November 2016
Tool

Overview

Primary care exam rooms are becoming the center of the healthcare experience. Technological advances, point-of-care testing, and improved organizational flow models are streamlining the patient experience. Because of this, patients will spend the majority of their visit inside the exam room instead of moving around among waiting areas, consult rooms, labs, or separate treatment spaces. Many are being redesigned to foster a caregiver-patient relationship and to accommodate the changing needs of technology. By designing the exam room to be more patient-centric, providers and care teams can significantly enhance effectiveness, efficiency, comfort, safety, and quality of care.

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  • Layout - Overall

    Desirable Outcome
    Reduced patient stress/anxiety and improved satisfaction
    Design Strategies
    • Separate patient and provider flows (e.g., one exam room with two doors, each accessible from patient area and staff area respectively) so that the back-stage staff work is not exposed to patients
    Desirable Outcome
    Enhanced communication/interaction
    Design Strategies
    • Large room size to accommodate big family visits or visits requiring the presence of interpreters
    Desirable Outcome
    Enhanced privacy
    Design Strategies
    • The location and orientation of the exam table and room door designed to minimize the possibility of the patient accidentally being viewed by patients and staff outside the room
    Desirable Outcome
    Reduced risk of contamination/infection
    Design Strategies
    • Special isolation rooms designated for patients who are or may be infectious
    Desirable Outcome
    Improved work efficiency and patient flow
    Design Strategies
    • Consultation/talking rooms interspersed with exam rooms for patient visits when disrobing is not required.
    • Large rooms to accommodate group visits and education (for chronic disorders, pregnancy, diabetes, smoking cessation, family planning, etc.)citation
    • Universal rooms or one-stop care rooms that accommodate a wide variety of care activities (e.g., registration, blood draw, checkout) to reduce patient movement.
    • Exam room layout that facilitates physical exam and other procedures (e.g., exam table angled away from walls, physician at patient’s right side, physician’s easy access to diagnostic instruments).
    • Standardized exam/consultation room layout (e.g., standardization of supplies stocked, same-handed rooms).citation
    Desirable Outcome
    Improved access/ wayfinding
    Design Strategies
    • Sufficient clearance (e.g., wide corridors) for wheelchair use
    • Use of easy-to-reconfigure/roll-away modular furniture and partitions to allow for multipurpose functions
    Desirable Outcome
    Change-readiness/ future-proofing
    Design Strategies
    • Building design that facilitates the potential changes in functional space layout (e.g., structural column location, modular layout, window modules)

  • Layout - Staff zone

    Desirable Outcome
    Improved work efficiency and patient flow
    Design Strategies
    • Convenient locations of medications, supplies, and medical equipment to minimize unnecessary travel by nurses and staff
    • Easy-to-access electrical outlets for using/charging equipment, diagnostic instruments, and portable devices

  • Layout - Patient zone

    Desirable Outcome
    Enhanced communication/ interaction
    Design Strategies
    • Consultation rooms (if included) designed to support patient-provider conversation (e.g., deemphasizing exam tables and medical instruments for stress reduction, spaciousness)citation
    • Furniture layout that allows patient and staff equal access to the computer screen with minimal height differential between patient and provider to maintain good eye contact. citation
    Desirable Outcome
    Enhanced privacy
    Design Strategies
    • Screened dressing spaces with lockable storage for personal items.

  • Layout - Family zone

    Desirable Outcome
    Reduced patient stress/ anxiety and improved satisfaction
    Design Strategies
    • Sufficient seating for individuals, including families and/or interpreters who may accompany the patient.

  • Flooring

    Desirable Outcome
    Reduced patient stress/ anxiety and improved satisfaction
    Design Strategies
    • High-quality home-like or natural materials that create an attractive non-institutional ambience for patients and families citation
    Desirable Outcome
    Reduced risk of contamination/infection
    Design Strategies
    • Easy-to clean or antibacterial/antimicrobial finish materials to reduce surface contamination.
    • Smooth surfaces, with minimum perforations and crevices.
    Desirable Outcome
    Improved access/ wayfinding
    Design Strategies
    • Color coding (e.g., floor, wall color, etc.), together with lighting, landmarks, and views of exterior, to make wayfinding easier for patients. citation
    Desirable Outcome
    A healthy environment (reduced negative health effects)
    Design Strategies
    • Interior materials that contain low-VOC or minimized use of hazardous content (e.g., phthalates). citation
    • Interior materials that require less harsh chemicals than typical materials during installation, cleaning, maintenance, and replacement. citation
    Desirable Outcome
    Increased recycling
    Design Strategies
    • Interior materials that contain rapidly renewable materials (e.g., bamboo flooring, straw & wheat board, cotton batt insulation, etc.) or recycled content when possible.

  • Wall

    Desirable Outcome
    Reduced patient stress/ anxiety and improved satisfaction
    Design Strategies
    • High quality home-like or natural materials that create an attractive non-institutional ambience for patients and families. citation
    • Clock displayed in direct view of patients.
    • Display of expected waiting time in direct view of most patients.
    • Mirror for patients to check clothes before leaving the room.
    • Nature scene artworks created by local artists, or other pleasant stimuli visible for patients. citation
    Desirable Outcome
    Enhanced communication/ interaction
    Design Strategies
    • Neutral color background wall for video-conferencing without busy patterns or direct light reflections.
    • Electric and data outlets located conveniently close to the telemedicine equipment so that there is no visible clutter of electrical cables.
    Desirable Outcome
    Enhanced patient sense of control
    Design Strategies
    • Controls of air-conditioning temperature, window blinds, and music so that they are adjustable by most patients.
    • Controls of air conditioning temperature, window blinds, and music within reach of most patients.
    • Controls of air-conditioning temperature, window blinds, and music so that are easy and intuitive to be used by patients.
    Desirable Outcome
    Enhanced privacy
    Design Strategies
    • Solid walls (e.g., full-height partitions, materials with high noise reduction ratings - noise reduction coefficient (NRC), sound transmission class (STC), ceiling attenuation class (CAC)) that sufficiently prevent conversations in one room from being overheard by patients in neighboring rooms/corridors. citation
    • Potential acoustic "holes" (e.g., receptacle boxes at same location on both sides of a partition wall) are minimized.
    • Solid walls preventing patients in rooms from being seen from outside the rooms.
    Desirable Outcome
    Increased patient healthy behaviors
    Design Strategies
    • Visible and salient motivational signs/educational materials promoting physical activity.
    • Age-appropriate artwork, TV broadcasts, brochures, and other visual displays of health education materials that include healthy lifestyles, healthy food, etc. citation
    Desirable Outcome
    Reduced risk of contamination/infection
    Design Strategies
    • Easy-to-clean or antibacterial/antimicrobial finish materials to reduce surface contamination.
    • Smooth surfaces, with minimal perforations and crevices.
    • Minimal horizontal surfaces, ridges, reveals, or seams that could serve as dust collectors. citation
    Desirable Outcome
    Improved work efficiency and patient flow
    Design Strategies
    • Sharps containers located within arm’s reach and below eye level at point of use. (Use anthropometric charts.)
    Desirable Outcome
    Improved access/ wayfinding
    Design Strategies
    • Color coding (e.g., floor, wall color, etc.), together with lighting, landmarks, and view of exterior, to make wayfinding easy for patients. citation
    • Handrails that support frail, obese, and other patients when needed.
    Desirable Outcome
    A healthy environment (reduced negative health effects)
    Design Strategies
    • Interior materials that contain low-VOC or minimized use of hazardous content (e.g., phthalates). citation
    • Interior materials that require less harsh chemicals than typical materials during installation, cleaning, maintenance, and replacement. citation
    Desirable Outcome
    Increased recycling
    Design Strategies
    • Utilization of rapidly renewable interior materials (e.g., bamboo flooring, straw & wheat board, cotton batt insulation, etc.) or that contain recycled content when possible.

  • Ceiling

    Desirable Outcome
    Reduced patient stress/ anxiety and improved satisfaction
    Design Strategies
    • Sound-absorbing ceiling tiles and other noise reduction measures.
    • High quality home-like or natural materials to create an attractive non-institutional ambience for patients and families.
    Desirable Outcome
    Enhanced communication/ interaction
    Design Strategies
    • Sound-absorbing ceiling tiles to reduce noise and reverberation to minimize potential interference with verbal communication.
    Desirable Outcome
    A healthy environment (reduced negative health effects)
    Design Strategies
    • Interior materials that contain low-VOC or minimal use of hazardous content (e.g., phthalates). citation
    • Interior materials that require less harsh chemicals than typical materials during installation, cleaning, maintenance, and replacement. citation
    Desirable Outcome
    Increased recycling
    Design Strategies
    • Interior materials that contain rapidly renewable materials (e.g., bamboo flooring, straw & wheat board, cotton batt insulation, etc.) or recycled content when possible.

  • Window

    Desirable Outcome
    Reduced patient stress/anxiety and improved satisfaction
    Design Strategies
    • Windows and/or skylights to provide plenty of direct or indirect natural light. citation
    • Views of outside nature/gardens. citation
    Desirable Outcome
    Enhanced privacy
    Design Strategies
    • Window design elements (e.g., blinds, sill height) to ensure patient privacy.
    • Minimal placement of potential acoustic "holes" (e.g., gaps between window mullions and partition walls).
    Desirable Outcome
    Improved work efficiency and patient flow
    Design Strategies
    • Window glazing to facilitate skin color assessment (e.g., no bronze or green color).
    Desirable Outcome
    Improved access/ wayfinding
    Design Strategies
    • Natural light, views of outside, and landmarks o provide visual aids for wayfinding.
    Desirable Outcome
    A healthy environment (reduced negative health effects)
    Design Strategies
    • Glazed windows with UV protection to reduce staff and patient UV exposure.
    Desirable Outcome
    Reduced resource consumption
    Design Strategies
    • Proper shading (interior, integral, and exterior shading devices) to minimize direct sunlight and solar exposure in the main indoor spaces. citation
    • Light shelves to maximize daylight penetration so that electricity for artificial lighting is reduced.
    • Window sealant to minimize air leakage and reduce heating and cooling needs.
    • Window insulation to reduce heat transmission.
    • Glazed windows with high visual transmittance to maximize daylight penetration in the building without significantly increasing heat transmission.
    Desirable Outcome
    Enhanced security
    Design Strategies
    • Measures to secure and protect all windows that open to building exterior with entry alarms or other devices.

  • Door

    Desirable Outcome
    Enhanced privacy
    Design Strategies
    • Solid doors (e.g., materials with high noise reduction ratings - noise reduction coefficient (NRC), sound transmission class (STC), ceiling attenuation class (CAC)) that sufficiently prevent conversations in one room from being overheard by other patients in neighboring rooms/corridors.
    • Minimized potential acoustic "holes" (e.g., pocket doors).
    • Solid doors (including location and swing direction) to protect patients in rooms from being seen from outside the rooms.
    Desirable Outcome
    Improved access/ wayfinding
    Design Strategies
    • Door design that facilitates pass-through of wheel chaired patients (e.g., wide door, clearance at the opening side).

  • HVAC

    Desirable Outcome
    Reduced patient stress/ anxiety and improved satisfaction
    Design Strategies
    • Efficient ventilation to minimize unpleasant smells.
    • Controls to maintain a comfortable air temperature, relative humidity, and airflow speed to prevent dramatic differences between nearby spaces.
    Desirable Outcome
    Enhanced privacy
    Design Strategies
    • Ventilation supply and return in each room to prevent sound transmission through door.
    Desirable Outcome
    Reduced risk of contamination/infection
    Design Strategies
    • Ventilation system with features such as HEPA filters or 100% outside air to minimize air contamination.
    Desirable Outcome
    A healthy environment (reduced negative health effects)
    Design Strategies
    • Mercury-free and CFC-free HVAC equipment to minimize potential health risks and environmental impacts.
    • High-performance ventilation systems (e.g., high ventilation rate) to minimize VOC levels and smells. citation
    Desirable Outcome
    Reduced resource consumption
    Design Strategies
    • High-efficiency HVAC equipment that uses relatively less energy for ventilation and air-conditioning citation
    • Appropriate size of HVAC equipment to increase efficiency and reduce energy consumption.
    • Separate ventilation and air-conditioning controls to provide flexibility of use throughout the building.

  • Lighting

    Desirable Outcome
    Enhanced communication/ interaction
    Design Strategies
    • Lighting that allows effective interaction including good recognition of facial expressions of patients, clinicians, and other people in the room. citation
    • Lighting that minimizes veiling glare and reflection visible to patients and clinicians during face-to-face conversations.
    Desirable Outcome
    Improved work efficiency and patient flow
    Design Strategies
    • Moveable and adjustable exam lighting that is available when needed.
    • Lighting sources that provide good color rendering capacity for physical examination.
    • Sufficient illumination level for medication dispensing to minimize errors (for pharmacy and other places where medication dispensing is performed). citation
    Desirable Outcome
    Reduced resource consumption
    Design Strategies
    • Lighting fixtures that include high-efficiency fluorescent lamps and LEDs that use relatively less lighting energy.
    • Occupant sensors and daylight sensors to control lighting fixtures so that artificial lighting is turned off automatically when there is enough daylight or there is no occupant in one room/space.

  • Furniture/ Accessories

    Desirable Outcome
    Reduced patient stress/anxiety and improved satisfaction
    Design Strategies
    • Furniture that is comfortable to use for the majority of patients (e.g., armless chairs for pregnant, obese, or disabled patients).
    • Easy-to-adjust furniture to improve the comfort of various users.
    • Magazines, information booklets, TV, or Internet available for patients.
    • Soothing music and nature sounds accessible to patients. citation
    • Hard toys and books available for children of different ages when waiting in the room.
    Desirable Outcome
    Reduced staff stress and improved job satisfaction
    Design Strategies
    • Furniture design features that enhance staff comfort (e.g., enough leg room for computer desk, left-handed staff).
    • Movable workstations that are easy to access by clinicians and stow away when not in use.
    Desirable Outcome
    Improved work efficiency and patient flow
    Design Strategies
    • Furniture design features that enhance staff comfort (e.g., enough leg room for computer desk, left-handed staff).
    • Movable workstations that are easy to access by clinicians and stow away when not in use.
    Desirable Outcome
    Reduced risk of contamination/infection
    Design Strategies
    • Easy-to-clean or antibacterial/antimicrobial finish materials to reduce surface contamination in the design.
    • Surfaces that are smooth, with minimal perforations or crevices.
    • Minimized horizontal surfaces with ridges, reveals, or seams that could serve as dust collectors. citation
    Desirable Outcome
    Improved staff health
    Design Strategies
    • Adjustable exam tables to facilitate use by special needs patients (e.g., low height motorized exam table for obese patients).
    Desirable Outcome
    Improved patient access/wayfinding
    Design Strategies
    • Adjustable exam tables to facilitate use by special needs patients (e.g., low height motorized exam table for obese patients).

  • Casework / storage

    Desirable Outcome
    Reduced patient stress/anxiety and improved satisfaction
    Design Strategies
    • Layout and fixture design that prevents patients from directly viewing trash and medical waste. citation
    • Plenty of storage space (e.g., cabinets that conceal medical gear) to reduce clutter.
    • Plenty of storage for patients' personal items (e.g., coats, umbrellas) during the waiting process.
    Desirable Outcome
    Reduced risk of contamination/infection
    Design Strategies
    • Easy-to clean or antibacterial finish materials to reduce surface contamination.
    • Smooth surfaces, with minimal perforations or crevices.
    • Minimized horizontal surfaces, ridges, reveals, or seams that could serve as dust collectors. citation
    • Separate storage areas for clean and dirty supplies.

  • Plumbing/Sink/ Alcohol Gel Dispenser

    Desirable Outcome
    Reduced patient stress/anxiety and improved satisfaction
    Design Strategies
    • Drinking water easily accessible to all patients, staff and visitors.
    Desirable Outcome
    Reduced risk of contamination/infection
    Design Strategies
    • One sink and one alcohol gel dispenser located within easy reach in each clinician-patient interaction space.
    • Plenty of sinks and/or alcohol gel dispensers located within easy reach of patient and staff walking paths. citation
    Desirable Outcome
    Reduced resource consumption
    Design Strategies
    • Faucets and toilets that are low flow and use relatively less water. citation
    • Water recycling system that facilitates water reuse (e.g., storm water, gray water, air-conditioning condensate) and reduces water consumption.

  • Patient handling / movement equipment (ceiling lifts)

    Desirable Outcome
    Improved staff health
    Design Strategies
    • Patient lifts (portable or ceiling mounted) and other equipment for patient handling and movement.
    Desirable Outcome
    Improved work efficiency and patient flow
    Design Strategies
    • Patient lifts (portable or ceiling mounted) and other equipment for patient handling and movement.

  • Communication / monitoring equipment

    Desirable Outcome
    Enhanced communication/ interaction
    Design Strategies
    • Wireless or wired connection to facilitate communication of electronic medical records and telemedicine procedures.
    • Equipment for clinicians to conduct teleconferences with remote patients.
    Desirable Outcome
    Improved work efficiency and patient flow
    Design Strategies
    • Visual indicators such as color flags and lights that communicate clearly to staff the presence of a patient in each room and type of service needed.
    Desirable Outcome
    Change-readiness/ future-proofing
    Design Strategies
    • Flexible building design to accommodate potential changes in the medical and communication technologies.

  • Sound-masking equipment

    Desirable Outcome
    Enhanced privacy
    Design Strategies
    • Sound masking to prevent conversations from being overheard by other patients in nearby areas.

  • Privacy curtain

    Desirable Outcome
    Enhanced privacy
    Design Strategies
    • Curtains to protect patient privacy by blocking views from accompanying family members and interpreters during a physical exam.
    • Curtains and other visual barriers to prevent patient- sensitive information (such as weight measurements) from being viewed by other patients or staff.