The global response to the COVID-19 pandemic: how have immunology societies contributed?

The COVID-19 pandemic is shining a spotlight on the field of immunology like never before. To appreciate the diverse ways in which immunologists have contributed, Nature Reviews Immunology invited the president of the International Union of Immunological Societies and the presidents of 15 other national immunology societies to discuss how they and their members responded following the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Transitioning to a New Facility: The Crucial Role of Employee Engagement.

EXECUTIVE SUMMARY: Transitioning to a new facility can be challenging for employees and detrimental to operations. A key aspect of the transition is employee understanding of, and involvement in, the design of the new facility. The literature lacks a comprehensive study of the impact of change engagement throughout the design, construction, and activation of a project as well as how that can affect perceptions, expectations, and, eventually, satisfaction of employees. The purpose of this research was to examine employee perceptions and satisfaction throughout a hospital design, construction, and activation process. Three pulse-point surveys were administered throughout the transition of a children's hospital emergency department and neonatal intensive care unit to a new facility. We also administered a postoccupancy survey 3 months after the move into the new facility. We received 544 responses and analyzed them to assess the relationship between involvement in design or change engagement initiatives and overall perceptions. The results revealed a strong relationship between employee engagement and their level of preparedness to move, readiness to adapt, and satisfaction. Early involvement in the design of a facility or new processes can significantly affect staff preparedness and readiness to adapt as well as employees' overall satisfaction with the building after occupancy. In addition, our findings suggest that keeping a finger on the pulse of employee perceptions and expectations throughout the design, construction, and activation phase is critical to employee preparedness and satisfaction in transitioning to a new facility.

Identification of Tools and Techniques to Enhance Interdisciplinary Collaboration During Design and Construction Projects.

The purpose of this study was to collect the perceptions of design professionals and clinicians regarding design process success strategies and elements of interprofessional engagement and communication during healthcare design and construction projects. Additional objectives were to gather best practices to maximize clinician engagement and provide tools and techniques to improve interdisciplinary collaboration for future projects. Strategies are needed to enhance the design and construction process and create interactions that benefit not only the project but the individuals working to see its completion. Meaningful interprofessional collaboration is essential to any healthcare design project and making sure the various players communicate is a critical element. This was a qualitative study conducted via an online survey. Respondents included architects, construction managers, interior designers, and healthcare personnel who had recently been involved in a building renovation or new construction project for a healthcare facility. Responses to open-ended questions were analyzed for themes, and descriptive statistics were used to provide insight into participant demographics. Information on the impressions, perceptions, and opportunities related to clinician involvement in design projects was collected from nurses, architects, interior designers, and construction managers. Qualitative analysis revealed themes of clinician input, organizational dynamics, and a variety of communication strategies to be the most frequently mentioned elements of successful interprofessional collaboration. This study validates the need to include clinician input in the design process, to consider the importance of organizational dynamics on design team functioning, and to incorporate effective communication strategies during design and construction projects.

It takes teamwork... the role of nurses in ICU design.

The changing economic environment in health care is pushing the health care construction industry to produce facilities which support improvements in patient care, patient experience, patient safety, staff satisfaction, and financial outcomes. The successful design, construction, and operation of a new or renovated intensive care unit (ICU) requires the participation of intensive care nurses to achieve success. A partnership between the architect and nurse, definition of the desired operational processes, and knowledge of evidence-based design are the foundations of good design. Hospital executives who support the participation of nurses in ICU facility projects will gain an efficient and safe intensive care facility.

Patient room considerations in the intensive care unit: caregiver, patient, family.

The Patient Room is one of the most important and costly rooms in the design of an inpatient bed unit. As a result, the patient room mock-up requires knowledge of the components that inform the patient room environment. This article provides the intensive care nurse with questions about patient care processes and unit policies that should be considered in a mock-up. The mock-up outcome should align with the project's goals and objectives of the health care system, infuse the principles of evidence-based design, and ensure that the design accommodates the best workflow for the patient population that will be served. The template will serve as a guide to evaluate the various features of the patient room and for the mock-up discussion between the nurse and the architect.

Factors impeding flexible inpatient unit design.

OBJECTIVE: To identify and examine factors extraneous to the design decision-making process that could impede the optimization of flexibility on inpatient units. BACKGROUND: A 2006 empirical study to identify domains of design decisions that affect flexibility on inpatient units found some indication in the context of the acuity-adaptable operational model that factors extraneous to the design process could have negatively influenced the successful implementation of the model. This raised questions regarding extraneous factors that might influence the successful optimization of flexibility. METHOD: An exploratory, qualitative method was adopted to examine the question. Stakeholders from five recently built acute care inpatient units participated in the study, which involved three types of data collection: (1) verbal protocol data from a gaming session; (2) in-depth semi-structured interviews; and (3) shadowing frontline personnel. Data collection was conducted between June 2009 and November 2010. RESULTS: The study revealed at least nine factors extraneous to the design process that have the potential to hinder the optimization of flexibility in four domains: (1) systemic; (2) cultural; (3) human; and (4) financial. CONCLUSIONS: Flexibility is critical to hospital operations in the new healthcare climate, where cost reduction constitutes a vital target. From this perspective, flexibility and efficiency strategies can be influenced by (1) return on investment, (2) communication, (3) culture change, and (4) problem definition. Extraneous factors identified in this study could also affect flexibility in other care settings; therefore, these findings may be viewed from the overall context of hospital design.

The biomechanics of patient room standardization.

BACKGROUND: The prevailing focus on cognitive load reduction in healthcare environment standardization excludes a domain of healthcare delivery that could contribute significantly to safety and efficiency through standardization, but it has escaped discussion in the context of the biomechanics of care delivery. Inappropriate biomechanics not only can harm caregivers but compromise care delivery. Little, however, is known regarding the biomechanics of patient care and the way it interacts with the configurational issues typically targeted in healthcare environment standardization. OBJECTIVES: Examine the types of potentially harmful or stressful actions exhibited by nurses during patient care delivery in an acute medical/surgical setting. Examine the sources influencing unsafe actions. METHOD: Twenty nurses provided three types of simulated care in an experimental setting involving nine care configurations that were systematically manipulated. A kinesiology expert coded 80 simulation segments representing two types of task and two levels of environmental challenge to identify potentially stressful and harmful actions. Exploratory and regression analyses were conducted on the data. RESULTS: Analysis suggests that a considerable proportion of potentially harmful and stressful actions are associated with the design of the physical elements as opposed to the configurational factors typically addressed in standardization. Both of these factors interact to produce work-arounds that result in unsafe actions. CONCLUSION: The standardization of healthcare environments needs a larger framework to address both cognitive lapses and the biomechanics of care delivery.

Understanding family requirements in the intensive care room.

This article explores how the built environment can promote family interaction in the intensive care room and how the family can be supported within the room to care for their loved one. Four families with children in the intensive care unit were interviewed about their intensive care room environment. Patient care and the diagnosis and treatment of the child were not discussed. Two families were chosen from a cardiac intensive care unit and 2 families from a medical-surgical intensive care unit. All intensive care rooms were equipped with medical gas booms. All families were preparing for transfer to the inpatient area. This article summarizes the discussion with families and identifies guiding principles for designers and health care personnel to consider when creating a new intensive care room environment.

An empirical examination of patient room handedness in acute medical-surgical settings.

OBJECTIVE: The study objective was to examine whether standardized same-handed room configurations contribute more to operational performance in comparison to standardized mirror-image room configurations. Based on a framework that physical environment standardization supports process and workflow standardization, thus contributing to safety and efficiency, the study examined the comparative effectiveness of the standardized same-handed configuration and the standardized mirror-image configuration. BACKGROUND: Patient room handedness has emerged as an important issue in inpatient unit design, with many hospitals adopting the standardized same-handed room concept at all levels of patient acuity. Although it is argued that standardized same-handed rooms offer greater levels of safety and efficiency in comparison to standardized mirror-image rooms, there is little empirical evidence either to support or refute these contentions. METHOD: An experimental setting was developed where elements of the physical environment and approach to the caregiver zone were systematically manipulated. Twenty registered nurses (10 left-handed and 10 right-handed) provided three types of care to a patient-actor across nine physical design configurations, which were videotaped in 540 separate segments. Structured interviews of the subjects were conducted at the end of each individual set of simulation runs to obtain triangulation data. Video segments were coded by nursing experts. Statistical and content analyses of the data were conducted. RESULTS: Study data show that standardized same-handed configurations may not contribute to process and workflow standardization--hence, to safety and efficiency--any more than standardized mirror-image configurations in acute medical-surgical settings. Data suggest that a global view of the patient care environment upon entry is the most sought-after familiarization factor to reduce cognitive load.

A multidimensional framework for assessing patient room configurations.

PURPOSE: A framework for multidimensional assessment of patient room configurations is presented. Twenty-three issues are considered and categorized under six domains of assessment: (1) patient safety, (2) staff efficiency, (3) circulation, (4) infection control, (5) patient considerations, and (6) family amenities. Use of the framework to rank issues by importance and assess six alternative patient room configurations by a diverse group of experts in a symposium is described. BACKGROUND: One of the key questions posed during inpatient room design is the location of the bathroom. What issues are affected by the variations in room configuration that arise from bathroom location? A complete articulation of the issues that potentially are affected by room configuration is not available in the literature. FRAMEWORK: The list of issues was developed by the authors in preparation for a symposium. The symposium was organized in May 2007 and attended by 14 experts from four institutions. Six alternative room configurations were used. Variations in the configurations included: (1) three same-handed and three mirror-image rooms; (2) three outboard, two inboard, and one nested bathroom; and (3) three rooms with footwall bathrooms and three with headwall bathrooms. In a four-step process, the attendees ranked the issues, discussed them in detail, rated each room configuration against each issue on a seven-point suitability scale, and conducted an overall assessment of the six configurations. CONCLUSIONS: Based on the ratings and rankings provided by the symposium participants, outboard bathroom locations were found to be most suitable, followed by nested and inboard configurations. Furthermore, configurations with patient bathrooms located on the footwall were rated as more suitable than headwall locations. The authors recommend, however, that the framework be used to determine a suitable room configuration in a specific context, rather than to identify configurations that will perform well universally.

An exploratory examination of medical gas booms versus traditional headwalls in intensive care unit design.

Should power, medical gases, and monitoring and communications systems be located in a headwall or a ceiling-mounted boom in intensive care unit (ICU) rooms? Often, only the financial costs could be determined for the options, whereas data regarding its potential influence on teamwork, safety, and efficiency are lacking. Hence, purchase decisions are more arbitrary than evidence based. This study simulated care delivery in settings with a traditional headwall and a ceiling boom. Observed were the way the following elements were managed and the extent either system affected flexibility, ergonomics, and teamwork: tubing for intravenous fluids, medical gases, and suction drainage; monitoring leads and equipment power cords; and the medical equipment itself. Simulation runs involving 6 scenarios were conducted with the voluntary participation of 2 physicians, 2 nurse practitioners, 2 respiratory therapists, and 4 registered nurses at a children's tertiary care center in December 2007. Analysis suggests that booms have an advantage over headwalls in case of high-acuity ICU patients and when procedures are performed inside patient rooms. However, in case of lower-acuity ICU patients, as well as when procedures are not typically conducted in the patient room, booms may not provide a proportionate level of advantage when compared with the additional cost involved in its procurement.