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For other articles and previous issues click here. September 19, 2005 Looking
to a Filmless Future — Designing a PACS Reading Room for Tomorrow
and Beyond Rooms filled with hard-copy film and bulky viewing equipment are steadily diminishing. Taking their places are PACS, decentralized radiology, and soft-copy reading. These digital developments change the way radiologists work—and their work environment. Many of today’s workspaces for soft-copy reading do not support the efficiency and increased productivity that radiologists require. By transforming the work environment and putting the gained space to productive use, hospitals and imaging centers can improve their bottom lines. An evidence-based design approach is infiltrating healthcare facilities; both operations and design must work together to meet objectives. The initial steps of evidence-based design—extensive research and planning—can greatly benefit radiology units as they transform from hard-copy to filmless environments. Staff at the Indiana University School of Medicine’s department of radiology and designers at BSA LifeStructures are working together, in the primary stages of an evidence-based design approach, to research and determine how the soft-copy environment should respond to the changing nature of radiology. In conjunction with the university’s PACS Training School, they performed a joint research project that began in 2003 studying sound, lighting, ergonomics, room layout, and other factors critical to the soft-copy environment. Researchers used the findings to create an ideal reading room. The team surveyed approximately 60 radiologists about the pros and cons of existing film reading environments. The findings revealed that satisfaction with the current soft-copy reading environment was low overall, and the three areas having the greatest impact on overall reading room satisfaction were lighting used for reading images, room layout, and workspace ergonomics. Layout and ergonomics had the lowest levels of satisfaction. The most requested equipment to have available in the reading room included a computer, viewbox, printer, and voice-recognition system. Radiologists’ perceptions are that improving the soft-copy reading environment to an “ideal” design would significantly improve efficiency. BSA LifeStructures used the data to design four possible layouts. In-depth interviews with radiologists provided detailed feedback, and a survey let them rank the options. The survey also included a blank workspace that allowed radiologists to create their own options. The surveys, interviews, and layout examples revealed that similarities exist in terms of ideal work areas and the need for multiple-user flexibility. There were differences in placement of peripherals as well as needs for a high-volume, single user vs. those in academic settings that need collaboration. As a result, designers made a “best-case” paper prototype for work areas using the input (figure 1), and a best-case paper prototype for the “pod” example, which allows for collaboration (figure 2). A final design prototype was built within the department, with working PACS stations used by radiologists in their day-to-day activities. The design sought to eliminate some common shortcomings of existing PACS facilities, such as poor lighting, temperature, and elements that cause stress, fatigue, inaccuracies, and discomfort. The team conducted time and motion studies to measure user satisfaction and assess productivity of the design. The research uncovered several practices to implement for a radiology department of the future. Facility types can range from decentralized radiation in the patient unit to a radiology department to a freestanding facility. The study looked primarily at freestanding facilities, but most of the best practices are applicable across all models. Location of the reading room. Reading room locations can vary from within a radiology department to a centralized area to decentralized radiology close to patient rooms. The decision for placement of the reading rooms depends on the owner’s preference and department size. Larger departments and teaching hospitals often require larger, decentralized areas because of the radiologists’ needs to collaborate with others. Evolving technology allows decentralization to occur virtually anywhere. Regardless of whether the unit is decentralized or centralized, consideration of how its location will affect workflow patterns is essential. Size and zones. Research revealed that radiologists worked best in an environment that allowed for private reading but still fostered colleague interaction. Designers can achieve these needs by creating the following zones: • The Task Zone provides privacy for the radiologist, with everything in reach. • The Colleague Interaction Zone fosters small group discussions and provides additional seating. • The Group Rounds Zone consists of multiple monitors and standing height accommodations. Flexibility makes spaces adaptable for changing equipment. The environment must be adaptable for equipment changes and upgrades. Recognizing that there is often a transition from hard to soft copy, spaces should allow for “hybrid reading” if necessary. When enclosing the space, using acoustic, modular wall panels and systems furniture instead of fixed partitions and fixed casework allows rooms to be reconfigured to accommodate changing technology and working methods. Support Functions. Locating entrances, restrooms,
administrative support, and rest areas near the reading room minimizes
walking distance for working radiologists. Lighting. Various lighting types are needed in the reading room, including ambient, task, and service lighting. Use indirect light sources to minimize glare and make sure the lighting is easily controlled and convenient to the radiologists. Proper lighting is important in any work area but is critical in radiology, where diagnoses are made based on visual images. According to one radiologist, “A low-level work light is necessary without having glare.” To minimize glare, use surface finishes with low reflectance and flat paint in neutral colors. Good monitor brightness and contrast should be maintained. Natural light is desirable, but radiologists should be able to limit or control the natural light if needed. Acoustics. Controlling sound minimizes distractions to radiologists and provides privacy, an issue for both physicians’ and patients’ confidentiality. Multiple reading areas and movable acoustic partitions can increase privacy. “Quieter reading rooms would be the most helpful,” said one radiologist who participated in the survey. “If reading rooms could be designed that kept outside noise down, I would be able to concentrate much better.” The term background noise, or white noise, sounds like something that would be distracting when radiologists are trying to concentrate. However, this type of noise does just the opposite. Sound masking adds background white noise to the environment to make intruding voices less distracting. White noise is created by electronically combining sounds of all different frequencies. Finish materials should be selected based on acoustical performance. This can be accomplished through the Noise Reduction Coefficient, which measures the average percentage of noise a material absorbs at four frequencies, and the Sound Transmission Coefficient, which provides a single number rating to identify the transmission loss of a partition as it varies with frequency. Mechanical systems. Temperature control and system sound attenuation, or reduction, are two important considerations when choosing mechanical systems. The room users should have control over the room. Air noise and mechanical noise should be considered when selecting heating, ventilation, and air conditioning systems. Electrical systems. Wire management, power, phone, and data all affect workflow. Wire placement should be carefully planned, accessible, and adaptable. Electrical systems should provide emergency power or an uninterrupted power source, depending on the system’s specific function. Document the location and quantity of receptacles for all types of electrical systems. The surveyed radiologists generally preferred wireless telephones in the reading room. Most did not prefer a headset or a speakerphone. With this in mind, wireless phones are ideal, but headsets should be available for high use and dictation. Ergonomics. Workspace ergonomics was among the lowest areas of satisfaction among surveyed radiologists, with 65% dissatisfied or very dissatisfied. “Ergonomics are extremely important,” one radiologist said. Fatigue can result in a greater risk of inaccuracies, which is a great concern with radiology. For ideal ergonomic safety and comfort, work surfaces should be adjustable, with ample storage. Articulating monitor mounts, elevated monitors, retractable keyboards, and document holders are all essentials for computers in the workspace. Seating should offer a full range of adjustments and be able to roll and swivel so radiologists can reach needed items. Rolling chairs ranked highest in the survey of types of chairs, followed by those with adjustable height and the ability to swivel. Such flexibility permits proper fit to every reading room user. Guest seating should be comfortable and portable. Equipment. A well-designed reading environment identifies all the equipment needs prior to construction, so space is used efficiently and the need for modifications is reduced. The Indiana researchers asked radiologists to rank the equipment needed in the reading room environment. The top seven responses are: 1. Computer (with network access and RIS): 91% 2. Viewbox: 78% 3. Printer: 67% 4. Voice-recognition system: 64% 5. Fax: 44% 6. Stereo: 36% 7. Dictation system: 24% Radiology should have a dedicated area in the patient unit to support interaction between radiologists and other hospital staff. Also, acoustics and lighting become even more important since the department is in the midst of activity. All the design considerations discussed for the radiology department apply to the reading area in the patient units as well. The same considerations apply to physicians’ offices and other areas where image access is needed. Flat-screen monitors and digital records are taking the place of bulky film readers and storage libraries. The leftover space resulting from technological advancements to radiology provides a great opportunity. Rather than using the space for workstations or storage, the spaces can be transformed into other intradepartment or hospital revenue-producing needs, such as an extra CT scanner. Transforming static spaces into revenue-generating ones can add a boost to the financial benefits already coming from increased efficiency and productivity. While some may think the evolution to digital for their facilities is still a few years away, in reality, the changes are happening quickly. It’s something to start thinking about now. Researching and implementing the findings into design are only a part of an evidence-based design process. The next step is follow-up research, which reveals whether the design is truly a success or additional adjustments need to be made. At the end of the process, expect a radiology facility that is efficient, beneficial to the facility’s bottom line, and ready for whatever changes the future will bring. — Todd M. Buerger, AIA, is an architect with BSA LifeStructures Inc., an architectural, engineering, planning, and interior design firm with offices in Indianapolis and Chicago. Contact Buerger at 317-819-7878. |
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