociates (RFA, 2004), an ergonomics and designconsultancy, at Loughborough University where NHSE states has located its mock-up bed space. Thesestudies provided a physical framework for theergonomic assessment of the space inform the research described above, three otherstudies have particular relevance: a. a study of the minimum space requirements for staffusing appropriate equipment to transfer patients inand out of beds, to use sanitary facilities, and tocirculate freely within a residential care facility. Theresults of this study were published by Arjo Ltd in1996 and entitled Guidebook for architects andplanners nursing homes and an elderly carefacilities ;b. carried out in the Netherlands, a study investigatedexperimentally the workspace required around biggerbeds in hospital wards. The results were published bythe STAGG study group in the report Area aroundbigger beds floor areas in relation to costs (1992);c.

10 An Australian study carried out as part of theVictorian Work Cover Authority s health and age tocare project resulted in Guidelines for the Design ofHealth and Aged Care Facilities . The aim of thisstudy was to reduce the incidence and severity ofback injuries in LAYOUTS WITH SINGLE ROOMS AND SPACE FOR FLEXIBILITY2 Methodology for the researchThis document is not intended to form the basis ofdesign briefing. It contains the evidence base supportingthe provision of sufficient space around the bed andmore single rooms. From January to 31 March 2005there was an opportunity for readers to comment on the contents of the document. Thank you to those whohave taken the trouble to comment. Where appropriate,amendments have been made to the document. Othercomments will be taken into account for the publicationof the new document HBN 4 Adult acute in-patientaccommodation which is currently in preparation.