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For other articles and previous issues click here. February 7, 2005 Designing
a Facility for People, Not Just the Equipment New equipment—especially going digital—can mean reassessing radiology department design. Make sure your facility’s changes accommodate the radiologists, technologists, and patients just as much as the equipment itself. Technological advancements have major impacts on workflow and efficiency within imaging facilities, which begs an important design question: How should the departments’ architecture and design complement those equipment changes? At RSNA 2004, a refresher course titled “The Digital Department: Its Architecture and Design” offered some answers about the nuts and bolts of justifying, planning, and budgeting for the redesign of radiology departments. Why Redesign? Imaging is at the center of patient care and images must be quickly transmitted to the emergency department, intensive care unit, medical/surgical beds, operating room, and healthcare enterprise. “The operations are changing,” Rostenberg said. “We have to look at workflow, and that includes the flow of radiologists, technologists, medical images, patient records, and inpatients and outpatients.” Traditionally, said Rostenberg, image acquisition was measured by how many films radiologists could read in one day. “We could only take as many patients as we had time to read the films,” he noted. In the expanding digital environment, that is obviously no longer the case. More tests are being ordered and performed, increasing the need to get people in and out as efficiently as possible. “High technology enables high patient focus,” said Morris A. Stein, FAIA, FACHA, president of The Stein-Cox Group, an architectural planning and interior design firm in Phoenix. “Design is based on workflow and effectiveness, not tradition.” With an effective design, Rostenberg said, patients can be easily transported through the department. Inpatients and outpatients should be in different areas, and the circulation should be arranged so technologists can get to the patients as quickly as possible and get them in and out. Steven C. Horii, MD, FACR, FSCAR, a professor of radiology and clinical director of the medical informatics group at the University of Pennsylvania Medical Center, who also presented during this course, added that the inpatient area should be close to an elevator for easy and quick transport, thus mitigating hallway traffic in the facility. Horii also noted that everything should not be placed in one corridor because it can get crammed with people moving at a fast pace. “You need holding space and room to maneuver,” he commented. “I’ve seen facilities where there isn’t even room in the hallway to turn a bed around. They have to back the bed into a room to be able to rotate it and go the other way.” All this said, however, Horii commented that many facilities are not able to completely change their department layout or relocate the reading rooms. “Reading rooms are often designed into space leftover after the rest of the department is laid out,” he said. The Reading Room In film-based environments, the department layout is based around the ability to pass cassettes right off for developing and reading. As departments go digital, there is often a reduced size needed for the work core of image processing. Therefore, said Rostenberg, “Plate readers are being relocated to the point of use.” He also noted that the archives can now be in or out of the department. Horii said that in filmless environments, the reading areas can be decentralized, which may free space for improving imaging workflow. “Radiologists can read in their offices,” he said. “But you have to be careful with that because it may decrease productivity. Radiologists like it because it’s quiet and comfortable for them, but it can also make the radiologist harder for the technologist to find.” Comfort and silence may not be the first things that come to people’s minds when they think of reading rooms. Rostenberg noted that reading rooms are often underdesigned, adding that this concept seems wrong. “After all,” he said, “the purpose of imaging is the reading.” So what should be done? “Reading rooms must be enclosed, have proper lighting, be ergonomically accommodating, and have good acoustics,” he said. Good acoustics prevent those outside the room from hearing what is going on inside and also reduce external noise penetrating the walls and interfering with workflow. Eye strain is a problem that arises from poor lighting or highly reflective surfaces, said Rostenberg. “Lighting is critical,” said Horii. “Improved lighting reduces reading times.” With the transition to the digital environment, ergonomics becomes more important because everything is more reliant on the computer. “Everyone is aware of how damaging that can be, and it needs attention,” Rostenberg said. “Sadly, attention usually isn’t given until problems arise.” Nogah Haramati, MD, chief of radiology at Montefiore Medical Center in Bronx, N.Y., another RSNA presenter in a scientific paper session titled “Radiology Informatics (PACS: Cost, Security, and Ergonomics),” described the need to redesign the reading workstation itself to accommodate ergonomic needs to increase ease and productivity, thereby customizing workflow (see sidebar <WHERE>). Rostenberg also urged the need for adjustable equipment, saying that built-in casework should be avoided in design. He labeled the reading room prototype as “COTS” (commercially-off-the-shelf). Other issues faced in designing the reading room is the wiring and power adequacy. In a digital environment, with all or most of the reading being done on computers, the wires need to be out of the workstation itself for safety and power reasons. A sufficient power supply is also necessary to ensure that no problems occur with shortages or surges. Budgeting for Design The hard part, Horii said, comes with justifying redesign costs to the “powers that be.” “It’s easy to justify technology costs, but it’s not so easy to prove that productivity will go up after redesign,” he noted. Therefore, planned steps must be taken to ensure that all the bases are covered in presenting a convincing proposal and budget. Horii’s advice? “Call an architect before it’s even on paper,” he said. Provide all the space requirements for equipment by getting plans from the vendors for the installs as early as possible and provide the architect with those “cut sheets” so they know what needs to go where. From there, the architect should come in to survey the space and see what needs to be done. The architects, he added, want to see where radiologists, technologists, and patients have to go within the facility, why they go there, when they go there, and how far they have to travel to get there. “Get the architect involved early,” Horii said. “Don’t make it an afterthought. It’s what they do. They can help a lot.” In addition, it is important that people do not assume that architects understand the requirements of a digital department vs. a film-based department, so everything must be presented in detail. Horii also advised seeking external consultants in the event that the architect doesn’t have experience with digital department design. Perhaps the most essential part of the redesign process is letting the architect do the designing. While it’s important to stay in constant contact with architects throughout the process, the architects are the “builders.” The keys to successful redesign? Plan ahead. Provide a sufficient budget. Share the goals of the department with the architect to make sure everything is understood. Also make sure that the design is flexible and scalable. Once everything is said and done, said Rostenberg, “the reaction [is] favorable. It’s more efficient and it’s a more pleasant environment if it’s not in a dark, secluded area. — Cristen Leaper is assistant editor of Radiology Today. Furnishing a Reading Room — One Size Must
Fit All What sparked the transition? According to Haramati, he noticed that ergonomic problems existed and that the injuries really occurred. “We heard about nerve injuries in the arms and back and neck problems,” he said. “With a high percentage of adults already having back problems, it doesn’t take much to aggravate them.” First, Haramati looked at the chairs being used, realizing that they needed to be comfortable and adjustable. “The back of the chair has to be high enough to support the upper back, so it has to be moveable to accommodate radiologists of different heights,” he said. He also noted that the user should be able to lean the seat back and lock it in that position. “Not only does the chair itself have to be moveable, but the seat also has to be able to move forward and backward,” Haramati said. In evaluating the arm rests, he found that they must also be height-adjustable and be long enough to support the entire forearm to the wrist. Once the chair is designed, next comes the table, where the placement of the keyboard, mouse, and monitors are essential, as well as the table height. Haramati noted that the height of the table should be adjustable to match the height of the arm rest for each individual. Radiologists are generally more comfortable when the keyboard is on the table surface near the monitor, so it is important to make the keyboard moveable. The mouse must also be able to go anywhere the radiologist wants, said Haramati, so he made the whole workstation table a mouse pad surface. Since the whole reading process revolves around the monitor itself, it is crucial that they be moveable as well. “Monitors must be separate from the desktop,” he said. “They are best viewed when they are perpendicular to the [radiologist’s] pupil, so we put them on hinges” to accommodate different people and preferences. This way, it also leaves the option to stand while reading, which also relieves lower back pain. Another reliever of back pain is the footrest, which
can be set at different levels at the workstation. “Footrest
height is critical to the relief of back pain,” Haramati said. Haramati also noted that people from other facilities have come in for site visits to see how the ergonomic workstation works at Montefiore Medical Center. — CL |
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