Many risks remain unobserved in plain sight though on occasion can be perceived by the more perceptive individual. This was perhaps the case in respect of the physical layout of an intensive care unit in an acute hospital. The link had become apparent only after the development of a model to simulate the risk of ‘interventions’ in a critical care environment. Such ‘interventions’ can be described as the myriad of tasks undertaken on behalf of the patient. An element of risk is present if an intervention is omitted or undertaken imperfectly. Thus omission of a session of oral hygiene in a patient on a ventilator imperceptibly increases the chance of developing pneumonia. A so called ‘risk engine’ was developed using elements of Fuzzy Logic to provide a numerical probability of such lapses. The long time tracking of such a system – captured within many modules of programming – was a challenge to my professional science peers to appreciate but totally beyond the ken of clinical colleagues.
There was, however, one observation that was intriguing and that related to functions associated with direct observation of patients in the intensive care environment. The layout and grouping of beds influenced the general ability of staff to observe the condition of patients. Usually with one to one nursing, a nursing member of staff would prioritise looking after his/her assigned patient but would also be on hand to observe adjacent patients where, for whatever reason, the key nurse was not present at the bedside. Where beds were unduly far apart, this mutual ‘oversight’ function would be impaired and there would be an increased risk of patient harm if a deteriorating condition was not promptly observed. Also, if there was a construction pillar as part of the building design, this could also degrade the mutual ‘oversight’ function. It is unlikely, however, that these factors are appreciated by those teams that design Critical Care facilities.
It is prudent to mention also the location of clinical store items in relation to the Critical Care unit. Staff frequently fetch and carry a range of consumable items for use on their patients. In the time that they are in transit there is no one-to-one supervision of their patient. It makes obvious sense to locate such stores so as to minimise such loss of direct supervision. This factor can be considered to impact significantly on risk factors associated with patient survival and is another factor for hospital design teams to get right.
Of course we largely spend our time in a built environment, elements of which we assume have been designed with safety in mind. I would like to think that the modern day designers have access to tools to simulate the function of their creations and minimise such risks. An obvious exercise would be to simulate vehicle traffic over periods of several years and determine solutions that minimise collisions and provide optimum traffic flows. Such an approach would prevent ‘accident blackspots’ from being transferred from construction plans to an unsafe built environment.
A link to the Thesis describing this work in the clinical area is attached below. Various of the factors about the risk factors due to physical bed layout are outlined in chapter 6 – see section 6.7.
