Ambulatory Clinic Exam Room Design With Respect to Computing Devices to Enhance Patient Centeredness (Kentucky)

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Although significant research has been conducted on the impact of health information technology (IT) use on provider-patient interactions, challenges persist on how to effectively integrate these tools into healthcare environments in a patient-centered manner. Some providers worry that the use of computer documentation during patient visits negatively impacts the provider-patient relationship. However, directly involving patients with computerized applications during visits may ehance this relationship. This approach, however, is impossible with poorly placed computers.

This project, conducted at the Veterans Health Administration (VHA), investigated the impact of exam room layout on patient centeredness. Researchers created a new exam room design and tested it in a laboratory simulation study and a pilot field study. The new design included a wall-mounted monitor for ease of re-positioning. In addition, a mobile table was used as a consult surface for a keyboard or printed materials to be shared with the patient and family members. This layout change was evaluated for its impact on clinical workflow, patient engagement, and enhanced patient safety.

The specific aims of the project were as follows:

  • Prototype and evaluate a re-designed exam room layout and compare the redesigned layout to a current, typical exam room layout in the VHA.
  • Refine the redesigned exam room layout, implement it in a live clinic setting, and compare it to currently designed exam rooms in a Veterans Affairs (VA) Medical Center. 

In a lab-based experiment, 28 providers used prototypes of the new and legacy outpatient exam room layouts to conduct simulated patient encounters. In a subsequent pilot field study, researchers conducted observations and interviews with 11 primary care providers and their patients and compared the new exam room design standard with the legacy exam rooms.

For the laboratory simulation study, there were no statistically significant differences between the exam room layouts for efficiency, errors, or time spent focused on the patient. However, when using the new layout, providers spent 75 percent more time in screen sharing activities, resulting in 31 percent lower workload. Additionally, the pilot test of the new exam room layout found that providers spent a greater proportion of time focused on the patient, more time in screen-sharing activities with the patient, and had more self-reported situational awareness. Overall, providers seemed to be unwilling to compromise their focus on the patient when the computer was in a fixed position away from the patient; as a result, they experienced greater workload, lower situational awareness, and poorer workflow integration when using the legacy layout. Next steps for investigators include conducting a similar, larger study that includes more diverse settings and increases sample size.

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Ambulatory clinic exam room design with respect to computing devices to enhance patient centeredness - final report

Saleem, J. Ambulatory clinic exam room design with respect to computing devices to enhance patient centeredness - final report. (Prepared by the University of Louisville under Grant No. R03 HS024488). Rockville, MD: Agency for Healthcare Research and Quality, 2018. (PDF, 388.17 KB)

The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
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