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HELSEVEL-Gode og effektive helse-, omsorgs- og velferdstjenester

Innovative løysingar for einerom i sjukehus

Awarded: NOK 0.28 mill.

1. Introduction Single-bed units (SBUs) has become the new standard in hospitals. This has many benefits for the patient, but one concern is that it requires more resources. This summary focuses on children, adolescents and mothers, and summarizes the pros, cons and possible solutions related to SBUs in hospitals. The inputs are from literature, patients, parents and employees at the Children and Youth Clinic and Women's Clinic at Haukeland University Hospital (HUS), and from a study visit at the Østfold Hospital. 2. Pros and cons for patients and parents Findings from literature show that SBUs has a positive effect on treatment, through better sleep and improved developmental outcomes in infants (respiration, digestion, weight and language) which in turn gives shorter hospitalization. Better chance of using the Kangaroo method can prevent behavioural and emotional problems. SBUs can also cause fewer infections and lower incidence of sepsis. Better experiences for both children and parents, better privacy, better sleep for the children because parents can stay overnight, less disturbances and better opportunity to do daily activities are other benefits. Parents experience less anxiety, stress and depression. Use of the Kangaroo method gives parents confidence in caring, but they may also experience increased stress related to the need to take more responsibility for the children. Mothers are more comfortable with breastfeeding and express milk. Patients and parents interviewed at HUS also prefer SBUs, due to better privacy, private bathroom, better sleep, easier to receive visits and less disturbances. Employees at HUS mention better infection protection, better association between children and parents, and shielding children and parents from noise and strong impressions as an advantage of SBUs. The disadvantages of SBUs are loneliness and isolation, and possibly higher threshold to contact nurses, to not be a bother. 3. Pros and Cons for employees In the literature we found that nurses experience SBUs as less safe (visibility, cannot hear alarms) and healthcare professionals experience increased workload, walking distance and stress. These drawbacks decrease over time (1-2 years). We also find that health professionals are more satisfied because they experience to a better job due to higher quality patient care and more time with parents and children. SBUs can lead to reduced team feeling among nurses, less contact with physicians, fewer learning opportunities, increased sense of isolation and fear of not getting help when needed. Hostile or inappropriate behaviour from parents was also a concern. The input from staff at HUS is that SBUs can provide better utilization of staff and bed capacity due to less relocation of patients and no need to use multi-bed rooms for single patients. Not having to expose other patients to any negative mood in the room and taking into account who will stay in a room together is positive. SBUs also saves time for nursing staff because parents do more of the work and it is beneficial to have one patient at a time. The cons are that you work more alone and increased independence requires more competence. The training time may also be longer because you lose some of the skills transfer when you work more together. Increased walking distance is also a drawback. 4. Organization and use of resources In literature, we found that SBUs reduce overall operating costs, due to reduced bedtime, higher occupancy, and reduction in treatment costs. SBUs provides higher construction costs, and higher operating costs during the transition period (1-2 years) from multiple beds to SBUs. 5. Possible solutions to achieve benefits and reduce inconvenience For patients and parents, room design is important: separate patient and parent area, access to equipment for daily activities and possible to regulate light and temperature. To counter isolation, possible measures are a parental coordinator, the use of an AV-1 robot for the children, and the use of common areas for meeting places. Technological solutions such as smartphones, distributed alarm systems, voice enabled communication systems, electronic boards, and possibly video surveillance can facilitate communication between healthcare professionals and patient monitoring. Access to information and the ability to register necessary information in patient rooms as well as flexible, large enough and well-designed patient rooms are important. Resources available centrally for assistance when needed, design to minimize walking distance, soft floors and beds that are easy to drive are desired. Frequent team meetings to counter isolation, longer training periods for new employees and regular training days to ensure sufficient competence. To ensure that SBUs do not require more resources, one must ensure a good transition from multi-bed to SBUs (information and training) and ensure efficient work processes on wards.

Prosjektet har gjennomført en systematisk gjennomgang av relevant kunnskap og erfaringer med enerom i sykehus, for å kartlegge utfordringsbildet og mulige løsninger. Konkret har prosjektet hatt følgende oppgaver: -Gjennomgang av litteratur -Innhente innspill fra brukere (pasienter og pårørende) - Innhente erfaringer fra ansatte ved HUS (Haukeland Universitetssykehus) - Innhente erfaringer fra andre sykehus, blant annet gjennom studiebesøk

Haukeland Universitetssjukehus byggjer nytt barne- og ungdomssjukehus med i overkant av 80 % einerom. Einerom har mange fordelar for pasienten, men kan kreve meir ressursar. Vi har ikkje funne studiar eller undersøkingar som har evaluert korleis det er å drifte einerom på sjukehus i Noreg, og kva utfordringar dette ev. medfører. I dette forprosjektet ønsker vi å gjennomføre ein systematisk gjennomgang av relevant kunnskap og erfaringar med einerom i sjukehus, for å kartlegge utfordringsbildet og moglege løysingar Vi ønskjer å knytte dette forprosjektet til utviklingsarbeidet knytta til det nye Barne - og ungdomssjukehuset. Dette utviklingsarbeidet er organisert i program BUS, med eit byggeprosjekt og eit organisasjonsutviklingsprosjekt (OU-prosjekt). Prosjektet har brei deltaking frå klinikkar, brukarar og universitet/høgskule, med ulike delprosjekt som går på tvers av klinikkar og delprosjekt internt i den enkelte klinikk. Forprosjektet kan vere eit delprosjekt i OU-prosjektet for BUS, for å sikre involvering av riktig kompetanse og koordinering mot resten av OU-prosjektet. Dette gir gode informasjonskanalar med klinikkar, brukarar og universitet/høgskule, og ein har moglegheit til tett oppfølging for å sørgje for at måla i prosjektet vert oppfylt. Prosjektet vil ha 3-4 halvdagsmøter, der deltakarane frå dei ulike fagmiljøa blir einige om fokus og innhald i kartlegginga. Deretter fordeler ein oppgåver og jobbar mellom møta, og der resultatet leggast fram for resten av gruppa på neste møte. Det kan også vere aktuelt med felles studieturar for å innhente erfaringar frå andre sjukehus. Dette prosjektet kan vere ein pilot for å prøve ut samarbeid mellom klinikk, universitet/høgskule og brukarar i BUS-OU prosjektet generelt, og ein vil også ha nytte av desse samarbeidsrelasjonane i det vidare utviklingsarbeidet i hovudprosjektet, der fleire typar tiltak kan vere aktuelle.

Funding scheme:

HELSEVEL-Gode og effektive helse-, omsorgs- og velferdstjenester