Spotlight on Success—PDC-Duke ensures a safe physical environment

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Courtesy of the Joint Commission's EC News

The Duke Health Integrated Practice, PLLC (DHIP), the physician practice of Duke Health, founded in 1931, currently owns an operates 75 ambulatory care clinics throughout North Carolina, making it one of the oldest and
largest academic group practices in the country.

The DHIP first achieved ambulatory care accreditation from The Joint Commission in 2000 and successfully completed its latest review in fall 2016. During the most recent survey, Joint Commission surveyors commended the DHIP for its innovative strategies to create safe clinic environments for patients, providers, and staff.

Foundation in design

DHIP’s success in creating a safe physical environment comes from two factors: incorporating safety into design and engaging patients, clinic staff, and physicians in the design process.

With 75 multispecialty care clinics, the DHIP is constantly changing, expanding, and renovating its clinic spaces. To ensure a successful and safe clinic design, the DHIP engages its stake- holders—and not just any stakeholders but the right stakeholders.

“We believe that safety begins at the foundation—literally and figuratively,” says Kimberly Denty, RN, associate vice president of Accreditation, Patient Safety, and Clinical Site Development at DHIP. “During the design process, we view everything from a patient safety standpoint.”

“As a clinician, I have seen many examples of clinic development that included only leadership in the design process,” Denty explains. “However, at DHIP, we make a point of including end users from all departments throughout the design process. Patients, staff, physicians, and providers are actively involved at every stage.”

To encourage full participation, Denty schedules meetings before and after clinic hours so physicians and staff can attend without affecting patient care.

For example, the DHIP recently built a new, state-of-the-art endoscopy clinic in one of its multispecialty locations. The clinic health center administrator, Dariele Cooper, RN, CGRN, was a lead decision maker on the design and build because of her knowledge of endoscopy clinic operations. Cooper was invaluable in making patient-centric design-related decisions for the Brier Creek clinic.

Many individuals and departments provide valuable input at every stage of the process, including Stan Branch, MD, FACP, FASGE, director of Endoscopy Services; Melissa Teitleman, MD, AGAF, medical director; clinic nurses, patient care technicians, patient service associates, and internal support departments such as Environment of Care, Fire Safety, and Infection Prevention and Control.

“The physicians, too, have a strong interest in design,” says Denty. “The entire team takes pride in the process. By partic- ipating, they can make sure their patients are receiving top-quality care in a safe environment that they helped design.”

Compliance with the code

Life Safety Code®* compliance is complex and challenging, and most accredited organizations have survey findings in this area. However, the DHIP success- fully passed nearly all the measures in this category.

“We actually had no Life Safety Code findings that were directly under the DHIP’s control,” Denty says. “We lease space for our clinics, and the findings we had in this area were related to components controlled by the landlord, such as exterior lights and fire doors.” Again, Denty credits integrating the end users into the design process as the reason for the DHIP’s high compliance with Life Safety Code standards.

“In order to comply with codes, you must have a knowledgeable team of health care architects and engineers who have experience in designing ambulatory care clinics and ensure that all are  up-to-date on all federal, state, local, and Joint Commission standards,” says Denty. In addition, the DHIP was careful to select only architects, engineers, and contractors who had experience in building specialty care practices.

“Our team, which includes our DHIP Fire Safety team, reviews all state and county fire codes, Joint Commission standards, and other fire safety–related issues when designing our locations,” says Denty. “We always follow the strictest available standards for safety.”

In summer 2016, the organization made the transition from the 2000 edition of the Life Safety Code to the 2012 edition. The transition was smooth, according to Denty, partly because the organization participated in The Joint Commission training on the topic.

Reducing patient anxiety

Organizations can take many approaches to creating a safe clinic environment. However, the DHIP recognized that reducing a patient’s anxiety is also an important factor to consider. Patients can have high anxiety when they enter an unfamiliar space or when they will be undergoing a surgical procedure.

After some research, the DHIP design team found an innovative, fun, and evi- dence-based solution to reducing patient stress: fish tanks. “You have probably noticed that most dentists’ offices have fish tanks,” Denty says. “There’s a reason for that.”

Because real fish tanks can pose significant infection prevention and control risks, the DHIP sought a safe alternative. Denty engaged a digital fish tank vendor and software engineers to create a customizable virtual fish tank displayed on a 70-inch television monitor. Staff members can populate the tank by choosing from more than 200 types of fish and can even name the digital fish.

Selecting locations for the digital fish tanks was important. To be effective, the tanks had to be visible to patients and located in areas where patients experience the highest anxiety. Clinic physicians and staff were a large part of that deci- sion-making process. Based on their experience, they determined that patients are most likely to experience anxiety in the preop and postop areas, so that is where they located the digital fish tanks.

“Masking” medical gases

Another source of anxiety for patients is some of the health care equipment in the clinical space. For example, the DHIP design team identified medical gases as one of these anxiety-inducing elements. “Seeing the medical gas fixtures hanging from the wall can be intimidating for patients,” Denty says. “We asked ourselves what we could do to address that without compromising safety.”

The solution was to “mask,” or hide, the medical gases behind custom artwork. DHIP hired a metal fabricator to create a frame for the medical gas array that can be accessed quickly and easily in an emergency. An artist collaborated on the project to create an attractive piece of art to attach to the metal frame.

It was not easy to find a design that worked initially, Denty says. The fabricator and artist presented several versions of the piece to the design team onsite so the team could see how it would work in the actual space. The team rejected a number of variations of the frame and artwork before settling on the final piece.

Cooper explains that staff are trained to use the new devices, and testing access to medical gases is part of the nurses’ daily checklist. “Gases are readily accessible in an emergency,” Cooper says. “But 99% of the time, the patient sees beautiful artwork and not the medical gas fixtures.”

Preventing falls at DHIP

Another component of DHIP’s safety initiative is the falls prevention program, led by Heidi Campbell, COT, a health center administrator at the Duke Eye Center. “A good falls prevention program is monitored regularly to maintain safety, and we are constantly looking for ways to improve our program,” Campbell emphasizes.

Each clinic has a falls prevention champion who conducts monthly rounds to identify new and potential risks. The champions know the individual circum- stances and needs of their clinics—the types of patients who use the facility, how they move through the space to receive care, where they sit, where they walk, how doorways and fixtures are situated, and so on. The champions are best equipped to make informed assessments of fall risks and suggest design elements to mitigate those risks.

For example, Cooper notes that ambulatory surgery clinics are now removing stretchers from the preop rooms. “Because patients don’t have to get up on a stretcher, one potential risk of falling is removed.” These fall prevention strategies, as well as DHIP’s work to improve the overall safety of the physical environment, reflects the organization’s commitment to incorporating safety into design and engaging end users in the design process.


Source: EC News (Volume 20, Issue 5, Pages 7–9)

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