The Universal Room: A Comprehensive Approach to Comprehensive Care

By Bob Lundeen

The latest breakthrough in providing quality acute care in hospitals is not an innovative drug or technology, but a concept that brings all the necessary care components to the patient in a single location.

The concept of the universal room, or the universal bed, which has its origins in obstetrics, eliminates the practice of physically moving patients from one specialized space to another during the various stages of recovery. The larger room size can accommodate changing levels of equipment support, and the same nursing and support staff can care for the patient throughout a patient's hospital stay. The universal room also provides space for family and loved ones to visit and even stay overnight, dispelling patient anxiety through a reduced sense of isolation. The positive outcome is often a shortened recovery period and a quicker return home. A universal room concept also makes sense for a hospital's bottom line. Administrators can better align their staffing and other operational needs, overcome staff shortages through reduced staff turnover, shortened patients' lengths of stay and help eliminate the risks associated with repeated patient moves between rooms and floors. They can also take advantage of the rooms' inherent flexibility to more easily respond to changing patient population needs.

Shaping Spaces Typically, a universal room is 225 to 300 sq. ft. or up to two times larger than a standard medical/surgical room. While the resulting nursing floor space for the facility may be larger, the facility's overall square footage requirements may be reduced through the need for fewer total patient rooms.

The layout of a universal room must balance the needs of the patient, staff and family. A zoning strategy can be applied to the room layout to provide sufficient space adjacent to the patient's bed for both mobile equipment, workstations and working room for caregivers and other staff. Some types of equipment may be positioned on retractable overhead booms, freeing up additional floor space. Other, more permanent room features require careful thought so they don't obstruct access to the patient's bed and monitoring equipment.

Building code requirement and licensing standards for building system infrastructure vary for different patient acuity levels, and that can impact costs. The capacity of a universal room's HVAC, electrical, medical gas and communication systems is approximately twice the capacity of standard medical rooms. The positions of lighting fixtures and controls, power outlets and air supply/return vents must also reflect the room's multi-purpose uses. A universal room will need to meet or at least make provisions to meet, the highest acuity level standards and code requirements.

A Prescription for Planning Designing and building universal rooms is not without its challenges. The concept is almost exclusively limited to new construction projects. Structural and support system constraints, code conflicts and effects on adjacent areas will likely make renovating an existing facility difficult.

And because a hospital employing the universal room concept may encounter higher construction costs than a conventional facility, a lifecycle approach to design is essential to ensure that this investment yields the highest possible return in efficiency and reliability. Cost analyses performed as part of the programming and conceptual design phases may identify opportunities to maximize system efficiencies. For example, high-efficiency chillers, boilers and generators can offset the added operating expense of room and floor systems that must meet higher levels of code and health care requirements. Also, including taps, valves and other provisions for adding buildings systems will support the subsequent, low-cost upgrade to intensive care unit capability or to provide specific services such as cardiac care, cancer treatment and obstetrics.

The key to success in applying the universal room concept is a collaborative planning and coordination effort by the owner, consultants and the architectural/engineering team. Together, they can identify potential problems and opportunities using various approaches and refine the design to maximize construction and lifecycle cost savings, operational efficiencies and staffing requirements.

With this information, the owner will be better able to make decisions about applying the universal room concept to a new facility. The result is a sound investment in facilities and equipment, a productive working environment for staff and caregivers and a higher level of service and continuity of care for patients.