Presentation
Preparing for Workflow Changes when Converting Nurse Alcoves to Anterooms on an Inpatient Acute Care Unit
SessionPoster Session 1
DescriptionBackground
During the COVID-19 pandemic, healthcare facilities rapidly adjusted to meet the needs associated with patient care under surge capacity levels and with extensive isolation practices. In anticipation of future pandemics, research opportunities exist to study how hospitals can be equipped for the prevention and control of airborne illnesses. This includes the possibility of converting nurse alcoves into anterooms on an inpatient acute care unit.
One of the main design features to contain airborne illnesses and keep providers safe is the use of anterooms. Anterooms have been shown to be effective for both patient isolation and staff protection. They work by having a difference in air pressure between the corridor, anteroom, and patient room, along with high air circulation to eliminate contamination and secondary infection. At an academic hospital, one 17-bed unit was remodeled to include nursing alcoves that can be converted to anterooms for every room.
Nurse alcoves are small areas outside the patient room that act as workstations. They are used for patient observation, staff rest areas, and decentralized nurse documentation to ensure patient safety and comfort. They include a phone, computer, and window that can be transparent or frosted for patient protection. If the nurse alcoves were converted to anterooms, the workspace at the alcove would temporarily be lost.
This study was conducted on the newly renovated 17-bed unit. A surveys were intended for Registered Nurses (RN), Licensed Practical Nurses (LPN), and Certified Nursing Assistants (CNA), whereas observations on the unit included all clinical staff (including pharmacists, physicians, and allied health staff). This unit offered a practical setting to study how alcoves function in daily nursing practice and explore how the removal of the alcoves could impact staff and workflow.
Objective
The objective of the study was to explore both the benefits and barriers of this conversion and identify ways to mitigate workflow disruptions once the alcoves are no longer available for daily use. By understanding the effects of removing this nursing alcove space, the team will be able to design solutions to mitigate the workflow challenges.
Methods
This study started with a simulation and survey where the Clinical Quality Nurse Lead (CQNL) walked all the nurses on the unit through an inactive simulation room that had been converted to an anteroom. The simulation was looking at whether there was enough space for the anteroom to be functional. After the walkthrough, the participants were asked questions and filled out a survey to record their thoughts.
To gather information about who would be affected and what tasks would be displaced, a Nurse Alcove Observation was completed, which included two types of observations. The first was a general observation to see what the alcoves were being used for and by whom, without talking to clinicians. One non-clinical observer would periodically walk around the unit and note activities in the alcoves and record the role, task, tools/tech they were using, internal environment, and desired outcome. The second observation was a time study spanning six and a half hours. The same observer rounded the unit every 10 minutes and recorded activities, allowing for tracking the duration of use for each of the alcoves. Data included the time of the recording, if the patient room was occupied, the clinician’s role, and the task being performed.
It was determined there was more information needed directly from the clinical staff to get a complete understanding, so another survey was embedded in the nurse’s weekly newsletter. It was open for four weeks with the emphasis on how converting the alcoves to anterooms would change a nurse's daily workflow. Based on those results, another simulation, focused on horizontal spaces to temporarily place items, was completed to find possible solutions to mitigate barriers the loss of alcoves would create. There were three different-sized tables provided with questions about the desired size and location of the table, and what it would be used for.
Results
There was a significant overlap of findings gathered from the surveys and observations during the evaluation process. There were twelve nurses who participated in the walkthrough anteroom simulation, which included all the nurses on shift that day. The majority responded, saying the space was large enough to be functional for one person at a time. There was also feedback requesting additional items be in the anteroom and concerns with it being too tight for Power Aire Purified Respirator. The survey embedded in the newsletter received six responses, and the data aligned with the observation about what the alcoves were being used for daily, including charting, patient observations, and staff discussions. Nurses expressed concerns about being less accessible to the patient and loss of ability to do quick, immediate charting without the alcoves. The horizontal space survey received 11 responses, with the majority wanting the medium-sized table (46x81 cm) or something close to it. Most nurses said they would use it mainly for holding food trays, linens, and glucose monitors.
The primary concern that emerged was the impact on nurse workflow. Removing the alcoves from everyday use would disrupt medical staff routines, likely increase walking distance and time, reduce access to workstations, and introduce potential barriers to timely documentation or direct patient observation. Despite these concerns, the study also engaged front-line staff to identify practical ways to reduce the barriers, including additional workspaces or computers in the hallway, using workstations on wheels (WOWs) to provide access to online medical records, or identifying other underutilized spaces that could temporarily replace the alcove function. While those changes wouldn’t completely replace the convenience of the alcoves, they could help make the changes less extreme and maintain workflow efficiency and patient safety.
During the COVID-19 pandemic, healthcare facilities rapidly adjusted to meet the needs associated with patient care under surge capacity levels and with extensive isolation practices. In anticipation of future pandemics, research opportunities exist to study how hospitals can be equipped for the prevention and control of airborne illnesses. This includes the possibility of converting nurse alcoves into anterooms on an inpatient acute care unit.
One of the main design features to contain airborne illnesses and keep providers safe is the use of anterooms. Anterooms have been shown to be effective for both patient isolation and staff protection. They work by having a difference in air pressure between the corridor, anteroom, and patient room, along with high air circulation to eliminate contamination and secondary infection. At an academic hospital, one 17-bed unit was remodeled to include nursing alcoves that can be converted to anterooms for every room.
Nurse alcoves are small areas outside the patient room that act as workstations. They are used for patient observation, staff rest areas, and decentralized nurse documentation to ensure patient safety and comfort. They include a phone, computer, and window that can be transparent or frosted for patient protection. If the nurse alcoves were converted to anterooms, the workspace at the alcove would temporarily be lost.
This study was conducted on the newly renovated 17-bed unit. A surveys were intended for Registered Nurses (RN), Licensed Practical Nurses (LPN), and Certified Nursing Assistants (CNA), whereas observations on the unit included all clinical staff (including pharmacists, physicians, and allied health staff). This unit offered a practical setting to study how alcoves function in daily nursing practice and explore how the removal of the alcoves could impact staff and workflow.
Objective
The objective of the study was to explore both the benefits and barriers of this conversion and identify ways to mitigate workflow disruptions once the alcoves are no longer available for daily use. By understanding the effects of removing this nursing alcove space, the team will be able to design solutions to mitigate the workflow challenges.
Methods
This study started with a simulation and survey where the Clinical Quality Nurse Lead (CQNL) walked all the nurses on the unit through an inactive simulation room that had been converted to an anteroom. The simulation was looking at whether there was enough space for the anteroom to be functional. After the walkthrough, the participants were asked questions and filled out a survey to record their thoughts.
To gather information about who would be affected and what tasks would be displaced, a Nurse Alcove Observation was completed, which included two types of observations. The first was a general observation to see what the alcoves were being used for and by whom, without talking to clinicians. One non-clinical observer would periodically walk around the unit and note activities in the alcoves and record the role, task, tools/tech they were using, internal environment, and desired outcome. The second observation was a time study spanning six and a half hours. The same observer rounded the unit every 10 minutes and recorded activities, allowing for tracking the duration of use for each of the alcoves. Data included the time of the recording, if the patient room was occupied, the clinician’s role, and the task being performed.
It was determined there was more information needed directly from the clinical staff to get a complete understanding, so another survey was embedded in the nurse’s weekly newsletter. It was open for four weeks with the emphasis on how converting the alcoves to anterooms would change a nurse's daily workflow. Based on those results, another simulation, focused on horizontal spaces to temporarily place items, was completed to find possible solutions to mitigate barriers the loss of alcoves would create. There were three different-sized tables provided with questions about the desired size and location of the table, and what it would be used for.
Results
There was a significant overlap of findings gathered from the surveys and observations during the evaluation process. There were twelve nurses who participated in the walkthrough anteroom simulation, which included all the nurses on shift that day. The majority responded, saying the space was large enough to be functional for one person at a time. There was also feedback requesting additional items be in the anteroom and concerns with it being too tight for Power Aire Purified Respirator. The survey embedded in the newsletter received six responses, and the data aligned with the observation about what the alcoves were being used for daily, including charting, patient observations, and staff discussions. Nurses expressed concerns about being less accessible to the patient and loss of ability to do quick, immediate charting without the alcoves. The horizontal space survey received 11 responses, with the majority wanting the medium-sized table (46x81 cm) or something close to it. Most nurses said they would use it mainly for holding food trays, linens, and glucose monitors.
The primary concern that emerged was the impact on nurse workflow. Removing the alcoves from everyday use would disrupt medical staff routines, likely increase walking distance and time, reduce access to workstations, and introduce potential barriers to timely documentation or direct patient observation. Despite these concerns, the study also engaged front-line staff to identify practical ways to reduce the barriers, including additional workspaces or computers in the hallway, using workstations on wheels (WOWs) to provide access to online medical records, or identifying other underutilized spaces that could temporarily replace the alcove function. While those changes wouldn’t completely replace the convenience of the alcoves, they could help make the changes less extreme and maintain workflow efficiency and patient safety.
Event Type
Poster Presentation
TimeMonday, March 234:45pm - 6:15pm EDT
LocationRhinelander Gallery